NEWSLETTER - WINTER 2003/2004
|Dr. Fine with Commander
Tanzer on the
flight deck of the USS Stennis.
Commander David Tanzer, MD, a naval aviator and ophthalmologist
on staff at the San Diego Naval Medical Center, recently asked me
to participate as a visiting professor in a once-a-year program specifically
designed for the ongoing training of residents in cataract surgery.
I agreed and that’s how I found myself aboard the USS John
C. Stennis, a Nimitz-class aircraft carrier.
Dr. Tanzer told me that
my visit would involve flying to the carrier on a C-2 Greyhound, “trapping
aboard” (making a carrier-arrested
landing), touring the ship while underway, observing day and night
flight operations, and flying off the following day via catapult
launch. I found the thought thrilling, albeit somewhat frightening.
two days before assuming my teaching assignment at the Naval Medical
Center, I did indeed go on that tour. The experience left me awestruck
at the enormous commitment and responsibility of the men and women
who serve in the defense of the United States.
Commissioned in 1995
at a cost of $3.5 billion, the Stennis is a fixed-wing, nuclear-powered
aircraft carrier with a projected service life of more than 50
years. It is as tall as a 24-story building and has a 4.5 acre flight
deck. The 97,000-ton Stennis can carry 85 to 90 aircraft and is capable
of more than 20 years of continuous service without refueling.
Including the air wing, the Stennis has a crew size of 6,200 - requiring
18,000 meals a day.
While on board,
I observed the training of new pilots in their first nighttime carrier
landings. These operations involved several types of aircraft, including
Super Hornet and Hornet jet fighters, Prowler tactical electronic-warfare
planes, and Hawkeye surveillance and patrol aircraft.
I watched some
of these operations on the forward deck, very close to the catapult
assisted take-offs. I stood beside the captain on the bridge during
the night operations. He answered my questions immediately — all
the while concentrating on the control panel above him, which electronically
monitored all of the pilots in the air, the number of take-offs and
landings they had completed, and their fuel levels. The captain was
in immediate communication with those approaching and leaving the
ship. Unlike me, he remained calm and composed during several missed
and touch-and-go landings.
At the machine shop, I watched two female
mechanics repair a large jet engine. I learned about the need for
speed in repairing damaged aircraft to make them combat ready, but
also the requirement of extreme precision so that there was no threat
to the pilots’ lives.
Both the combat direction center and the center for avionics and
electronics contained multiple highly sophisticated computers, in
many cases operated by young people who were extensively trained
for their awesome responsibilities, despite the fact that they were
only several months out of high school.
In fact, we learned that
the crew has an average age of 19. Whether they are in training,
on maneuvers or in combat, they all work 12 hours a day, seven days
a week. In spite of this, there are far more applicants to serve
on aircraft carriers than positions available, resulting in the continuous
evaluation of all personnel. Anyone who is not fully proficient is
rotated off and replaced by others eager to serve on board.
aviation is the most potent and capable of all strike forces within
our defense establishment. It was amazing to see the devotion to
duty, the commitment, and the patriotism of the enlisted personnel.
That night I bunked in a stateroom just below deck. Despite the
earplugs, I spent much of the night enthralled by the enormous noise
of jet aircraft taking off and landing.
After my 24 hours on board the Stennis,
I was brought back to the Greyhound for a catapult take off, which
propels the aircraft from zero to more than 130 mph in less than
2 seconds. The force of the take-off was incredible — both
frightening and exhilarating. Shortly after take-off I was landing
again at the naval airbase in San Diego.
My experience on board the
Stennis left me awestruck, and filled me with a new sense of appreciation.
We sometimes take for granted the freedoms we enjoy and the options
these freedoms allow us. We take for granted the work of people like
the crew of this aircraft carrier, most of whom are quite young yet
work extremely hard with enormous patriotism, devotion and commitment.
I am grateful for this once-in-a-lifetime experience and for the
renewed sense of appreciation it has given me for the men and women
who remain so unselfishly dedicated to the defense of our nation. [ top ]
One of the most common questions we hear from our patients is “How
long will I be in the office for my appointment?” It seems
like such a simple question, but it has a surprisingly complex answer.
length of your appointment will depend on the type of exam you receive,
which can be broken down into two basic types: dilated or undilated.
An example of an undilated exam may be a return visit for an existing
condition, such as an abrasion or infection. If you are scheduled
for this type of an exam, the appointment may take as little as 30
minutes. A dilated exam may be scheduled for a vision exam, in preparation
for surgery, or for a medical condition such as diabetes, cataracts,
macular degeneration, etc. This type of appointment is expected to
take as long as 90 minutes. Both types of appointments begin in the
same manner with a technician gathering information for the doctor.
Our technicians obtain or update your medical history and ask questions
concerning any new problems or concerns to bring to the doctor’s
attention. Our technicians do our pre-exam measurements. Ophthalmology
is a highly technical field and eye measurements are a combination
of computerized and manual, as well as objective and subjective (requiring
your assistance) testing. Our technicians then start the dilation
process by instilling drops which take 15-20 minutes for maximum
effect, after which the doctor will review the information gathered
by the technician, perform your exam and discuss any concerns with
you regarding the health of your eyes.
exams usually take longer. It is not uncommon for these visits to
take over two hours because additional testing, such as color vision,
extensive eye muscle evaluation, and stereo vision, is often required.
In addition, the medications used to dilate pediatric eyes are stronger
and take longer to be effective (20-30 minutes to reach maximum effect).
We understand that the longer wait can be very difficult on children
and, with parental approval, we have child-friendly videos for viewing
to help pass the time.
Additional testing by our technicians is performed
as ordered by your doctor based on need, and/or in preparation for
surgery, which can also extend your time with us. We try to make
the best decisions possible when considering your valuable time,
the urgency of the ordered testing, and our schedule when these additional
tests are ordered.
It is our goal to stay on schedule as much as possible.
However, because we are a medical office, unexpected needs do arise
and it is our policy to never turn away a patient in need. Sometimes,
during a routine exam, a finding that must be addressed in more detail
arises, or a patient may have extensive questions about a medical
condition. Unfortunately, it is impossible to predict when these
situations may occur. Please rest assured that if we are running
behind schedule it is often because a patient needed our extra time
and care, and if the situation were reversed with you or your loved
one, we would be there for you as well. We hope this article answers
some questions for you. We realize how difficult it is to wait in
office and we do appreciate your patience and understanding. [ top ]
|Mark Packer, M.D
I first learned about what was then called retrolental fibroplasia
(RLF) in a high school biology text. At the time it was recognized
that babies born prematurely and given supplemental oxygen to keep
them alive were susceptible to a blinding disease which led to
scarring behind the lens of the eye. A concerted, international
research effort to understand, prevent and treat this blinding
disease has resulted in tremendous progress, and I have been fortunate
to participate in this wonderful success.
As a resident at Boston
Children’s Hospital and Brigham & Women’s
Hospital I trained with Terri Young and Lois E. H. Smith, leaders
in the research that explains how ROP occurs. Before birth the
normal growth of blood vessels in the retina is stimulated by the
relatively lower oxygen environment in the womb. The nerve cells
make just the right amount of growth factors to maintain normal
growth. However, these retinal blood vessels do not complete their
growth until about 36 weeks of life. The oxygen that premature
babies get after birth shuts off the normal growth of the blood
vessels that nourish the retina. Then the areas of the retina that
do not have a blood supply go into a crisis, make excessive amounts
of growth factors and cause abnormal growth of blood vessels. These
abnormal blood vessels scar and contract, eventually detaching
the retina and leading to blindness.
The first major advance in
treatment came with the Cryotherapy of ROP (CRYO-ROP) study, which
demonstrated in 1988 that freezing the areas of retina without
a blood supply halted the progress of the disease and saved these
babies’ vision. The babies
who participated in that study are now in their teens and thankful
for their sight. As a resident at Boston City Hospital I participated
in the STOP-ROP study, which examined whether manipulating the
oxygen level in babies’ blood could help delay progression
of the disease (it didn’t).
Currently I examine every premature
baby at risk for ROP who passes through the Neonatal Intensive
Care Unit in Eugene. When indicated I treat these babies with a
laser, which is much safer and better tolerated than cryotherapy.
Our guidelines for treatment have until recently been based on
the original methods of the CRYO-ROP study, but a major re-evaluation
of outcomes published in Archives of Ophthalmology in December
2003, and widely reported in the media (including USA Today) has
prompted us to provide earlier treatment to eyes at risk. We are
making continued progress today because of the meticulous data
collection by researchers committed to preventing neonatal blindness.
If you’d like more information about ROP, please visit the
CRYO-ROP study page of the National Eye Institute at: http://www.nei.nih.gov/neitrials/static/study32.htm. [ top ]
The first week of December, I had the
pleasure of speaking as an invited guest of the XLVI Congress
of the Portuguese Society of Ophthalmology in Vilamoura, Portugal.
This gathering is considered the most important ophthalmic
meeting for Portuguese ophthalmologists and it was an incredible
honor to have the opportunity to speak to this group of physicians.
Portugal has more than 800 ophthalmologists and over 500 attended
the Congress in Vilamoura.
| Richard S. Hoffman,
My first presentation was a 30-minute
review of Current Trends in Refractive Lens Exchange. As
a guest of honor, I gave the final talk of the meeting on New
Perspectives in Cataract & Refractive
Surgery. Most of the meeting was in Portuguese, but several
American and British speakers were present making it educational
for those of us whose only language was English.
is a small resort town on the Portuguese southern coast
in the Algarve. There was a marina on one side of our hotel
and a deserted beach on the other side, sporting fisherman
with rods and reels fishing the Mediterranean surf.
On the return trip
to Eugene, I had an overnight layover in Lisbon. This gave
me the opportunity to explore the beautiful historic streets
of Portugal’s capital and receive an extensive lesson
from my hotel’s bartender in the finer points of Portuguese
In all, a wonderful experience! [ top ]
|Three men and a lady.
Noah, Zachary, and Jacob Hoffman (Dr. Hoffman’s three
sons) would like to announce the arrival of their new sister,
Macy Raquel Hoffman. Joann Hoffman delivered a healthy Macy on
November 1. Congratulations to the Hoffman family! [ top ]
| Madeline Kuykendall
When I was told I had cataracts I was shocked. I had
heard about cataracts but never thought I had developed them. After
listening to Dr. Fine explain what cataracts were and the surgical
process, I felt a little more at ease, however, I still needed time
to think about actually having the surgery. After several days I called
back to schedule the surgery. This was the best thing I had done for
myself in awhile. I didn’t realize how much I was straining to
see and how stressful it had become worrying about the simple things
like walking down steps and reading the newspaper. I had stopped driving
at night because I didn’t see as well in the dark and oncoming
headlights were so bright.
I noticed the biggest changes in my vision
and confidence after having the second eye surgery. That’s when
I realized how stressful not seeing well had been and how liberating
it felt to see without difficulty again. Now my vision is fantastic.
Everyone at Dr. Fine’s
office was helpful, kind, compassionate and professional.
for my new sight! [ top ]