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Drs. Fine, Hoffman & Sims Opthalmologists in Eugene Oregon

The Fine View: Spring 2006


The ASCRA Foundation
By Dr. I. Howard Fine

During my term as president of the American Society of Cataract and Refractive Surgery (ASCRS), I urged the activation of the ASCRS Foundation with three major goals. The first goal is patient education and awareness. This endeavor allows the gathering and dissemination of information necessary for patients to make well-informed choices regarding eye care, as well as to educate health care policy makers, congressional committees, and governmental agencies about the benefits of eye surgery, especially cataract and refractive surgery. The second major goal is to support research independent of industry sponsorship in order to facilitate the gathering of important information for eye surgeons and their patients.

The ASCRS Foundation's Robert. M. Sinskey Pediatric Eyecare in Addis Ababa, Ethiopia

The third humanitarian goal of the ASCRS Foundation is addressing pediatric cataract blindness in developing nations, and this goal has recently come to fruition with the completion of the construction of a pediatric surgery clinic in Addis Ababa, Ethiopia. The clinic was constructed and is entirely funded by the ASCRS Foundation in conjunction with volunteers from the ASCRS membership and other surgical societies internationally, and by the contributions of equipment, supplies and maintenance by many companies in the ophthalmic industry. You can imagine the impact this clinic will have in a country with 60 ophthalmologists and a population of 70 million people. We anticipate an enormous response to the clinic opening in January 2005.

With the track record we hope to establish in Ethiopia, we will endeavor to approach other foundations, such as the Rockefeller Foundation, the Ford Foundation, Gates Foundation, and Carnegie Foundation to expand into multiple sites within developing nations. I am chairman of the ASCRS Foundation governing board and the committee members are all esteemed members of the ophthalmic community or industry, serving on a voluntary basis. In addition, our pediatric cataract clinical committee consists of multiple, high-skill, philanthropic ophthalmologists who practice in or near developing nations, or who practice in the US and do multiple excursions into developing nations to treat pediatric cataract patients. The wonderful thing about this foundation is that almost all of the donated dollars go to achieve the goals of the Foundation with very little in the way of overhead expense. Very frequently, grateful patients have asked if there is a charitable organization to which they can make a donation, and we always recommend the ASCRS Foundation for any of our patients who wish to make a charitable contribution for any reason. This is certainly a worthwhile organization with laudatory goals. [ top ]

"If the Only Tool You Have is a Hammer, Everything Looks like a Nail. "
By Mark Packer, M.D.

Mark Packer, M.D

Rapid progress in cataract and refractive surgery has given surgeons many new tools.  From laser vision correction guided by the eye’s own wavefront of light, to implants that correct nearsightedness, farsightedness, astigmatism and presbyopia, to machines that quickly and safely remove cataracts through tiny ports, we now have a fabulous array of technology to improve vision and quality of life.  This abundance of tools provides surgeons with the opportunity to individually select the best approach for each of our patients. 

Tailoring technology to meet the needs of each individual patient has become a critical first step in our decision making process.  Because we serve as  investigators for many FDA monitored clinical trials of new devices, we have unique insight into new technologies and often a great deal of experience even prior to FDA approval.   Our relationships with the scientists and engineers who design new devices gives us the opportunity to participate in the continual process of improvement, and our experience using these devices allows us to provide valuable insights to the business leaders in our field, and to teach surgeons from around the world how to make the best use of new technology for the benefit of their patients.  In order to continue this work with industry we serve as consultants to a variety of companies that manufacture surgical devices for ophthalmology. 

Recently, consulting arrangements between physicians and industry have become a hot topic in the media because of potential bias and conflicts of interest.   Writing in The Journal of the American Medical Association, Troyen Brennan of Harvard Medical School states, “Conflicts of interest between physicians’ commitment to patient care and the desire of pharmaceutical companies and their representatives to sell their products pose challenges to the principles of medical professionalism.”1  It is easy to imagine how gifts and financial incentives from industry might pose a challenge to a physician’s integrity.  For us, the value of independent judgment, personal ethics and professional credibility represent significantly higher values than any token monetary rewards. 

The first step in maintaining trust and ensuring objectivity is full disclosure and complete transparency.  To that end I have listed in the accompanying figure my relationships with the business community.  These consulting arrangements involve a great deal of time and work on my part.  For example, in 2005 our consulting activities for Advanced Medical Optics, Inc., included my serving as Medical Monitor for two FDA monitored clinical investigations, meeting with the Global Advisory Board, writing 9 book chapters and articles, and presenting 17 lectures at scientific meetings.  For VisionCare, Inc., the manufacturer of the Implantable Miniaturized Telescope for macular degeneration, I performed several surgical studies in cadaver eyes at the Moran Eye Center at the University of Utah in Salt Lake City.  My work for Celgene, Inc., involved reviewing the scientific literature on transplantation and making a two hour presentation to their management team.  

Our recommendations to our patients about new technology for cataract and refractive surgery are based firmly on our judgment of what is going to make each individual happiest.  We work with many different companies, some of whom are competitors.  The value they see in us is honest and objective evaluation of technology.  After all, as doctors and teachers our only real wealth is our reputation. 

1 Brennan TA, Rothman DJ, Blank L, et al. Health Industry Practices That Create Conflicts of Interest.  JAMA 2006; 295: 429-433. [ top ]

First DSAEK Procedure in Lane County Performed at Oregon Eye Institute
By Richard S. Hoffman, MD

Richard S. Hoffman, M.D.

The first DSAEK (Descemet’s Stripping Automated Endothelial Keratoplasty) in Lane County was performed at the Oregon Eye Institute in December of 2005. The DSAEK procedure is slightly different than the posterior lamellar transplant technique that was described in our last newsletter.

Rather than dissecting the back surface of the patient’s cornea to make a space for the donor transplant, the thin membrane (Descemet’s membrane) on the back of the cornea is stripped away using a fine surgical instrument. This allows the surface where the transplanted tissue will lie to be much smoother than would occur if the patient’s cornea was dissected. In addition, the donor corneal tissue is dissected using an automated microkeratome similar to the devices we utilize to create a LASIK flap for refractive surgery. The microkeratome cuts a very thin piece off of the back surface of the donor corneal tissue that includes the corneal endothelium and a thin layer of cornea collagen.

This lamellar (partial thickness) tissue is then folded and inserted into the eye and positioned with special instruments. An air bubble is placed in the eye to hold the transplanted tissue in place and after one day the air is absorbed and disappears.

The advantages of utilizing a microkeratome to prepare the donor transplant are that it can guarantee a smooth surface and a consistent thickness to the donor tissue. It is much more precise than hand-dissection.

Microkeratome-assisted dissection of the donor lamellar endothelial tissue on a Moria artificial  anterior chamber.

These procedures that transplant only the back surface of the cornea have great advantages. The entire procedure can be performed through small incisions that require just one or two fine stitches or in some cases no stitches at all. By not creating a full-thickness circular incision in the cornea for a traditional transplant, the cornea remains stronger and there is much less astigmatism induced by the surgery. This translates into much faster visual recovery with many patients having driving vision of 20/40 within several months of the procedure.

The DSAEK procedure is only performed for individuals who have disease or trauma specifically to the back surface or endothelium of the cornea. This includes patients with Fuchs dystrophy, endothelial cell loss from traumatic cataract surgery, and rejected corneal transplants.

Please call our office if you thnk you may be a candidate for this new corneal transplant technique. [ top ]

Honors & Awards
by Sherrie Brunnel, MS

Drs. Fine, Packer, and Hoffman were excited by the release of their edited book, Refractive Lens Surgery, published by Springer.  This text covers almost every aspect of refractive lens surgery including the use of biometry and intraocular lens (IOL) calculations to obtain appropriate lens powers, the use of wavefront technology in selecting an IOL, the advantages and disadvantages of various IOLs and lens extraction techniques and technologies, and a discussion of the future of refractive lens surgery.  In addition to selecting the appropriate chapter topics and authors, and gathering and editing the chapters, Drs. Packer, Hoffman and Fine authored 12 chapters of the text.

Dr. Fine was delighted to be a winning member of the Cataract Challenge Cup team at the recent annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS).  As a member of the Flomaxinators, Dr. Fine and his teammates shared unique and innovative methods for dealing with intraoperative floppy iris syndrome, secondary to Flomax use, in a most entertaining fashion.  While at the ASCRS meeting, Dr. Hoffman was honored to have one of his papers selected as the Best Paper of Session.  His paper demonstrated that there is no difference in the amount of surgically induced astigmatism when utilizing the bimanual phacoemulsification technique versus standard coaxial phacoemulsification. 

Dr. Packer was honored to be selected to serve on the Cataract Clinical Committee for ASCRS.  As a member of this clinical committee, Dr. Packer will assist in determining the content of the cataract portion of the program for the next annual meeting.  In addition, Best Doctors, a service that rates doctors from around the globe, has selected Dr. Packer as one of the Best Doctors in America for 2005-2006. 

Dr. Hoffman was recently appointed as a member of the American Academy of Ophthalmology (AAO) Current Opinion Committee.  The current opinion committee is a sub-committee of the clinical education and new ophthalmic information committee.  As a member of the current opinion committee, Dr. Hoffman will be responsible for assigning, editing, and reviewing content for the Academy’s Educational Web Site.

Finally, we are proud of Amber Ambrozaitis, one of our ophthalmic technicians who recently passed the written portion of the Certified Ophthalmic Technician exam.  She is looking forward to completing the practical test for full certification.
[ top ]

New Faces

(From left) Carolyn Ketch, Patty Kimbell, and Charline Shipley

Please help us welcome the newest members of our team.
Carolyn Ketch is our new check-out receptionist.  Carolyn was born in Washington, but has lived in Eugene since she was five and is a graduate of Lane Community College.  Carolyn is thrilled to have joined the Drs. Fine, Hoffman and Packer team and although she has only been here for a few weeks, she already feels like part of the family.  Carolyn enjoys baking, quilting, sewing, canning vegetables from her garden, camping, and spending time with her husband of  35 years, their children and grandchildren.

Charline Shipley, also in our business office, was born and raised in the Willamette Valley, with her hometown in Brownsville.  Charline has a very impressive background including certificates in business and tax planning, and being a licensed insurance agent in the State of Oregon in life, health, and long-term care.  She served eight years on the City Council of Brownsville and was the first elected female Mayor of the City of Brownsville.  Charline enjoys spending time with her grandbabies and considers it an honor and a privilege to be a part of the best medical office team in the country.

Many of you may recognize our new ophthalmic assistant, Patty Kimbell.  Patty has worked at Drs. Fine, Hoffman, and Packer for 5 years, and until recently, she was the friendly face you saw at the end of your visit as our check-out receptionist.  While Patty enjoyed her previous position, she is excited to work with patients on a different level. She recently passed her Ophthalmic Study Course exam and is looking forward to taking her Certified Ophthalmic Assistant exam in the near future.  [ top ]

International Guests
By Sherri Brunell, MS

Dr. Fine with Drs. Weber, Unuchurtu, Ezmenjaud & Ramirez

As many of you know, we frequently have the pleasure of hosting international ophthalmologists who come to our clinic from all over the world to observe our doctors in surgery and the clinic. We were especially delighted to have four ophthalmologists from Mexico come to visit just prior to the annual meeting of the American Society of Cataract and Refractive Surgery. Dr. Everardo Barojas Weber, a long-time colleague and friend of Dr. Fine’s, was accompanied by Drs. Uruchurtu, Ezmenjaud & Ramirez. We had a wonderful time during their visit and look forward to their return. [ top ]

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