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Volume 6, Number 21
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Monday, May 29, 2006
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| Letter to the
Editor Regarding the May 22, 2006 Editorial: How Did It
Happen?
Dear Dr. Pascucci: While I agree with your observation that the system is broken, I have some disagreement with your perspective. There is no law that prevented the physicians in question to provide prompt and reasonable care for your assistant. If there is, please share it with me. Those physicians each made a conscious decision not to care enough. It simply wasn"t worth it. To be honest, the financial risk benefit ratio wasn"t there and, unfortunately, the "community standard" validates this unthinkable behavior. No excuses. The real power to set the standard of care comes from within the medical community, it is not granted by legislative bodies or insurance companies. The ugly truth is that those doctors didn"t see your assistant as a significant "profit center" and used the liability and community standard issue as sufficient justification to sit on their respective hands. I recall an oath that was designed to set our bar at a much higher level. Sincerely, Elliot M. Kirstein, O.D., F.A.A.O. Harper"s Point Eye Associates Cincinnati, Ohio 45249-2313 [email protected] Dear Dr. Kirstein: Your point is essentially what I was trying to make. Medicine seems to have lost its way. The public do not believe doctors care any more. We are our own worst enemies when it comes to the PR war that exists between doctors and attorneys when it comes to patients. More docs need to refresh their memories about that oath and step up to the plate for patients. Those that do will, likely, not be financially the most well off but will be (professionally) more content and financially successful enough. At least, that"s my practice philosophy. Stephen E. Pascucci, M.D. Eye Consultants of Bonita Springs, PLLC Bonita Springs, FL 34135 [email protected] |
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| Ten-Year Incidence
of Retinal Vein Occlusion in an Older Population Australia’s Center for Vision Research at the
University of Sydney conducted an assessment of the 10-year incidence
of retinal vein occlusion (RVO) and its predictors in an older population.
The Blue Mountains Eye Study examined 3,654 residents aged 49 years and older (82.4 percent response) from 1992 to 1994, reexamined 2,335 residents (75.1 percent of survivors) from 1997 to 1999 and reexamined 1,952 residents (75.6 percent of survivors) from 2002 to 2004. Investigators assessed incident RVO from stereoscopic retinal photographs and calculated Kaplan-Meier cumulative 10-year incidence. After excluding 47 residents with RVO at baseline and 171 residents with no photographs at either follow-up examination, 2,346 residents were considered at risk of developing RVO. The cumulative 10-year incidence of RVO was 1.6 percent. Age was significantly associated with the incidence of RVO. Factors predicting the incidence of RVO included mean arterial blood pressure (age-adjusted odds ratio [OR], 1.41 per 10 mm Hg increase), ocular perfusion pressure (OR, 1.71 per 10 mm Hg increase), obesity (OR, 2.16) and presence of retinal arteriolar wall signs (focal narrowing: OR, 3.37; arteriovenous nicking: OR, 4.09; and opacification: OR, 4.89). |
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SOURCE: Cugati S, Wang JJ, Rochtchina E, Mitchell P. Ten-year incidence of retinal vein occlusion in an older population: the Blue Mountains Eye Study. Arch Ophthalmol 2006;124(5):726-32. |
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| Hemoglobin A1c
Awareness Among Patients at a Tertiary Ophthalmic Center Researchers at the Wilmer Eye Institute, Johns Hopkins University School of Medicine conducted a nonrandomized clinical case series study aimed at determining awareness of hemoglobin A1c (HbA1c) among patients receiving eye care at a tertiary ophthalmic center for diabetic eye disease. The study included 150 adult patients with diabetes who were examined between July and October 2003 for diabetic retinopathy (DR). All were surveyed about HbA1c knowledge. Seventy-six (51 percent) understood HbA1c, 25 (17 percent) were not sure if they understood and 49 (33 percent) did not understand. Patients who understood HbA1c based on duration of DM were as low as two (29 percent) of seven with DM for less than five years and as high as 17 (55 percent) of 31 with DM for longer than 15 years. Seventy-six (51 percent) had proliferative DR, among whom 33 (43 percent) understood HbA1c; 69 (46 percent) had nonproliferative DR, among whom 39 (57 percent) understood HbA1c; and 5 (3 percent) had no DR, among whom four (80 percent) understood HbA1c. |
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SOURCE: Do DV, Nguyen QD, Bressler NM, et al. Hemoglobin A1c awareness among patients receiving eye care at a tertiary ophthalmic center. Am J Ophthalmol 2006;141(5):951-3. |
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| Pigmented Episcleral
Deposits After Brachytherapy for Uveal Melanoma Investigators at Finland’s Helsinki University Central Hospital conducted a study to describe the characteristics and evolution of pigmented episcleral deposits after brachytherapy for uveal melanoma in an effort to determine their origin and association with melanoma-related mortality. The noncomparative case series included 211 patients (108 men, 103 women; median age 61 years; range 14 to 88 years) who were treated with a single ruthenium and iodine plaque therapy (median dose to tumor base, 475 Gy and 392 Gy, respectively) for a choroidal and ciliary body melanoma. Median tumor diameter and height were 12 mm and 5.5 mm, respectively. Eighty-eight patients were treated prospectively during the study. Researchers recorded the number and location of pigmented episcleral deposits under the slit lamp during each visit after brachytherapy. They then analyzed the association of the deposits with tumor characteristics and survival using logistic regression and Kaplan-Meier analysis, respectively. The pigmented episcleral deposits ranged from black and brownish spots to slightly thickened patches. Most deposits appeared within the first six months after brachytherapy. By one year, 85 percent (95 percent confidence interval, 77 to 93) of eyes had at least one deposit (median 6). The deposits increased in number until seven years from irradiation and decreased with increasing distance from tumor center. An association between the number of deposits at one and two years and subsequent melanoma-related mortality could not be confirmed. The authors believe that the association of pigmented macrophage-related episcleral deposits with plaque size and isotope rather than with tumor size suggests that radiation atrophy of retinal pigment epithelium and choroid, in addition to tumor regression, contributes to the formation of the deposits. They suggest that knowledge of their existence may save patients from unnecessary enucleation. |
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SOURCE: Toivonen P, Kivela T. Pigmented episcleral deposits after brachytherapy of uveal melanoma. Ophthalmol 2006;113(5):865-73. |
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| Macular Grid
Photocoagulation after Intravitreal Triamcinolone Acetonide for Diffuse
DME Macular laser coagulation effectively maintains improved visual acuity after intravitreal injection of 4 mg of triamcinolone acetonide (IVTA) for diffuse diabetic macular edema (DME) and is believed to reduce recurrent DME after IVTA, according to results from a Korean study. Eighty-six eyes of 74 patients with diffuse DME were randomized into two groups. The laser group eyes (48 patients) were subjected to a macular grid laser photocoagulation three weeks after IVTA. The control group eyes (38 patients) underwent only IVTA. Both groups were compared regarding changes in visual acuity and central macular thickness at three weeks, three months, and six months after IVTA. The mean central macular thickness before, three weeks after, and three and six months after IVTA were 538, 250, 295 and 301 microns in the laser group vs. 510, 227, 302 and 437 microns in the control group, respectively. LogMAR visual acuities did not significantly differ between the two groups at baseline and at three weeks after IVTA, but they were significantly better in the laser group at three and six months after IVTA. |
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SOURCE: Kang SW, Sa HS, Cho HY, Kim JI. Macular grid photocoagulation after intravitreal triamcinolone acetonide for diffuse diabetic macular edema. Arch Ophthalmol 2006;124(5):653-8. |
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BRIEFLY
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