Ophthalmology

The current issue of Ocular Surgery News explores the question of routine genetic testing for macular degeneration risk, a practice that the American Academy of Ophthalmology has, probably appropriately, come out against. Aside from the technical limitations of genetic testing, one has to wonder at the personal value of trying to predict the future. In this age of information technology, it is generally believed that bringing facts into the light is always a good thing. Often that's the case, and with macular degeneration, one of medicine's most-feared ailments, many family members of people with this condition want to know their own risk. Certainly, they deserve to have whatever answers modern medicine can offer. But not all information is necessarily good.

The cover story in the current issue of Ocular Surgery News focuses on the progression of glaucoma, one of our field’s most perplexing mysteries. The longer I practice ophthalmology, the less certain I have become that we really understand glaucoma. Sure, I can follow accepted standards of care, setting target pressures and assessing regularly for compliance and efficacy, but I feel less and less like we really know what’s going on, especially with the enigmas we call low-tension glaucoma and ocular hypertension.

Last week, my children’s favorite aunt, who works in marketing for Mattel, gave my 7-year-old daughter a brilliant toy called Fijit. Fijit is a 9-inch-tall robot that talks to kids, tells them jokes ("Why was Cinderella such a poor soccer player? Because she kept running away from the ball!"), dances to music that you play and then asks, "What do you want to do now?"

Needless to say, Fijit has provided my kids with hours of entertainment. As I’ve watched them engage in conversation with this plastic, computerized toy, I’ve realized how much it mimics the human interaction that can happen between doctors and their patients.

Just a few years ago, I used to regularly make fun of my more senior friends and colleagues when they donned their reading glasses to see fine print. Now, at age 46, presbyopia doesn’t seem so funny anymore. Thankfully, a number of great technologies promise hope for us oldies. Personally, I love offering patients both the multifocal and accommodating IOLs that are approved but am very excited about newer, better IOL technologies. That is, if the FDA will ever approve them.

When I grew up in the early 1970s, I remember considering different professional careers. Among the most desirable were becoming a doctor, a lawyer, an engineer and a pilot. These were the most respected and best paid mainstream career choices.

I chose to be a physician because I loved science and loved helping people, but I always thought about becoming a pilot as well. Aviation offered an extremely respected place in society, highly technical skill, great pay and a reasonable workweek.

I believe there are a lot of reasons why doctors and patients will come to love the results of microinvasive glaucoma surgery. One of the best is its friendliness to the ocular surface.

A recent ruling in the U.S. Court of Appeals for the Second Circuit may have monumental implications for both medical education and the promotion of drugs and medical devices to medical providers.

At every Academy meeting, there’s a topic that dominates exhibit hall and hotel bar discussions. For the past couple of meetings it has been femtosecond cataract surgery, but this time it distinctly changed to health care reform. With President Obama continuing in office, the likelihood of repeal of the Affordable Care Act is quite small.

Twenty-five years ago, before I entered medical school, my uncle, John Piligian, who was a prominent pathologist in Michigan, advised me not to become a doctor. “They’re going to socialize medicine and treat doctors like a commodity,” he used to say.

How right he was! Changes in health care continue to erode the sanctity of a physician’s role and prevent us from practicing medicine the way patients deserve, although it’s taken much more time than my uncle ever predicted.