Eyeworld

EW NEWS & OPINION 26 T he bar at the Ritz was busy for a weekday noon. Its heavy oak and black leather stools coddled Philadelphia's financiers, attorneys, and assorted rainmakers. It smelled of old money. "Hello, Jack! Waiting long?" "David! Good to see you. When was the last time? ARVO? Fort Lauderdale? It's been too long. How're you?" "Drinks, gents?" asked the bar- keep whose crisp apron supported a starched white shirt showing he had done this for a while and knew how. "I'll have an iced tea unsweet- ened." "Make mine a glass of California red, something from Sonoma if you have," said Jack. "So, what's so important to pull you away from your practice on a Tuesday? Isn't this your postop day?" "You always had a good mem- ory, Jack. Well, I'm still active in our state society and the letter the Academy sent out about op- tometrists presenting at the annual meeting created quite a stir. What do you think about it? You always have an opinion." Jack laughed. "Yeah, but not al- ways the one that leadership wants to hear. David, before I tell you what I think, tell me what you think. That's a trick you taught me at the Institute when I was a second-year resident." Smiling at the memory, David sat quietly for a while. Cold beads of sweat coalesced on his yet un- touched glass of tea. "There are many of us who are confused. Frankly, we felt blindsided by the letter. Here in Pennsylvania, we have spent years and untold dollars fighting organized optometry in Harrisburg. The Academy has sup- ported us where it can. These fights are all over the country. We get the letter and now have to play nice. See what I mean?" "The letter did say that we would deal with the American Academy of Optometry. It's smaller than the American Optometric Asso- ciation, and it's the AOA that plays hardball with the politicians. It's awfully good at raising PAC money." David took a sip of tea. "Yes, but optometrists don't choose one or the other organization. Many belong to both. I just don't see what ophthal- mologists have to gain. By opening our meetings to a few gives ammu- nition to all for their pitch in state capitals. You've heard the old Arab saying about the camel's nose under the tent?" Jack gazed into the back bar's mirror and slowly swirled the syrah. "Yes, of course. But I think there are a lot of players in this drama. The view from the conference room at 655 Beach Street on Fisherman's Wharf is very different from what your buddies see from the trenches on the Main Line. The Academy knows that even us eyeballs are being forced to consolidate. The government and insurance compa- nies have changed the game. Get big or get lost is their mantra. The public never will get the difference between the three Os. The ODs are smart to position themselves as providers of primary vision care." "We know that, Jack. But we are concerned that optometrists—I'm not talking about the guy down the May 2014 by J.C. Noreika, MD, MBA With apologies to John O'Hara Insights street from me—that their leaders will take advantage of the situation no matter what safeguards the Academy tries to put in place. We fight scope of practice laws over and over again yet it takes only one vote on the Capitol floor to trash all our efforts." "David, I know," Jack said grimly. "It is tricky to see how this benefits private practice ophthal- mologists. You have to wonder if they can survive. I know I'm too old to go to work for some big organiza- tion. I haven't been in a hospital in years. We are dinosaurs. You teach at the Institute. You see it. The residents have very different expectations for their careers." David looked down. "Jack, we both belong to ASCRS. It invites some optometrists to its meeting. Its model for integration has the ophthalmologist leading the vision care team. I think that the Academy wants this too. It's just not clear how they intend to do it. Given the poli- tics, maybe the AAO doesn't want to tip its hand." "Sure, David, I remember when ASCRS changed its policy. It sparked fierce debate. A few members quit. On the basis of size and scope alone, the AAO's job is exponentially more difficult. I wish its leadership had been more transparent in the plan- ning stages though. But what's done is done." "I agree, Jack. But I still have a hard time seeing what's in it for ophthalmology. Optometry on the other hand … " Holding his glass in his left hand, Jack pushed away from the face in the mirror and looked di- rectly at David. "It does seem curi- ous that the Academy would extend an olive branch to optometry now. The commercials like LensCrafters and e-commerce sites like FramesDirect are killing them, putting tremendous … " Before Jack could finish, a hostess cradling two large menus approached. "Table for two, gentlemen?" EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for more than 30 years. Contact information Noreika: JCNMD@aol.com Reay H. Brown, MD, a glaucoma specialist in Atlanta and the glaucoma editor for EyeWorld, has been awarded the Innovator Award by his peers in the American Glaucoma Society (AGS). This award recognizes Dr. Brown's many impor- tant contributions to the field of glaucoma. Since completing his glaucoma fellowship at the Bascom Palmer Eye Institute, Dr. Brown has been awarded 20 patents for surgical eyecare applications. Among these are several patents related to trabecular bypass instrumentation that are relevant to a number of devices in current clinical use and in late-stage clinical trials. He was also among the first to report the efficacy of vitrectomy to create a unicameral eye in the setting of aqueous misdirection glaucoma. Overall, he has published more than 70 papers, given many named lectures, and held leadership positions in the AGS and ASCRS. EW Reay H. Brown, MD Reay H. Brown, MD, honored by American Glaucoma Society J.C. Noreika, MD, MBA

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