1. science
2. medicine
3. surgery

Winter 2013
| Volume 17 | Issue 1
655 Beach Street
San Francisco
CA 94109-9336
www.aao.org
The Newsletter of the Senior Ophthalmologist
James Bond Movies
Reached Age 50 in
2012
William S. Tasman, M.D., FACS
T
wo thousand and twelve
marked fifty years since the
first James Bond movie,
Dr. No, appeared in theaters. I
remember that particular film well
because my wife, Alice Lea, and
I were married in 1962. Although
I had had a fellowship in retina,
subspecialization was not yet in
full bloom. Having just started
in practice, I looked for other
avenues of survival. One opportunity was moonlighting as a
comprehensive ophthalmologist
in Doylestown, Bucks County,
Pennsylvania, which did not yet
have any ophthalmologists. Two
other fledgling practitioners and I
would each see patients one night
a week. The “office” we worked out
of was in the unfinished basement
of the general practitioner who
had conceived the idea. Imagine
seeing patients in a room where
pipes run down the ceiling of the
eye lane! But the patients came.
At that time Doylestown was
home to many show business
luminaries, such as Oscar Hammerstein, II, who allegedly wrote
“Oh What a Beautiful Morning”
while sitting on his front porch,
and Nobel and Pulitzer Prize
winning author Pearl S. Buck.
Just down the street from
our basement office was the
Doylestown
movie theater. Usually
Alice Lea came with me and
went to the movies while I saw
patients. As fate would have
it, the first movie that was
playing when we started our
Doylestown trips was Dr. No.
Just who was 007, and what
was the origin of the Bond name?
When Ian Fleming was writing
his first Bond novel, Casino Royale,
in Jamaica in 1952, he noticed a
book in his library entitled Birds
of the West Indies by James Bond.
Fleming was somewhat of a bird
watcher himself, and as he later
explained, this brief Anglo-Saxon
masculine name—James Bond—
was what he needed for his 007
character, rather than a name
such as Peregrine Carruthers.
The authentic James Bond lived
in Chestnut Hill, a Philadelphia
suburb, with his wife Mary Wickham Bond. He was a curator at the
Academy of Natural Sciences in
Philadelphia. The closest I got to
meeting him was when his oph-
thalmologist, Dr. Francis Heed
Adler (who, like Alice Lea and
me, was a Chestnut Hill resident),
phoned to ask if his patient
James Bond, who
had sustained a
corneal abrasion,
could call me if
he had a problem
over the weekend.
Dr. Adler, who loved
fly fishing, was off to
the Poconos for the
weekend, and I told
Dr. Adler I’d be glad to
take a look if the occasion warranted. However,
the phone never rang.
Though I never met the ornithologist, I did get to know his wife
Mary. She authored at least seven
books, including To James Bond With
Love and How 007 Got His Name. She
was kind enough to give me a copy
of the former in 1987, when the 007
movies had been around for only
25 years. The book includes an
exchange of letters between
Ian Fleming and Mary. In her
February 1, 1961 letter to Fleming, Mary mentions the London
Times review of the new edition
of Birds of the West Indies, which
apparently revealed that the 007
Bond liked martinis shaken, but
not stirred. A mutual friend of
the Flemings and the Bonds, Mr.
Charles Chaplin (not the actor) of
Haverford, Pennsylvania (a mainline Philadelphia suburb), gave
Mary a copy of Dr. No, in which
those words are first uttered.
In a letter to Mary, Fleming
is apologetic about how James
Bond II came to be. He then
offers Mary Bond unlimited use of
the name of Ian Fleming should
James one day discover a particularly horrible species of bird
which he would like to “christen in an insulting fashion.”
2
By my count, there have been
six James Bond actors. My favorite is Sean Connery. I love how
when asked his name, he says
“Bond” (usually exhaling cigarette smoke), and after a pause,
“James Bond.” However, I have to
give high marks to Daniel Craig
for “parachuting” into the 2012
London Olympics opening ceremonies with Queen Elizabeth,
thereby celebrating fifty years of
Bond films and the Queen’s sixty
years on the British throne.
James Bond films have a number
of memorable features. The musical
accompaniment is great. 007’s cars,
guns and gadgets are spectacular as
are some of the supporting characters.
My favorite villain: Oddjob, with
the razor-sharp brim on his hat, who
dispatches his victims by throwing
the hat. I’d like to have him on my
frisbee team.
“As I Remember It”
Frank P.
Philip C. Hessburg, MD
I
t was decades ago, during the
early rush to document uses
for systemic steroids in ophthalmology, and Jack Guyton, MD
had just completed a successful
penetrating keratoplasty with a
very early version of the Hessburg
trephine. All were pleased with
the patient’s progress until, in a
follow-up visit, Dr. Guyton noted
early signs of graft rejection. As
Departmental Chair, and a mathematical and surgical genius from
Wilmer, all of us were aware that
Dr. Guyton’s view of the use of steroids in ophthalmology could not
have been exceeded in negativity.
Knowing all this, but also hoping to keep a perfect graft from
going sour and perhaps adding
a blemish to the trephine, I convinced him to let me handle the
rejection. After a few calls around
the country – Mayo, Wilmer,
New York, as I remember – we
settled on 100 milligrams a day
for weeks. Sounded fine to me!
Wondrous response. In days the
graft looked better. The signs of
rejection melted away. Dr. Guyton
grudgingly announced on rounds
that “Phil’s right on this one…”
At about the two week period
following the inception of steroid
therapy, Mrs. P., the patient’s wife,
called to tell me that she didn’t
know what had gotten into Frank,
but he had asked for a divorce.
After about another week this
pious Polish Catholic decided
to quit the Church, and Mrs. P.
gave me another frantic call.
Too ill-informed then about possible side effects of steroid use
to connect this erratic behavior
to my regimen, and so pleased
by the gorgeous, crystal clear
graft, I appeased her with some
sort of “these things will hap-
pen” line until a daughter of the
patient called to tell me that
Frank sold the business – a highly
successful commercial painting company for, quite literally,
a song. She noted further that,
“Daddy gets stranger by the day!”
Several follow-up calls to internists around the country whose
names were atop steroid papers in
JAMA and NEJOM revealed that,
yes, occasionally patients on steroids have psychotic breaks and
do really looney things. Swell!
There followed a frantic phone
call to Judge (and patient) O’Leary,
“How do we undo everything that
Mr. P. has done in the last month?”
“Not all that easy, my son, but the
court can, on occasion, write unofficial letters of sufficient strength
to undo things.” “Please, your
Honor, I’ll take care of your eye
needs for the next millennium...”
The letters went out from the court.
And ultimately, Frank did return
to his wife and to his church.
He got back his business after
some court wrangling, and, magically, the graft stayed clear.
The vacuum trephine did survive as well, but none of us on the
Senior Staff of the Department of
Ophthalmology of the Henry Ford
Hospital mentioned steroids again
to Dr. Guyton for about a decade.
As I Remember It
Vignettes of the
days of training
and early practice
SCOPE solicits interesting
and entertaining vignettes
of readers’ days of training and early practice.
Please limit your submission to 500 words or less.
Send submissions to
[email protected]
From
the
Editor’s Desk
is already a classic as it leaves the
author’s pen.” I couldn’t agree more.
This book is beautifully written and
addresses “sight” in most of its ramifications. Written for the lay reader,
it has very special meaning for
all who have been entrusted with
the ability to help others appreciate beauty and light as they, too,
have been gifted with sight by their
patients for whom they have cared.
Great Gifts
T
he 2012 holidays have just
passed and this first day of
the New Year is a proem for
the days to come. The holidays
are special in that we share gifts of
appreciation and love. No longer
do I need clothes and new tools;
I have plenty of both. Gifts now
most meaningful are donations to
worthwhile charities and books.
Books are the compilation of
human experience and wise people
learn from the experience of others. Our own life, however rich
and varied, is but a drop of water
in the ocean of human experience. I received three memorable
books; memorable, in part, because
they are quite personal for me.
I have always loved the English
language and reading and writing.
The origin and varied meaning of
words has fascinated me since college days. Thus the book, Rare Words
with ways to master their meaning
and use, was gratefully received.
Written by a father-daughter combination, Jan and Hallie Leighton
(Levenger Press), it reminds us
that we forget gems that are buried in the English language.
The New York Times just listed
The Endgame by Michael Gordon and
General Bernard Trainor (Pantheon
Books, New York) as one of the ten
best scholarly books of 2012. The
book follows their best seller, Cobra
II as the inside story of the struggle
for Iraq from George W. Bush to
Barack Obama. It is a hefty and fascinating account of what arguably
has been “the most widely reported
and least understood war in American history.” The book is special
for me because the authors wrote
an acknowledgement to Wesley
Morgan, who they feel was “integral
to the research and writing of this
book… his encyclopedic knowledge
of the American military and its
wars, along with dogged reporting
(from Iraq and Afghanistan while
still a student at Princeton) added
substantially to the work.” Wesley
is my grandnephew with whom I’ve
maintained close contact for his 24
years. He inscribed the acknowledgement, “To Papa, let’s see if
you can make another 90.” Wes is
now on his way to Afghanistan in
search of material for a new book.
Most special is the recently
published, Gifts of Sight by Bruce
Shields (WestBow Press) of which
Frank Delaney, the author of the
best seller Ireland, has said, “…(it)
is meditative and Chekhovian (and)
Bruce Shields is a physician, scientist, researcher, and old friend
who served patients in humble
and friendly fashion and learned
much from them about life and
sight. A world renowned authority
on glaucoma, Dr. Shields is also
known among friends as the consummate Mr. Nice-Guy whose help
and opinions are carefully crafted
and delivered with gentle authority. Now retired from academia, he
spends time in a clinic providing
free general eye care, writing, and
enjoying life with his family. He is
also a valued member of the Senior
Ophthalmologist (SO) Committee and contributes to SCOPE.
Get a copy of Gifts of Sight for a
most pleasurable reading experience.
Maybe you will find glimpses of
yourself as you read about some life
stories that have transformed faith,
beauty and light into gifts of sight.
3
The Perfect Storm
for a Killer: Video
Game Addiction
and Violent Video
Games
Andrew Doan, MD, PhD
M
y heart grieves for the
lives lost at Sandy Hook
Elementary. As the smoke
clears from this tragedy, the question of violent video games and
video game addiction must be
addressed. Based on reports in
the media, the shooter may have
shot the mother in fear of being
committed for mental illness, the
computer was destroyed, and the
shooter played hours of the game
4
‘Call of Duty.’ In my years struggling
with video game addiction during
medical school and ophthalmology
residency, I raged when I couldn’t
play my games. When an addict
does not have access to their drug
of choice, in the case of video
games the digital drug of choice,
rage and anger are common. I envi-
sion two most likely scenarios: 1)
mother smashed the computer and
the shooter raged; or 2) shooter
smashed the computer and then
raged, both being a manifestation
of the acute depression followed
by refractory psychosis associated
with withdrawal symptoms. I’ve
been there, and it is real. Clearly,
without additional facts associated
with the Sandy Hook Elementary
tragedy, this may only seem theoretical; however, there is hard evidence our society is ignoring.
The perfect storm for the formation of a killer is mental illness combined with violent video
games. A child addicted to anything is mentally ill, whether it is
an addiction to drugs, alcohol, or
video games. When the drug or
activity of choice results in dysfunction, this is
defined as addiction. Unfortunately,
the medical community ignores
violent video
game addiction
because there is no
diagnostic ICD-9
code or DSM criteria, the written
guide for psychiatric illnesses.
As a society, we
agree that pornography leads to sex
crimes and deviant
sexual behaviors.
We generally do
not give children
access to pornography because of
the consequences
of this potentially
addictive behavior. However,
when a game like Grand Theft Auto
allows a child to have sex with a
prostitute, kill her, and steal her
money, we allow teenagers to
play because “It is only a game.”
“It is only a game” is a ridiculous
response because we do not allow
our children to watch pornography, as “It is only a video.”
The evidence for violence and
addiction associated with video
games extend beyond my personal
opinion and experiences. In one
national study of over 1,100 8 to
18-year-olds in the United States,
Gentile found that 8.5 percent
would classify as pathological
gamers. Although this could be
considered a somewhat small
percentage, the true nature of
the problem becomes clear when
one considers this percentage in
population terms. There are about
forty million children between
eight and eighteen in the United
States. Approximately 90 percent
of them play video games. If 8.5
percent of them are pathological,
that’s over 3 million children seriously damaging multiple areas of
their lives because of their gaming habits! That’s over 3 million
children who probably should get
some help, but most won’t because
there is no medical diagnosis for
the pathological use of technology. Once there is, it will be similar
to the approach focusing on dysfunction. The medical diagnostic
definition matters because, until
there is one, insurance companies will not pay for treatment.
A new study from Ohio State
University that will be published
in the Journal of Experimental Social
Psychology shows that violent
video games promote aggression. The researchers found that
people who played a violent video
game for three consecutive days
showed increases in aggressive
behavior and hostile expectations
each day they played. Meanwhile,
those who played nonviolent
games showed no meaningful
changes in aggression or hostile
expectations over that period.
What happens to our minds
when we devote significant hours
to a task or an activity? What happens to our brains when we focus
hours and hours on a video game?
Stickgold and his research team at
Harvard University published an
experiment in the research journal Science illustrating that people
Virtual Futures (Fig.1)
Charts ©Copyright Zone’in Programs Inc. 2012. www.zonein.ca
who played the video game Tetris
for seven hours over a period of
three days experienced hallucinatory replay of the activities as they
fell asleep. This phenomenon is
referred to as “The Tetris Effect.”
The game Tetris is a puzzle game
where falling blocks of various
shapes must be aligned to form a
continuous line. When such a line
is created, it disappears, and any
block above the deleted line will
fall. When a certain number of lines
are cleared, the game enters a new
level. As the game progresses, each
level causes the blocks to fall faster. The game ends when the stack
of blocks reaches the top of the
playing field, and no new blocks
are able to fall. Participants playing
Tetris have reported intrusive visual
images of the game at sleep onset.
When a child has mental illness
or addiction to video games, allowing the child’s mind to fill with
intrusive, violent images is the
perfect storm for a non-empathetic
killer. Cris Rowan, expert in child
psychology and author of the Virtual Child – The terrifying truth about
what technology is doing to children,
proposes the following formula for
the making of a pathological killer:
(technology addiction from youth,
with Tetris Effect) + (violent media
exposure) +/– (psychotropic medi-
Building Foundations (Fig.2)
cation) + (deprivation of movement, touch, human connection
and nature) = pathological killer
Rowan proposes that introduction of technology to children too
early results in medical problems,
psychological dysfunction, and
failure in life (see figure 1). Rowan
emphasizes that our technological society has strayed away from
traditional teaching and mentoring of children that lead to desirable outcomes (see Figure 2).
Whether or not there is
an ICD-9 code or DSM criteria for video game and
Internet addiction, I know
personally it is real from
my own struggles with
playing 50 to 100 hours
a week for more than ten
years. I am not alone. I
know of an ophthalmologist in his 60’s who plays
World of Warcraft between
patients all day and
wears moisture goggles
for dry eye, likely from
staring at this computer
screen. If this surgeon
was drinking between
patients, then we would
not tolerate this behavior.
However, because “It is
only a game,” excessive
and problematic video game playing is widely tolerated throughout our society. It is time that
as physicians, we stand up and
make a difference in our children’s
lives and futures by recognizing
and providing treatment options
to this pervasive addiction.
Andrew Doan, MD, PhD is the author of
Hooked on Games, which is available
in print and on the Kindle on Amazon.
com. More information can be found at
www.hooked-on-games.com
5
2012 Annual
Meeting Review
T
he 2012 Joint Meeting in
Chicago was a great meeting
in a great city. Some of the
events for Senior Ophthalmologists
that took place in Chicago were:
6
Senior Ophthalmologist Lounge
The SO Lounge turned out to be
a great benefit for SO members
who attended the Joint Meeting. In
its fifth year of existence, the SO
Lounge accommodated over 600
visitors, twice as many as in 2011.
The lounge offered refreshments,
comfortable seating, computers
with internet access, an opportunity to enjoy a photo archive loop
of esteemed ophthalmologists,
and a wonderful location that gave
our SO members total access to
the meeting. We thank everyone
who stopped by over the course of
the meeting and took advantage
of this relaxing and very convenient environment. Stay tuned
for more information on the SO
Lounge for 2013 in New Orleans.
Senior Ophthalmologist Special
Program and Reception
The Senior Ophthalmologist Special Program and Reception had
over 250 attendees. We heard
two engaging local speakers.
Lynn Osmond, Hon, AIA, CAE,
President and CEO of the Chicago
Architectural Foundation, was fan-
Dr. Shields speaking at the 2012 Then
and Now Symposium.
tastic. In her presentation, Chicago’s
Architectural Legacy, attendees listened to stories and viewed images
of prominent Chicago buildings
developed by leading architects in
a variety of styles common for the
period. Ms. Osmond’s presentation highlighted buildings from
the mid 1800’s to the present and
it was clear that the windy city
has no plans of slowing down.
From its skyscrapers to its bridges,
amazing engineering feats have
made the skyline of Chicago completely unique and unforgettable.
The second presentation, “Snapshots from Deep Time: Paleontological
work in the 52-million year old fossil-rich
limestone’s of Southwestern Wyoming”
Lance Grande, PhD was extraordinary. Dr. Grande is Senior Vice
President and Head of Collections and Research at The Field
Museum where he is responsible
for the four academic departments
(Anthropology, Botany, Geology,
and Zoology), the Library, the
museum’s scientific journal, Fieldiana, the interdisciplinary scientific
labs, and the museum’s collection
of over 25 million specimens. His
presentation detailed his work in
Southwestern Wyoming where he
has led several excavations and
has immersed himself in exploring how and when and why the
area was so unique in prehistoric
times. Photos of the fossils of prehistoric fish, bats, birds, etc., were
described and enjoyed by all.
The program concluded with
members of the Academy’s Young
Ophthalmologist (YO) Committee
presenting the 2012 EnergEYES
Award to Susan H. Day, MD.
The EnergEYES Award was created
in 2009 by the YO committee to
annually recognize and honor an
ophthalmologist who demonstrates
exemplary leadership skills by
energizing others to improve ophthalmology. Dr. Day follows in the
footsteps of three previous EnergEYES
Award recipients, David W. Parke, MD;
Bruce E. Spivey, MD; and Stanley
Truhlsen, MD. YO Committee members joined
California Pacific Medical Center
(CPMC) residents in presenting
the award to Dr. Day, currently the
CMPC Chair and Program Director
for the Department of Ophthalmology as well as a pediatric ophthalmologist in private practice. YO
committee member and former
CPMC resident Christian Hester,
MD, stated that “We are so honored
to have the opportunity to present
this prestigious award to someone
as deserving as Dr. Day. Dr. Day
has mentored many young ophthalmologists; she serves as a strong
role model, and has displayed high
energy that has motivated YOs to
get involved. The 2012 YO Committee recognizes Dr. Day’s lifelong
contributions and commitment to
improving the careers and opportunities for future eye surgeons.”
With the Blink
an Eye
of
W. Banks Anderson, Jr., MD
Ed: Rated R for violence.
A
s aircraft improved toward
the end of WWII, pilots
were blacking out because
the gravitational forces generated
in pulling out of steep dives cut
off their brain’s circulation. Pilots
would gray out, black out, and
then pass out. The trove of fact
and fancy that is the internet cites
Antoine Lavoisier as the author of
an experiment to determine just
how long the brain remains sentient after its circulation is cut off.
Lavoisier, born in Paris in 1743,
brought quantitative chemistry into
being. He established that oxygen
was essential for both combustion and respiration, distinguished
between elements and compounds
and formulated the law of conservation of mass. His many scientific
achievements were based upon
careful observation, accurate measurement, and rational thought.
His wife, Marie-Anne who was 13
at the time of their marriage, kept
his records, translated treatises by
Priestley and Cavendish and illustrated experiments. Both were from
affluent families. Lavoisier’s father
bought him a title in 1772. In 1775
Antoine Laurent Lavoisier (1743-1794)
as a member of the
Royal Gunpowder
and Saltpeter Commission the couple
moved into the
Paris arsenal where
with the help of
Éleuthère Irénée
du Pont they explosively improved
French gunpowder.
There he set up
and financed his
own private laboratory. He also joined
his father-in-law
as a partner in a
lucrative private
enterprise collecting taxes for the
King. In 1791 the
revolutionary government abolished
this ferme générale
business and he
was evicted from
the arsenal. Arrested in 1793 and
marked as both a
tax collector and one of the French
1%, he and the other fermiers
généraux were sent to the guillotine that next spring by Robespierre’s Committee for Public Safety.
Anticipating his execution
Lavoisier, according to the story,
arranged with a friend to count
the number of eye blinks that he
could do after his head came off.
One assumes that he also arranged
to be guillotined facing up toward
the blade in order to facilitate the
study. His blinking is alleged to
have stopped after fourteen blinks.
There is no contemporary evidence
that this story is factual and plenty
of logistical evidence that it is a
modern fancy. The killing field of
the Place de la Revolution, now the
Place de la Concorde, was efficiently operated. One account says it
took only thirty minutes to decapitate all 28 tax collectors. Accurately
counting the eye blinks of a head
toppling into a basket from a distance seems improbable if not
impossible and there is no record
of any observer on the platform.
This is not to say that brain function doesn’t persist after decapitation. The retina, a tract of the brain,
has a very high metabolic rate.
Its circulation can be completely
stopped by raising the intraocular
pressure above arterial supply pressure as in ophthalmodynamometry.
Vision will persist for 10 seconds or
so following total circulatory occlusion. I can blink more than 20 times
in 10 seconds so the described
experiment is not totally illogical.
Although it came too late for
Lavoisier, the Terror soon ended
as Robespierre’s head also went
into that basket. A year later MarieAnne Lavoisier got back their
confiscated papers along with a
note that her husband had been
unjustly executed. E. I. du Pont
de Nemours fled to the United
States and built a gunpowder
mill on the banks of Brandywine
creek. Joseph Priestley sought out
a friendlier community on the
banks of the Susquehanna. Antoine
Lavoisier continues to be a source
of amazing facts… and fancies.
7
Schizophrenics
Anonymous
David W. Parke, M.D.
I
8
first met Steve five years ago.
He was then 34 years old and
suffered from far advanced glaucoma with great loss of peripheral
vision. He had been referred by a
state agency for evaluation and to
establish a record of “legal blindness.” Steve was not a very pleasant person. Obtaining a history
from this unkempt and quarrelsome man was quite difficult. In
the eleven years that he had known
he had glaucoma he had seen at
least a half dozen different ophthalmologists, none of whose names
he chose to divulge. He had had
several surgical procedures, had
been noncompliant with medications, and presently was not using
eye drops. He was estranged from
his family, lived in a rooming house
and ate poorly. He insisted that he
was not a drinker and said he was
taking no drugs. He admitted to
being a “loner” since childhood and
had completed a year of college,
but his father withdrew financial
support because he didn’t study.
Steve’s visual acuity was 20/30 in
each eye with correction of moderately high myopia and had no
trouble reading fine print. His discs
were pale and showed almost complete cupping. Tensions were 24
on applanation in each eye. Confrontation fields were constricted
to about 10 degrees in each eye,
but he would not undergo perimetry. He refused a referral to the
glaucoma service saying that all
ophthalmologists were “stupid.”
He just wanted me to fill out the
state forms so that he could get
some financial help. He didn’t want
any low vision or social services.
Steve returned a year later
because he had lost his glasses
and the state required a new
prescription. After refraction he
refused any further evaluation and
left. It was impossible to reach him.
One year ago Steve again was
referred by the state. He said he
wanted all the help I could provide. He was neatly dressed, clean
shaven and actually pleasant. His
only new visual complaint was
losing his place when reading.
He said that he wanted to “set
the record straight” and continue
his education. He was working as
a volunteer clerical worker in a
state run rehabilitation center.
And then the past history unfolded. He lived in a neighboring state
and as a teen had been referred to
a psychologist because of “mood
swings.” He eventually went to a
psychiatric clinic where he was
called bipolar and was placed on
medications. At first he did well,
but when he went to college he
stopped his medications, began
to drink heavily and also became
addicted to marijuana and cocaine.
Raised a strict Roman Catholic,
he quit going to church, missed
most of his classes and failed to
communicate with his parents.
Steve’s parents eventually recognized some of the magnitude
of his problems, took him out of
college, and enrolled him in a
rehab program. In the next few
years he was in and out of rehab
a number of times. It was during one of these sessions that he
was found to have glaucoma. His
parents paid for his ophthalmologic care for a time, but eventually
then gave up on him completely.
Alone, he moved to Connecticut
where he lived mostly on hand outs,
money acquired in petty thefts or
in temporary jobs. He was arrested
for stealing and when it became
apparent that he had great visual
problems court officials referred
him to state services for the blind.
After the state helped him
receive counseling and financial aid
he continued drinking and using
drugs. One day he met a former
street acquaintance who somehow
shamed him into attending a meeting of Alcoholics Anonymous. His
relationship with AA at first was
sporadic. Eventually he accepted
the fact that he had a drinking
problem and became an AA regular. Not only did he stop drinking,
he stopped using drugs. At one
meeting he had a verbal altercation
with a man who had been aware
that Steve sometimes exhibited
belligerent tendencies. Steve had
accused the man of putting a viletasting substance in his coffee.
That man was a schizophrenic and
confronted Steve with the proposition that he needed special help
that AA could not provide. He invited Steve to attend a meeting of SA,
Schizophrenics Anonymous. He
protested that he was mentally ill,
but fortunately agreed to go along.
At his first meeting of SA Steve
met a psychiatric social worker
who quickly elicited the history
of a past bipolar diagnosis. He
arranged for professional help and
Steve eventually was diagnosed
as schizophrenic and started on
appropriate medication. He continues with AA, but has added SA
to his meetings schedule—and
thus a new Steve has emerged.
After a very pleasant visit, Steve
agreed to undergo complete glaucoma evaluation and is now medication compliant. I see Steve every
three months. He accepted referral
to a state run agency to help him
become computer literate using
visual-auditory helps. I helped him
enroll in a community college that
has recognized his visual restrictions and allows greater time to
complete reading assignments
and testing. His aim is to earn a
degree and become a rehabilitation
counselor. He has reunited with his
parents who provided him with a
smart phone complete with email,
internet and GPS capabilities. He
also has returned to his church.
Trends & Tidbits
SA is administered through an
organization called Schizophrenic
and Related Disorders Alliance
of America (SARDA). It is a confidential Self-Help Peer Support
Group and in many respects is
not unlike AA. SA helps members
strive to get well and stay well.
It provides information and education about schizophrenia and
provides positive reinforcement,
empowerment and enhances
social skills and self-esteem.
Catholic Horses
Steve says that SA has given
him peace of mind and a sense
of achievement. He follows SA’s
Six Steps for Recovery which
encompasses admitting a need
for help and choosing to be well.
They discover help through inner
resources and gain the ability to
forgive themselves for past mistakes and to forgive others for any
harm they may have inflicted. Life
can be transformed by eliminating erroneous thinking that used
to cause failure, fear and unhappiness. Depth of change requires
recognition of a supreme being, as
one understands Him, and trusting and accepting this guidance.
Steve’s transformation has been
amazing. I am grateful to him for
teaching me about Schizophrenics Anonymous. There are many
support groups available for a
variety of problems. The medical
profession must become attuned
to the potential benefits and use
of personal experiences as well
as those of an evidence-based
approach. Support groups can
impact on how patients act upon
medical information we provide
with care and compassion.
My favorite Christmas card in
2012 was signed, “Thanks for caring
—Steve.”
Further information on SA may be
obtained from: SARDA, PO Box
94122, Houston, TX 77094-8222 or
[email protected]
B
utch was at the track playing the ponies and all but
losing his shirt. Then he
noticed an old priest blessing the
forehead of a long shot. Miraculously that horse won. The same
thing happened in the next race.
This really got Butch’s attention.
For the next four races Butch
bet on the long shot horse that
the priest blessed and won every
time. Butch collected his winnings
and anxiously awaited the priest’s
choice in the last race. The old
cleric stepped onto the track and
blessed the forehead of an old nag
that was the longest shot of the day.
The priest also blessed the eyes,
ears and hooves of the horse. Butch
knew he had a winner. He ran to the
ATM and withdrew all of his savings
then added to that the day’s winnings and placed his bet on the nag.
He watched dumbfounded as
his horse came in dead last. In
shock he raced down onto the
track and confronted the old priest.
“Father, what happened? All day
long you blessed horses and they
won, but in the last race the horse
you blessed lost by a Kentucky
mile. Now, thanks to you, I’ve lost
every cent I owned—all of it.”
The priest nodded wisely and
with sympathy. “Son, that’s the
problem with Protestants, you
can’t tell the difference between a
simple blessing and the last rites.”
9
“As I Remember It”
First Day of Gross Anatomy
With Dr. Vitz
Dr. Gerald Bowns received this vignette
from his son Jared, who wrote it after his
first day at the University of Southern
California School of Medicine.
O
ur introduction to gross
anatomy took place on
Monday afternoon. Before
the lecture started several second
year students walked in and stood
in the front row. Then Dr. Vitz
walked onto the stage pushing
a cadaver. He had all of us stand,
said a few words about respecting
the bodies we would learn from,
and told us to be seated. My immediate impression was that he
was young.
10
After introducing himself he proceeded to outline the structure of
the course. Gross Anatomy would
be the most important course we
would take as medical students
and without a doubt would be the
most difficult. To emphasize his
point, he announced that we first
year students would be joined by a
number of those who failed a portion of anatomy the previous year
and were repeating the section(s)
they had failed. I was truly amazed.
What could be more humiliating
than being forced to stand in front
of hundreds of students as an
example of poor scholarship and
personal failure? “I am sure some
of you will be standing here next
year, so take a good look.”
He then proceeded to write the
word “cadaver” on the board and
asked if anyone knew how to pronounce it. Without asking for a
volunteer, he asked someone to
pronounce the word. He did. Sounded
good to me, but not to the good
doctor. “I am sure most of you, if
called on, would have given the
same pronunciation. You would
be wrong. (Pause—glares at us).
The correct pronunciation is
‘cadaver’ (long “a”).” “Now how do
you say this word in Spanish? You
don’t know? Sit down! You will be
responsible not only for knowing
anatomical terms, but also for their
correct pronunciation and their
Spanish equivalents.” Stunned
silence.
Dr. Vitz asked the student his name.
Vitz pronounced it incorrectly. The
student (somewhat sheepishly)
corrected him. This was obviously
not something you were supposed
to do. Dr. Vitz asked if the student
suffered from delusions about his
importance, and whether he was
under the influence of drugs or
alcohol. NEVER waste his time with
a name.
We will study the anatomy of the
cadavers we work with, but will
also get instruction in surface
anatomy. Since cadavers are often
useless in this respect, we will use
each other. The class will be partitioned into groups of three with
two males and one female in each
group. We will study the entire
body and everyone is expected to
participate. Hopefully the ratio will
be such that there will be one circumcised and one uncircumcised
male in each group. This prompted
a few giggles which merited an
immediate response. Did we think
this is funny? A game? Things
were going from bad to worse.
About the curriculum. Most will
find it necessary to spend much
time outside of lab to master
the material, in addition to several hours of textbook study each
night. He gave 65 hours a week as
a reasonable time commitment.
A woman stood and claimed this
was not fair. Dr. Vitz’ response was
predictable. He gave the standard
commitment to medicine speech
and questioned her desire to
become a physician. She sat down.
He then launched into a discussion about nerves and pointed out
that our cadavers were relatively fresh
and still had some function in their
nerves. To demonstrate this fact,
he and an assistant moved to the
cadaver and positioned their hands
under its back. They found the
nerve they were looking for and a
leg rose in the air. As he was speaking, he spelled out a mnemonic on
the board. Our unease and incredulity started to fade as we realized
what was being spelled, and most
people stopped taking notes. The
message? G-O-T-C-H-A! The entire
one and a half hour ordeal was
a traditional hazing produced by
the second years for our benefit.
Academy Foundation
Looking Back and
Forging Ahead
By B. Thomas Hutchinson, MD
B. Thomas Hutchinson, MD
T
he New Year is a natural
time for reflecting on personal, professional and
institutional accomplishments
and for setting new goals. For
me, professionally, this new year
is also a time of transition – my
final term as chair of the Foundation Advisory Board (FAB) and
my regular letters to you end with
2012. Let me begin with the Foundation’s major past initiatives.
I think that we all should be
incredibly proud of the Foundation’s accomplishments over the
last 30 years. Foundation funding has made many beneficial
programs possible. The Museum
of Vision and the National Eye
Care Project were developed in
the early 1980s. The Academywide campaign for The Spivey
Educational Trust Fund in 1992
and more recently, the development of the Hoskins Center for
Quality Eye Care and the Academy’s online education portal,
the ONE Network, have been
breathtakingly successful. Through
innovation and a clear vision
of what ophthalmologists need
to better serve patients, we are
achieving results today – now
on a global scale – that have
exceeded most expectations.
By any measure, the work of the
Foundation has benefited both
our patients and our profession.
We must continue to champion
the many key Academy programs
that exist, in large part, because
of Foundation funding. Whether
it is for public service, ophthalmic education, quality of care
research, help for less fortunate
colleagues in the developing
world, or preserving our ophthalmic heritage, the need exists. The
Foundation must be there to help.
Update
philanthropic giving each year by
making a gift at either the Partners
for Sight ($1,000) or the Leadership Council ($2,500+) level. I
am also a member of the Legacy
Society and I invite you to join me
by including the Foundation as
a beneficiary in your estate plan!
However much and whenever you
choose to show your support,
your gifts will be appreciated!
The reins of the FAB now rest in
the capable hands of Dr. Christie
Morse, who recently served as
an at-large member of the Academy’s Board of Trustees and is
currently chair of the Academy’s
Ethics Committee. Christie is a
good friend, a real dynamo and
a tried-and-true supporter of the
Academy’s mission. Please join
me in strong support of both
Christie and our Foundation!
On a personal note, many of you
know that EyeCare America (ECA)
holds a special place in my heart.
From its genesis as the National
Eye Care Project, which started as
a pilot program in three states,
EyeCare America has become the
largest public service program in
American medicine. It has served
more than 1.7 million people
with the help of nearly 7,000 volunteer ophthalmologists across
the United States. I am extraordinarily privileged and honored
to have had the opportunity to
be a part of ECA and many of the
other Foundation programs these
past years – a lifetime experience always to be treasured!
As outgoing chair, my wish is
for each of you to join me in giving back to our great profession,
which provides enormous personal satisfaction for each of us and
offers the opportunity to make a
real impact in our patient’s lives.
I hope that you will consider
including the Foundation in your
Dr. Christie Morse
As I continue on the FAB, I hope
to stay in contact with you, my valued Academy Seniors colleagues,
for the duration. My e-mail
address is [email protected].
May we all have a happy, healthy
2013!
11
SCOPE
The Senior Ophthalmologist
Newsletter
P.O. Box 7424
San Francisco, CA 94120-7424
Editor
David W. Parke, M.D.
North Branford, CT
Associate Editors
W. Banks Anderson Jr., M.D.
Durham, NC
William S. Tasman, M.D.
Philadelphia, PA
“As I Remember It”
My Oldest Cataract Patient
By E. Fredrick Bloemker M.D.
I
have been practicing ophthalmology for over 40 years. One of my
more interesting patients was a
99-year-old lady that I first saw in
1984. Her first name was Priscilla,
which is a name from the 19th
century in which she was born. Her
insurance was a closed panel HMO
and I was not a member of this
HMO. She came to me for a second
opinion. She was well-dressed and
was very “with it.” Her best corrected visual acuity was 20/50 in
either eye. She was still driving and
played bridge five days a week. She
stated that her reduced vision was
making her an unsafe driver. According to her, her insurance company
would not allow her cataract surgery
because she was” too old.” I sent
a letter to her insurance company
requesting that they allow one of
their ophthalmologists perform the
surgery. The request was denied.
The patient then
decided to have me do
her cataract surgery on
her right eye. The surgery
was done with a 20/20
result. Now the lady
wanted to have her left
eye cataract removed. She
is now 20/20 in her right
eye and 20/50 in her left
eye. I asked her to see
me again in six months
at which time she was 99
½. I thought for sure that I could
put her off. She couldn’t live forever. I kept having her return at
six-month intervals. At her next six
appointments, she was 100 years of
age, 100 ½, 101, 101 ½, 102, 102 ½.
Finally, when she was 103 years of
age, she came in with her 79-yearold son. He said “Doc, you have to
take the cataract out of my mother’s
left eye because she’s driving the
family nuts”. She was still mentally
alert and playing bridge five days
a week. I did do the surgery when
she was 103. I did get a lot of ribbing from my cohorts about doing
cataract surgery on someone that
old. She had a very good result
and was one of my most appreciative patients. She lived to be 106.
Subsequently, I have used this
story when any of my patients states
that they are “too old” to have cataract surgery. It has convinced many
elderly patients to go ahead with
cataract surgery. This taught me
that you can’t make decisions based
solely on the age of the patient.
It still brings a smile to my face
whenever I think of this lovely lady.
Assistant Editor
Neeshah Azam
AAO, San Francisco, CA
Senior Ophthalmologist Committee
Harry A. Zink, M.D. Chair
Wooster, OH
Susan H. Day, M.D.
San Francisco, CA
H. Dunbar Hoskins, M.D.
Belvedere, CA
David W. Parke, M.D.
North Branford, CT
M. Bruce Shields, MD
Burlington, NC
Gwen K. Sterns, M.D.
Rochester, NY
Martin Wand, M.D.
Farmington, CT
C.P. Wilkinson, MD
Baltimore, MD
Tamara R. Fountain, M.D.
Secretary for Member Services
Chicago, IL
Staff
Gail Schmidt
Neeshah Azam
Design
Lourdes Nadon
P.O. Box 7424
San Francisco, CA 94120-7424
Tel. 415.561.8500
Fax 415.561.8533
www.aao.org/careers/seniors