EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/76185
July 2012 Warren Hill: Flying high beyond ophthalmology by Maxine Lipner Senior EyeWorld Contributing Editor mercial rating you need to control the airplane to within 100 feet, but for formation flying this is within 12 inches because you are almost flying wingtip to wingtip. "You get stupid and don't pay attention and three other people are going to have a really bad day," he said. "So it's a lot of training." continued on page 66 Mitosol® (mitomycin for solution) Kit for Ophthalmic Use Rx only BRIEF SUMMARY: information Dr. Hill is pursuing formation flying, in which four airplanes cruise the air performing a series of maneuvers in tight formation Source: Warren E. Hill, M.D. Leading practitioner masters the art of the wingman I magine being at the helm of an airplane, nose diving toward the ground only to pull up at the last second, all while being wingtip to wingtip with other planes, with a gaggle of onlookers below. Warren E. Hill, M.D., East Valley Ophthalmology, Mesa, Ariz., doesn't have to imagine; such is an average afternoon for him while pursuing his passion for formation flying. While today this is one of his fa- vorite ways to spend his time, ironi- cally this was not always true for Dr. Hill. "I had never been in a private airplane until I was 52 years old," he said. "I had no desire. I had lived my life in 5-minute increments." All of that changed, however, when he received a birthday present offering three free flying lessons, something that initially he was less than happy about. "I thought that was the worst idea in the world," he recalled. "I could care less; I didn't have the time and I wasn't interested." Passion ignited After about 6 months, Dr. Hill fi- nally went down to the airport and took his introductory flight. He still was less than impressed. "I don't even remember anything about it," he said. "We got in an airplane and flew around and landed, and the worst part was that I had two lessons left." Likewise, the second time was far from memorable. It wasn't until the close of the third flight that Dr. Hill's view shifted. "I was coming in to land and the guy told me to land the airplane and folded his arms," Dr. Hill recalled. "I hadn't been pay- ing attention; he talked me through it and I landed the airplane." Dr. Hill couldn't believe he had done it. From there his passion was born. Within 3-and-a-half years he had not only become a private pilot, he went right to the end of the certifi- cation process and got his multi- instrument commercial license. His desire to excel at this new- found passion had kicked in. "A lot of the upper tier ophthalmologists have certain personality pathologies, and one of them is that for a lot of us anything worth doing is worth doing to excess," Dr. Hill said. He also pointed out that he's a typical knowledge junky. "When I got my private pilot license I realized that I didn't know anything," he said. From there he felt compelled to get an instrument rating, followed by a single-engine commercial rating, a multi-engine rating, a multi-engine instrument rating, and finally a multi-engine instrument commer- cial rating. "I wanted to be the best pilot possible," he said. Shortly after that someone took him up in a military airplane. "We did 1-and-a-half hours of what we refer to as 'loosen your fillings' aero- batics—4, 5, and 6 G maneuvers," he recalled. "Most people are asking for the baby Jesus to save them, and I just said, 'Sir, may I have another.'" After that Dr. Hill went out and got a military airplane. He found that the activity that he was drawn to was formation flying in which four airplanes cruise through the air just three feet apart, performing a se- ries of maneuvers in tight formation. This takes a tremendous amount of control and discipline. Dr. Hill pointed out that to simply get an in- strument rating all you need to do is to control the airplane; to get a com- Please consult package insert for full prescribing INDICATIONS AND USAGE: Mitosol® is an antimetabolite indicated for use as an adjunct to ab externo glaucoma surgery. CONTRAINDICATIONS: Hypersensitivity: Mitosol® is contraindicated in patients that have demonstrated a hypersensitivity to mitomycin in the past. Pregnant women: Mitosol® may cause fetal harm when administered to a pregnant woman. Mitomycin administered parenterally has been shown to be teratogenic in mice and rats when given at doses equivalent to the usual human intravenous dose. Mitosol® is contraindicated in women who are or may become pregnant during therapy. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. WARNINGS AND PRECAUTIONS: Cell Death: Mitomycin is cytotoxic. Use of mitomycin in concentrations higher than 0.2 mg/mL or use for longer than 2 minutes may lead to unintended corneal and/or scleral damage including thinning or perforation. Direct contact with the corneal endothelium will result in cell death. Hypotony: The use of mitomycin has been associated with an increased instance of post-operative hypotony. Cataract Formation: Use in phakic patients has been correlated to a higher instance of lenticular change and cataract formation. ADVERSE REACTIONS: Ophthalmic Adverse Reactions: The most frequent adverse reactions to Mitosol® occur locally, as an extension of the pharmacological activity of the drug. These reactions include: Blebitis: bleb ulceration, chronic bleb leak, encapsulated/cystic bleb, bleb-related infection, wound choroidal effusion, serous choroidal dehiscence, conjunctivial necrosis, thin-walled bleb; Cornea: corneal endothelial damage, epithelial defect, anterior synechiae, superficial punctuate keratitis, Descemet's detachment, induced astigmatism; Endophthalmitis; Hypotony: choroidal reactions (choroidal detachment, detachment, suprachoroidal hemorrhage, hypotony maculopathy, presence of supraciliochoroidal fluid, hypoechogenic suprachoroidal effusion); Inflammation: iritis, fibrin reaction; Lens: cataract development, cataract progression, capsule opacification, capsular constriction and/or capsulotomy rupture, posterior synechiae; Retina: retinal pigment epithelial tear, retinal detachment (serous and rhegatogenous); Scleritis: wound dehiscence; Vascular: hyphema, central retinal vein occlusion, hemiretinal vein occlusion, retinal hemorrhage, vitreal hemorrhage and blood clot, subconjunctival hemorrhage, disk hemorrhage; Additional Reactions: macular edema, sclera thinning or ulceration, intraocular lens capture, disk swelling, malignant glaucoma, lacrimal drainage system obstruction, ciliary block, corneal vascularization, visual acuity decrease, cystic conjunctival degeneration, upper eyelid retraction, dislocated implants, severe loss of vision. USE IN SPECIFIC POPULATIONS: Pregnancy: Teratogenic Effects: Pregnancy Category X (see Contraindications). Nursing Mother: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, and because of the potential for serious adverse reactions in nursing infants from Mitosol®, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. It is recommended that women receiving Mitosol® not breast feed because of the potential for serious adverse reactions in nursing infants. Pediatric Use: Safety and effectiveness in pediatric patients have not been established. Geriatric Use: No overall differences in safety and effectiveness have been observed between elderly and younger patients. More detailed information is available upon request. For information about Mitosol® contact: 1-877-EYE-MITO (1-877-393-6486) Please also see full Prescribing Information at MobiusTherapeutics.com Manufactured for: Mobius Therapeutics, LLC 4041 Forest Park Avenue St. Louis MO 63108 USA (314) 615-6930 Mitosol® is a registered trademark of Mobius Therapeutics, LLC © 2012 Mobius Therapeutics, LLC MOB0022 BS 02/16/2012 EW IN OTHER NEWS 65