Revista Vega Número 19 Inglés by Instituto Oftalmológico Fernández-Vega

Free journal Take it home! Third quarter 2014

Nº 19

Magazine del Instituto Oftalmológico

F E R N Á N D E Z -V E G A

The presidents of the SEO and SECOIR, in the Institute

The Foundation returns to Cambodia

Tears, the great unknown pág. 13

“Freedom is not only the act of choosing”. Gustavo Bueno, philosopher pág. 30

pág. 34

Una compañía

que siempre juega en casa.

Ophthalmological advances but who does so with minimum pain and with a much easier post-op. The basis of these achievements lies both in the research and the continuous training of those who, efficiently and responsibly, and thanks to their good work, have won the trust of the patients throughout the years.

Prof Luis Fernández-Vega.

In the last few years, the advances made in this area of medicine have been impressive and, without a doubt, they live up to the advances made by any of the disciplines that have been subject of the greatest innovation. Therefore, the leap in the qualification of the professionals has matched the sophistication of the technology that can now be applied, which means, for example, that we can now use surgical treatment for visual impairments that weren’t suitable for this type of treatment until recently. And, as could not be otherwise, with all types of advantages for the patient who not only sees his/her problem solved or alleviated,

At the Institute we pay special attention to these two aspects, although I may now underscore the latter since we have played a relevant role at the important national and international conferences that have been recently celebrated; conferences in which our team has been able to update and assess different aspects of its performance. In this field of on-going improvement, the two main Spanish Ophthalmological Societies – SEO y SECOIR – are decisive; it also happens that its two presidents are significant members of the medical team of our entity. We give an account of this, and of numerous other issues that we trust are of interest to our readers, in the following pages.

Editorial

MAGAZINE OF THE INSTITUTO OFTALMOLÓGICO FERNÁNDEZ-VEGA Avda. Dres. Fernández-Vega, 34 33012 OVIEDO T. 985 240 141 F. 985 233 288 www.fernandez-vega.com Direction and coordination, content writing and editorial management: Atlántica Empresas Advertising: SGANMEDIOS 678 684 457 Design: Eteria, Marketing y Comunicación D.L. AS 5668-2007

Table of contents pág. 6 Conversations amongst doctors • “It’s worth having lived 30 years like this, hopefully we’ll live another thirty” pág. 13 Fundación Fernández-Vega • The Foundation returns to Cambodia • Close to 400 free check-ups in the centre of Oviedo • The Fundación Fernández-Vega, Antena de Oro for Science pág. 18 Making headlines • 90th Conference of the Spanish Society of Ophthalmology • The Institute, at the Conference of the ESCRS • ASICOM • Dr Luis Federico Leloir Award • Best image sent to the web • Prizes for the FIO • Ambassadors and representatives of 16 Arab countries visit the Institute pág. 26 Part of the asturias that works pág. 28 Our departments, one by one • The best foundation for an exact diagnosis pág. 30 Ophthalmological divulgation • Tears, the great unknown pág. 32 Research • Hope for the recovery of vision pág. 34 They look kindly upon us • “Freedom is not only the act of choosing”. Gustavo Bueno, philosopher pág. 38 Discussions with... • Dr Eduardo Alfonso: “The idea of improving the medical system in the USA is very good, but there is dissatisfaction with the practical part” pág. 40 Lets see • Dr Miguel Naveiras answers the questions of our patients regarding their eye care pág. 42 Gastronomy • Extra virgin olive oils pág. 44 Crossing of glances • Colin Firth Table of contents

“It’s worth having lived 30 years like this, hopefully we’ll live another thirty” When Prof Fernández-Vega and Dr José F. Alfonso get together for an interview, no questions are needed. Conversation flows amongst them, like in those couples that tell their stories as if they had rehearsed them over and over again. They respect each other’s turns, they look at each other with complicity and, when one lacks data, the other has a surplus of memories. And, little by little, they build – in this case – the story of their friendship. This is the story, told by themselves, of two doctors that currently preside over the most important societies of Ophthalmology in Spain, but who met nearly thirty-five years ago, simply as Luis and Pepe. It was back in 1976 when the Fernández-Vega/Alfonso binomial was conceived. Luis (Oviedo, 1952) was already a fully-fledged physician, specialising at the Hospital Clínico de Madrid, while Pepe (Murcia, 1957) collaborated as a student in the department of Anatomy of the Universidad Complutense, dreaming of becoming a researcher in Genetics. Urged by Prof Javier Puerta, they buckled down

Conversations amongst doctors

together: Pepe helped Luis with his dissertation with all the structure pertaining Ocular Embryology they had in the Department and Luis, nearly without meaning to, instilled in his assistant, amongst microscopes and sheets of wax, the curiosity for Ophthalmology. They soon discovered that the team worked, and that working relationship became a budding relationship. Luis presented his dissertation, he started to

prepare his public examination to become a University Professor, and they never parted ways again. LFV. We met in Madrid and we started working together in my dissertation, we got along from the beginning. Once I finished and I presented the dissertation, I started to prepare the public examination for Assistant Professor, and Pepe continued to help me with this. We had to

study the whole syllabus, the lectio magistralis… He came every evening to my Residence Hall to help me out.

Residence Hall and we started his training.

JFA. Ophthalmology wasn’t studied in third year; it was studied in fourth year. As Luis was preparing for the public examination, I was his personal trainer. I tested him every day; he had to memorise 45 lessons.

JFA. …and he presented the appropriate lesson. Imagine, I who had no idea of anything regarding eyes, every single day, for a whole year, listening to a lesson on ophthalmology. I consulted the biography, I analysed it, and Ophthalmology slowly started catching my eye.

LFV. And he did it out of pure friendship. JFA. Because we got along really well. He studied his lessons and then gave them to me; he spent all day studying a lesson and, at the end of the day, he had to present it to me. Every day, when I was done at University, I went to his

LFV. He stood in front of me…

LFV. I remember that I always said to him: “You must do Ophthalmology Pepe, you must do Ophthalmology”. And he answered: “No, because you see, as an ophthalmologist I can help one person, but with research I can help more people. I’d rather do Genetics”.

JFA. At that time, Genetics was very limited; despite this, I went to voluntary classes in the Faculty of Biology during the whole year. Then, when I started fourth year I already knew a lot of ophthalmology, before having taken the class before. Therefore, it was easy to get into the specialty; one starts liking things when one starts understanding them. And if someone explains them well, if one has a good teacher, like Luis, it’s easier to follow the path. LFV. At that time I lived in the Residence Hall Alfonso X el Sabio, in Ciudad Universitaria. JFA. And I lived on the other side of Madrid, in Plaza de Legazpi, with my parents,

Prof Luis Fernández-Vega and Dr José F. Alfonso.

Conversations amongst doctors

Friends, co-workers and Presidents: Prof Fernรกndez-Vega of the SEO and Dr Alfonso of the SECOIR.

Conversations amongst doctors

although I spent most of my days in his Hall. LFV. When I was studying the different lessons both for the position of Assistant and for Professor, together with Pepe, six to eight physicians from the Hospital Clínico started showing up every afternoon to listen to my presentation at the end of the day. The lessons where completely up to date and it benefited them to listen to them. They sat around a table, and I explained the lesson as if I were in a classroom. We used to finish around nine and go out for dinner afterwards. JFA. From 1977 to 1982, those five years, our agenda consisted on studying all day and, when we were finished, go out for a walk or for dinner. We studied a lot, but we also had time to have fun. By the way, the day in which I invite Luis to dinner is yet to come. I’ve never paid for dinner when he’s been around. Never. And especially then, because I was a student and he was earning money. At the time, Luis helped us all. He was a fullyfledged physician and we were students; he’s always supported us and protected us as if he was our own father. After this first period of camaraderie, study and friendship at the Residence Hall, Luis obtained the position of Professor of Ophthalmology, becoming, at 30 years old, the youngest professor in Spain. In 1983 he was already back in Asturias holding his position at the Universidad de Asturias. Meanwhile, Pepe was doing the military service and faced one

of the most difficult dilemmas of his life: to take the position that he had been granted in the Clínico to do the specialty, or to follow his friend who was calling him from the capital of the Principality with a much more ambitious, daring albeit exciting project: to develop the Department of Ophthalmology of the Hospital General de Asturias and to boost the growth of the Practice of Drs Fernández-Vega. JFA. I remember that decision as a very hard one. I asked my father “Dad, what should I do?” and he answered: “Go with Luis, go with Luis”. He never hesitated in his advice. At the time, coming with Luis was something else. His added value was a future: building everything from scratch. On the one hand, the Hospital, where there was only one person, Manolo Rodriguez, may he rest in peace. On the other hand, the private practice, where Mr Luis and Mr Álvaro (grandfathers) had a very simple (but at the same time great) base, and the idea of building an Institute like the Castroviejo in New York. Luis (grandfather) had seen it in the 50’s. It was his dream, and what he conveyed to us at every opportunity. And of course I, a 28 year-old lad who’s told: we’re going to build a new hospital service, a new institute with everything… That wasn’t a job; that was a life project. And we had all we needed to make it happen. So I left. Motivated by a friendship and with the commitment of promoting a specific specialty.

LFV. He joined the Hospital and we started growing a little bit. We fought a lot; we kicked a lot. Thanks to the intervention of my mother in law, Mariví Botas, we obtained a grant from a lady who died, Josefina Fabián Finley, who left 40 million pesetas to the Faculty of Medicine. My mother in law was her friend, and that’s why we got in touch with the executor and we made him see the advantages of giving the donation to Ophthalmology. With that money we completed the works of the department and we equipped it with everything that was necessary. At the time, 40 million pesetas was a lot of money. JFA. We thus spent eight years, from 1983 to 1991, when I obtained the position of Tenured Professor of the Universidad de Oviedo. I was then told that I could no longer work in Luis’ practice in the afternoons, that it was incompatible with University and the Hospital. Well, it wasn’t going to be so. We made (again!) a bold decision, because at the time we weren’t thinking of building such a big institute. It was 1991 and the Institute was built in 1998. LFV. Things were much more complicated at the time, we didn’t have the piece of land yet, the final business project… JFA. And this was another moment when we said: we have to risk it. Because it wasn’t only I who was taking a risk, it also meant that Luis was left without his right hand at the Hospital, so that I could devote myself completely to the practice. At the time I said: ok, I have to

Conversations amongst doctors

concentrate fully on the practice. The timing coincided with the purchase of the first Excimer laser; Luis went to the USA to see it and bought it LFV. In 1992 I went with my cousin Álvaro to Kansas to see the laser and to see patients who had undergone surgery. JFA. Indeed, it was the Excimer laser what really revolutionised the field of Ophthalmology in the 90’s in Spain. It brought refractive surgery to our country. LFV. We started in 1992 with the Excimer. The number of patients that came to the private practice looking for refractive surgery (myopia, hyperopia, astigmatism) increased enormously. JFA. Before we mainly operated cataracts. LFV. And some radial keratotomies. Not many. But we really disliked this technique. JFA. In eight years we might have operated 50 cases of radial keratotomy. And in the first year of Excimer we operated on 200 patients. This meant a very significant turnaround for the practice, thus, we thought: ok, we can devote these resources to grow and to build the Institute. LFV. Between 1995 and 2003, a large part of those resources was invested in the development of the current Instituto Oftalmológico Fernández-Vega. Without that, it wouldn’t have been possible.

Conversations amongst doctors

The leap from the practice at calle Uría to the Institute forced Luis to take care of the business, social and representation aspects of the business as well as the medical aspect of the practice. ”Issues – he stated – for which I had no training, because what I love is Ophthalmology”. Professor Luis Fernández-Vega has maintained the medical leadership and has also occupied an institutional position as spearhead of the centre. Meanwhile, Dr Alfonso, has focused on the medical development and is responsible for the scientific coordination and for everything regarding ophthalmic optics surgery at the Institute (cornea and crystalline). Currently, Prof Fernández-Vega is the President of the SEO (Spanish Society of Ophthalmology in Spanish) and Dr José F. Alfonso, is President of the SECOIR (Spanish Society of Implant-Refractive Ocular Surgery). It’s the first time that something like this happens: two physicians from the same centre holding the two most important Ophthalmological Presidencies in Spain. And from Asturias.

advantage of this. But, first and foremost, they admire one another.

During these decades of work and friendship, Luis and Pepe (now Professor Fernández-Vega and Doctor José F. Alfonso) have formed – in the words of the Professor – “an informal marriage in ophthalmology”. They know each other better than anyone else. They seek each other’s advice on every matter; they disagree in some cases, but they always come to an agreement. They know that they have complementary characters, and they take

JFA. It’s a theory of mine: progress in parallel or in line. He see thing one after another, with an order of priorities.

LFV. I admire him in many areas. First, that he’s a good person. Second, that he’s intelligent. Third, that he has an enormous gift for synthesis… And he is brave too; he can develop any innovative technique. And he is a completely loyal person, with an unbreakable loyalty. JFA. Luis is also a good person. Honest. Loyal. Very intelligent, probably the most intelligent person I’ve ever met. With an extraordinary memory. Very reflexive - too reflexive sometimes. When he told me that he wasn’t sure if we would be able to achieve what we have achieved, I was completely sure that he would do everything in his power to make it possible. And it worked. So, indeed, he achieves all his goals. LFV. And there is something about us that he’s always said and that I believe to be true. That I advance vertically upwards little by little.

LFV. I realise that. It’s my way of thinking. I’m thinking about something and I don’t want to think about anything else. I start it and I finish it. He doesn’t. He can think of several things at a time. JFA. I have a parallel way of thinking. Each thing has its own

life and they advance at the same time. We cannot stop the development of one because of the slowness of the other. LFV. For that reason, sometimes Pepe goes very fast and I go too slowly. And, together, we go at cruising speed. JFA. And that’s why we are where we are, and we have realised all our dreams. This binomial has been paramount to be able to grow. Someone had to be braver and someone had to be more reflexive, one has to be more aggressive and the other more quiet. And, mainly, we have to want to do things: to make an effort every day to maintain the same spirit as when we first met. LFV. We’ve gone through a lot together. And for me, Pepe has always been my alter ego. I never took a step without discussing it with him first. Y then followed his advice in many issues, and in others, I ignored him. JFA. And in those in which you ignored me… Were you right? [Laughs]. LFV. He’s more courageous than I am. I’m more reflexive… JFA. I would say that more careful. Because he has information in his head that I haven’t. I’m free from the burden that can mean having 200 employees behind me, or a social responsibility. I’m focused on not being set back in our medical advance we must always be up-to-date. I’m very critical

with myself and I also criticise him, but when one puts thing in perspective, one says: It’s really worth having lived 30 years like this, and hopefully we’ll live 30 more. I wouldn’t have wanted to be anywhere else, nor in which I would like to be now. Because here I’ve always done what I’ve wanted to, I’ve never had any obstacles to advance. Never. And we would like to keep it like this.

LFV. Us, and the new generation that’s coming. The most important thing is for Luis, as senior representative, and the children of my cousin Álvaro -Álvaro and Carlos-, the daughter of Dr Alfonso -Belénand my younger son Andrés to be able to carry this forward. And I believe that our main mission is to (when the time comes, because we’re not there yet) carry out this transfer of power in the best way possible.

At the first

roundabout JFA. I can still remember the first time we quarrelled. LFV. In Madrid? JFA. In Madrid. LFV. Because you were late, surely. JFA. We were going to the walk in clinic. Luis worked there a few days a week and I went along. And I wasn’t there yet, and I wasn’t there yet. And Luis calls me… And can’t reach me… He starts to get angry… LFV. Of course. The same as currently, that you call him while he’s on his way and he always says that he’s “at the first roundabout”. And one never knows where that is. JFA. Well, that day I had had a huge accident with my car. And when he was able to reach me, to begin with, he tells me off: “Where are you?!”. “Why… at the hospital”. LFV. When he was in Madrid it wasn’t the first roundabout, but it was the Square Who Knows What. And that day I also believed that he was calling from Square Who Knows What. And it turned out that he had crashed his car. JFA. In a tunnel, against a lorry. I nearly died.

Conversations amongst doctors

The Foundation returns to Cambodia to facilitate access to ophthalmological services and healthcare to disadvantaged individuals and collectives.

A team of the Last year alone Fundación they provided Fernándezophthalmological Vega constituted by assistance to a the medical thousand people. director of the Institute, Prof Luis Fernández-Vega; his son Dr Luis FernándezVega; the director of the Foundation, Victoria Cueto-Felgueroso; and optometrist Javier Lozano will travel in early December to Cambodia to work again in the prefecture of Jesuit Enrique Figaredo, in Battambang, with whom they have been collaborating for a long time now and where last year alone they provided ophthalmological assistance to a thousand people. From the 6-13 December, consultations and surgeries will be performed and glasses and ophthalmological material will be provided to hundreds of patients who, otherwise, have no access to ocular healthcare; this way they fulfil the commitment of the Foundation of bringing together their traditional social and patronage activities

It will be the fifth expedition of the Foundation to Cambodia, where Jesuit Enrique Figaredo has spent over half his life working and embracing those who commit themselves to collaborating with his project. The importance of his performance in the Asian country as well as the personal relationship he enjoys with the Fernández-Vega family, made the Foundation think of the prefecture of the Bishop from Gijón in Battabang as one of its chosen established humanitarian destinations. The last expedition took place last November and lasted nine days, in which Dr Beatriz FernándezVega, Dr Javier Nicieza and optometrist Silvia García distributed over five hundred glasses and checked the eyesight of approximately 120 patients every day, as well as performing numerous surgeries. Those who are repeating the experience claim that they have noticed a pronounced change in the eye health of the inhabitants of this area over the last years. Currently, the Foundation is going to make another contribution with the expedition that will turn Prof Luis Fernández-Vega, Dr Luis Fernández‑Vega, Victoria Cueto-Felgueroso and Javier Lozano in the new voluntary workers of Monseñor Enrique Figaredo.

It will be the fifth expedition of the Foundation to Cambodia.

Fundación Fernández-Vega

Close to 400 free check-ups in the centre of Oviedo

Dr Rodríguez Uña during a check-up on the occasion of the celebration of the World Vision Day.

The Fundación Fernández-Vega did last September 9 close to 400 free ophthalmological check-ups in the centre of Oviedo, on the occasion of the celebration of the World Vision Day 2014, one of the initiatives of the programme of the WHO and the Agency for the Prevention of Blindness whose mission is to work to ensure that ocular health With this type becomes a universal right. This year the slogan of the campaign was of initiatives “No more preventable blindness”. This kind of initiatives aim to draw worldwide attention to blindness and visual impairment, as well as to raise public awareness about the importance of ocular health. If the project of the World Health Organisation ‘Vision 2007’ was to be implemented, fifteen million people’s blindness could be prevented.

Fundación Fernández-Vega

we aim to raise awareness about the importance of ocular health.

During the day, nearly four hundred people received ophthalmological care, out of which approximately 40% presented some visual problem. The Fundación Fernández-Vega strives to ensure that ocular health becomes a universal reality. Through national and international projects, and thanks to the work of the professionals and the resources provided by the Instituto Oftalmológico FernándezVega and other anonymous collaborators, the Foundation has treated hundreds of patients with different ocular issues.

“No more preventable blindness” Hundreds of people visited the tent in front of the Teatro Campoamor.

The Fundación Fernández-Vega, Antena de Oro for Science

The director of the Foundation, Victoria Cueto-Felgueroso; Prof Luis Fernández-Vega and Dr Luis Fernández-Vega, with the award.

Our Foundation has been garlanded with the Antena de Oro 2014 for Science, “in recognition of its research and humanitarian work with disadvantaged people in different countries”; we will receive the prize on November 22 during a gala dinner at the Gran Casino de Aranjuez.

These distinctions, awarded annually by the Federación de Asociaciones de Radio y Televisión de España (Federation of Associations of Radio and Television in Spain), recognise the work of the most outstanding professionals in the fields of communication, sports, art, politics and science, as well as in the area of bull-fighting and economy on this occasion the awards have gone to figures such as Albert Boadella, Carmelo Calvo, Ana Pastor, Pedro Sánchez, José Ramón Pardo or Juan Roldán, amongst others. This Federation has already distinguished the work of the Institute and of its professionals before. In 2006, it awarded the Antena de Oro to its medical director, professor Luis Fernández-Vega, and five years later, in 2011, to the Instituto Oftalmológico Fernández-Vega.

The award is granted in recognition of his research and humanitarian work with disadvantaged people from different countries. Fundación Fernández-Vega

90 Conference of the Spanish Society of Ophthalmology th

Two thousand ophthalmologists gathered in Bilbao between the 1st and 4th of October to celebrate the 90th Conference of the Sociedad Española de Oftalmología (Spanish Society of Ophthalmology), which in this last edition has presented the most state-of-the-art advances in refractive surgery and in diagnostic tools, as well as innovations in intraocular lenses that work better across all distances and results with new drugs. “Currently, another of the challenges of this specialty is to apply advanced techniques in the care of the eyes (tissue engineering, cell therapy and gene therapy) to cross borders in the treatment of blindness, as until recently we could not even think about it”, highlighted Professor Fernández-Vega during the opening of the conference. Headed by Prof Luis Fernández-Vega (president of the SEO), physicians from the Institute belonging to all subspecialties travelled to Bilbao with numerous lectures. The team from the FIO constituted by Ana Riestra and Nestor Carreño and Drs Nacho Alcalde and Jesús Merayo received during the conference the third prize of the Fundación Jesús Gangoiti Barrera for “Eficacia de las gotas regenerativas en úlceras corneales en un modelo animal experimental” (The efficiency of regenerative eye drops in corneal ulcers in an experimental animal model). Furthermore, Dr Fernández-Vega Cueto-Felgueroso, president of the Asociación de Jóvenes Oftalmólogos Españoles (AJOE in Spanish – Spanish Association of Young Ophthalmologists), stated in the meeting of this association that took place within the framework of the 90th Conference that the next Young European will be held in Oviedo in 2016; it is expected that approximately 300 young ophthalmologists from 27 countries will attend. This meeting, which gathered a total of 3000 participants, including ophthalmologists, businesses and companions, didn’t take place in the capital of Biscay since 1955. 18

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Professionals of the Institute, in the conference of the SEO.

The Institute, at the Conference of the ESCRS A team of ophthalmologists specialised in cornea, crystalline and refractive surgery from the Institute travelled to London to participate in the Conference of the European Society of Cataract & Refractive Surgeons (ESCRS). There, the company Staar awarded two prizes to the Institute for leading by example in the implantation of intraocular lenses (ICL), with a total of 3500 ICLs, out of which 500 were toric ICLs.

Furthermore, during the Experts Meeting in Wembley, Dr JosĂŠ F. Alfonso, coordinator of clinical research and head of the Department of Cornea, Crystalline and Refractive Surgery at the Institute, gave two lectures regarding the extensive experience of the Institute in the implantation of this type of lens; while Dr Carlos Lisa, from his team, talked about different clinical cases in two round tables.

ASICOM Ibero-American ASICOM Award Universidad de Oviedo Last October 9 the medical director of the Institute, Prof Luis Fernández-Vega, received in the Paraninfo hall of the historical building of Universidad de Oviedo the award granted by the Asociación Iberoamericana de la Comunicación, ASICOM, in collaboration with the Asturian academic institution and other Ibero-American institutions and entities. This international award, sponsored by the Department of Communication Theory El Universal and by the Department of Social Networks Marcos and Stephanie Fastlicht, recognises the accomplishments of professionals and academics that have excelled in different disciplines within the Ibero-American context. The professor expressed his gratitude for the generosity of the jury and credited the good work performed in the ophthalmological field by five generations of Fernández-Vega’s who, surrounded by an exceptional team, see over one hundred thousand patients every year. The medical director of the Institute pointed out that “it is indeed this close relationship with the patient the one immersed in the world of communi-

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cation” and remembered that, “even before it was theorised and studied, it was systematically applied by my father under the acronym SCAFEME (CICACOA in Spanish), a drug he prescribed to all his patients – the dose varied depending on each individual

tion of some of these countries to his professional development and to that of his eldest son, who has recently furthered his ophthalmological knowledge in Colombia. The day before receiving this award, Prof Fernández-Vega gave a speech at the closing ceremony of the fifth edition of the workshop ‘Jack F. Ealy’ of scientific journalism, in which, for half an hour and before a broad participation of students, he looked back at his family’s ophthalmological history over 125 years; he talked about the different stages they went through - both regarding facilities and

Barbara Gobel, Elvira Sanz Urgoti, Jordi Soler, Prof Luis Fernández-Vega and Hilario Pino.

and his/her personal and medical circumstances – and that was made up of science, affection, empathy and encouragement”. He assured us that this treatment is still prescribed nowadays, with a small additional dose of doctor-patient communication.

technology - until they shaped the current reality in which a high-level clinical and surgical activity is complemented by a strong research line, both clinical and basic, thus constituting a milestone in the framework of private ophthalmology.

Prof Luis Fernández-Vega took the opportunity to stress the importance of an institution that “has the increased added value of working in these two seashores that unite us so and that offer us so many opportunities in all areas”, and recalled the contribu-

The president of OHL, Juan Miguel Villar Mir; the Organización Nacional de Ciegos Españoles (ONCE - Spanish National Organisation of the Blind); chef Martín Berasategui or footballer Emilio Butragueño have received this award in previous editions.

Dr Luis Federico Leloir Award

Prof Carlos Belmonte.

Prof Carlos Belmonte, main researcher of the y la neurociencia española. Aupados a hombros de Fundación de Investigación Oftalmológica, gigantes” (The exploration of the brain and Spanish received last November 17, in Buenos Aires, the neuroscience. Being carried on the shoulders Dr Luis Federico Leloir Award for International of giants); the Prof provided an overview of the Cooperation in Science, Technology and advances that have taken place in the study of the Innovation. The Argentinian brain, since the pioneering government distinguishes work of Cajal, founder of The Argentinian with this award those foreign Government grants modern neuroscience, to scientists who have made a date. Likewise, he described this award to foreign significant contribution to the vicissitudes of Spanish scientists that have made science during this period, honing and strengthening a significant contribution starting from the difficult international cooperation with its country in these fields to the promotion years after the war. The of knowledge. account was, “as could of international not be otherwise, biased cooperation in Science, Likewise, Prof Belmonte and personal as befits the Technology and was proposed as ‘Maestro’ account of one who has been Innov ation. (Expert) of the Lección a privileged witness of what Magistral Andrés Laguna has taken place during a 2014, organised by Universidad de Alcalá de significant part of those years”; he also stressed the Henares and the Lilly Foundation. It took place role played by some of the Spanish scientists who, last October 17 in the academic institution from often in complicated conditions, brought about this Madrid, and was titled “La exploración del cerebro advances.

Best image sent to the web

Prizes for the FIO The performance of the Fundación de Investigación Oftalmológica continues to be recognised in different prestigious scientific forums. Drs Lydia Álvarez, Montserrat García, Héctor González-Iglesias and Pedro Pablo Rodríguez-Calvo and Professors Luis Fernández-Vega and Miguel Coca-Prados have received an award during the EVER International Conference for their work “Lysyl oxidase-like 1 gene haplotypes and their association with pseudoexfoliation glaucoma in the Spanish population”. Likewise, the team constituted by Ana Riestra and Néstor Carreño and Drs Nacho Alcalde and Jesús Merayo has received the third award of the Fundación Jesús Gangoiti Barrera for its work “Eficacia de las gotas regenerativas en úlceras corneales en un modelo animal experimental” (The efficiency of regenerative eye drops in corneal ulcers in an experimental animal model), which had already been presented in a lecture in the last conference of the Spanish Society of Ophthalmology held in early October.

“Closed window” Dr Ignacio Rodríguez Uña

The Sociedad Española de Oftalmología, SEO (Spanish Society of Ophthalmology), has granted Dr Ignacio Rodríguez Uña, who works at our Institute, the award for the best image sent to the web of the Society, www.oftalmoseo.com The photograph, ‘Ventana cerrada’ (Closed window), corresponds to the eye of a 74 years old patient who had undergone epiretinal membrane (ERM) surgery the previous month and who presented a gradual decrease of visual acuity over the last couple of days, to a point where he only perceived light.

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Drs Lydia Álvarez, Montserrat García and Héctor González Iglesias, with the diploma of the EVER Award.

La vida sin cataratas ...y sin astigmatismo. Hoy en día, existe una solución real a la hora de afrontar la cirugía de la catarata con astigmatismo. Las lentes intraoculares actuales permiten corregir el astigmatismo proporcionando una nítida visión a media y larga distancia sin necesidad de gafas. Su oftalmólogo le asesorará sobre las opciones disponibles.

Ambassadors and representatives of 16 Arab countries visit the Institute The dean of the representatives of the Arab countries, Mohammed Haneche, Ambassador of Algeria, headed the delegation of 16 Arab Nations that visited the Instituto Oftalmol贸gico Fern谩ndezVega at the end of last September on the occasion of the working session that took place in Asturias to enable financial and social relationships between the Principality and Algeria, Palestine, Sudan, Arab Emirates, Libya, Iraq, Lebanon, Qatar, Kuwait, Tunisia, Oman, Mauritania, Yemen, Saudi Arabia, Morocco and the League of Arab States.

Ministers for the Presidency and Health of the Asturian Government accompanied the delegation, received by the medical director and the deputy medical director. They visited at length the clinical and research areas, where they were able to see the consultation process as well as the state-ofthe-art technology used by the professionals at the Institute to provide the most efficient and the most comfortable treatment to the patients.

The medical director and deputy director of the Institute received the delegation.

Making headlines

Prof Luis Fern谩ndez-Vega took the group on a tour of the clinical and research facilities of the centre.

The ambassadors then heard the thorough explanations on the research and teaching activities undertaken by the Fundaci贸n de Investigaci贸n Oftalmol贸gica, which was established four years ago and which collaborates with various of the most prestigious entities within the field of patronage.

The visit came to an end with the commitment to further the information gathered in order to assess which practices can be transferred to the interested countries and how this countries can provide a wider dissemination of the ophthalmological services of the Institute.

Part of the asturias that works

The medical director of the Institute with three other businessmen who exemplify the ‘La Asturias que funciona’ (Asturias that works).

Even though pessimism can overcome us on occasion, not everything is currently going downhill. There is much effort, many skills and much solidarity that, mixed in the appropriate doses, makes society – with its sometimes too many problems – work. It is this particular exemplariness, based on good practices, what the daily paper La Nueva España wants to give visibility to; this newspaper has ben publishing for the last few years a series of articles about the good practice of many companies, even though the general public might not be too familiarised with these due to their line of work. The last two years, on top of the articles, there has been a

Part of the asturias that works

week full of meetings under the heading “La Asturias que funciona” (The Asturias that works); aimed mainly to students of economics and business, they have aroused widespread interest and have been attended by a high number of people. Within this framework, Professor Fernández-Vega has outlined the career path of the Institute since it was established, 151 years ago now, to the present day; nearly 200 people carry out their duties in 12 000 square metres where they do over 110 000 consultations every year - 25 000 in 1991 - where they perform 9 000 surgeries vs. the 2 500 surgeries in the 90’s. The leap has been such in little over a decade that it can only be explained by a determined commitment to excellence, a full exercise of ophthalmology, and the availability of an exceptional team of professionals. The medical director of the IOFV highlighted, as well as the aforementioned, the important role played by the study of social and financial changes, as well as of all scientific and technological advances in ophthalmology; this led to new organisational

models and to the establishment of a triangle consisting of assistance, teaching and research, as the most efficient formula to add value to the patient – the first and foremost aim of the project.

whose aim is not to grow for the sake of growing, but to meet the demand instead of emphasising the offer and to innovate constantly – to this end we need the best professionals.

It is this effort to improve constantly and to measure results regularly what has encouraged the quick implantation of a quantitative and qualitative

Other aspects that deserved attention were those regarding the effect of the Institute on the economy, beyond the 600 jobs it generates between direct and related. Thus, the study carried out by Universidad de Oviedo in 2012 shows that the activity of the IOFV generates over 50 million euros and that, for example, its patients “spend” during their stay in Asturias approximately 14 million euros; mainly in hotels, restaurants and transports.

Over 110 000 consultations every year.

control system, the permanent use of indicators and a powerful computerised system, which supports – amongst other advances – the medical history, providing immense benefits regarding control and speed. If we add to this a regular comparison with the sector and the adoption of corrective measures, we obtain a global overview of the corporate philosophy that enables a medical practice that is considered of reference internationally in the field of ophthalmology; one that doesn’t follow trends and

The last part of Professor Fernández-Vega’s lecture gave an overview of the work that takes place at the Fundación de Investigación Oftalmológica. The Foundation, focused on basic research, is an exception within the field of private medicine and, despite its short life, already presents encouraging results in the difficult field of finding satisfactory answers to pathologies currently lacking them. This initiative, as any research, demands numerous resources; to this end – as well as the contribution of the Institute – we count on the sponsorship of different prestigious entities in the field of social responsibility. The activity of the Fundación Fernández-Vega, which aims to grant access to ophthalmological services to disadvantaged individuals and collectives at national and international level, was the pinnacle of a presentation that, together with the rest of the members of the table, led to a lively discussion.

The best foundation for an exact diagnosis Contrary to what one might believe, it is a rare occurrence. The Institute is one of the few private practices in Spain that has a Department of Diagnostic Tests. The thirteen people that constitute its team enable the patient to receive a comprehensive treatment during their visit, and all the information and the necessary results to be on the physician’s desk before the patient comes through the door. They are, in essence, an indispensable part in the search for excellence in ophthalmological care.

While the examination rooms are closed, and the waiting room is still empty, when the clock strikes eight, an office at a time sees its devices, computers and tools come to life, so that when the Institute opens its doors and the physicians take up their positions, everything is set to run the tests of the first patients of the day. These tests will be performed and sent to the doctors, almost straight away, so that the patient receives a comprehensive treatment, without having to wait or come back for the results. The department of Diagnostic Tests is paramount in the functioning of a centre of reference such as the Instituto Fernández-Vega; it is likewise indispensable to be able to offer the care that characterises

Our departments, one by one

it. Current Ophthalmology cannot be conceived without certain tests. A pachymetry, a pupillometry, an OCT… The list is long. Therefore, the volume of work of this department is not trivial: over 160 000 diagnostic test were run at the Institute only from January to August. Each of these tests has a name and a face behind it making it possible. It can be Alberto, Vanessa, Susana, Miriam or Esther. Or maybe Verónica, or Alejandro, or Estela, or Emilio. Or Almudena. Or Alex. Or Nadiuska. Or Carmen, the most veteran one; the one responsible for the team. The one who arrived when there wasn’t even a Department of Diagnostic Test and a single individual handled an Orbiscan out-dated today. This was over a decade ago

Device used for corneal topographies.

and it hasn’t stopped growing ever since - both quantitatively and qualitatively. It has grown to a team of thirteen people with the highest level of training and with the most up-to-date knowledge – even though there is no specific training in Spain to learn how to run these tests. There are not many practices that have a specific department to this effect. But the lack of formal training is made up by exceptional teachers, as it is the specialists of the Institute themselves the ones in charge of providing it. It was Dr Álvaro Fernández-Vega who taught

The team of the department of Diagnostic Tests is constituted by Susana García Robledo, Alejandro González Santaclara, Almudena Rozas, Alberto Sandín, Verónica Expósito, Álex García, Miriam Merino, Emilio Tudela, Esther Iglesias, Estela López, Nadiuska Ferreira, Carmen Carús (in the photo above) and Vanessa Álvarez.

Carmen to run OCT’s. He mentored her while she learned how to perform retinal scans. But then necessities started to grow; the volume of work prevented one individual from performing all the necessary tests and, on top of this, seeing the patients, so it was decided that someone should be hired and trained to do this job. Despite this, the number of tests needed continued to grow, and the vocation of the Institute of being at the forefront also meant acquiring the latest devices; which in turn required more people who knew how to handle them. Today, each member of the team that constitutes the department of Diagnostic Tests knows how to handle each device, run each test, and assess its result. Everyone does everything; otherwise, it wouldn’t be efficient in the long term. They must be ready to perform any test that is required at any given moment, from eight in the morning until the last examination room closes for the day. Many patients come from outside Asturias, and we must try to do everything in one day in order to make the consultation easier for them.

The patient is received at the entrance hall, s/he is seen by the optician-optometrist, who decides which tests must be run, and the department of tests sees that the patient arrives to the next step - the physician - with everything ready and the results on the table.

Over 160 000 diagnostic test were run at the Institute only from January to August.

Teamwork is paramount for all this to work. This is far easier when a good working environment is the common denominator in the comments of all its members. “The comradeship that one can find here and the good relations with the company help a lot. It’s very easy to fit in”. For Emilio, who’s been working at the Institute for the last five years and travels every day the distance between Oviedo and his house in East Asturias, this is one of the perks of his job, together with the constant learning. He concurs in this point with Alberto; who’s not yet been a year in the department. “The comradeship amongst our co-workers is great, and we’re talking about a centre with state-of-the-art technologies. There is a lot of work, but one works really well”, he assures.

Indeed, contrary to what one might think, work isn’t monotonous at all. “The tests are very different and each patient is different. Furthermore, there is a patient-oriented focus and when one deals with people one sometimes ends up establishing a rapport”, explains Carmen, who admits that she loves her job. She loves her job and her people. This department is constantly training, it attended for the first time the Conference of Senior Technicians for Image Diagnosis that took place in Malaga last June; and had as a finalist one of the three posters presented by them at the Conference. A young team – most of the team is not yet 40 – keen to learn and to make the patient’s visit to the Institute as agreeable as possible. This team is already considered an essential part of the Instituto Oftalmológico Fernández-Vega.

Our departments, one by one

Tears, the great unknown

Dr José Ignacio Blázquez García.

A speck of dust, the smoke of a cigarette, a disappointment or even great news… The causes behind a tear rising to our eyes are very different, which means that - one way or another - they are an element that accompanies us through life. However, they are a mystery for the vast majority. What are tears, actually? How are they produced? What is their function? Dr José Ignacio Blázquez García, specialist at the Institute, recently explained to the readers of ‘Infosalus’ some key facts regarding tears; we will reproduce some below.

Ophthalmological divulgation

To protect, nourish and improve the refractive quality of ocular surface. Dr Blazquez thus synthesises the function of tears, in charge of maintaining the moisture of the eye, removing residues and foreign bodies and protecting them from infections. A role that turns them into a critical component of the ocular structure, even though, once played, they must leave the eye; to this end they are drained towards the lacrimal system, although 25% evaporate through air. To know their origin we must go to the lacrimal gland, located on the upper, outer portion of each orbit, and which is responsible for their production with a constant basal secretion that increases before external aggressions. When theses causes, ranging from changes in temperature, foreign bodies or psychic motivations appear, the sensory nerves inform the brain of these aggressions, setting off an increase in production of tears by the involuntary nervous system (autonomic nervous system). Once created, they continue their path – facilitated by the mobility of the eyelids – to the internal angle of the eye, and then proceeding through the tear duct towards the nose. This means that, if there is a significant increase in tear production, nasal

Tears consist of three parts: a mucinic component, an intermediate part and a lipid part. drainage increases, also producing an increase in rhinorrhoea or outflow of liquid through the nose. In cases where an obstruction of this tear duct exists, the usual path towards the nose doesn’t take pace, and tears flow over the eyelids. In rheumatic conditions – in general all autoimmune diseases of the organism, like rheumatoid arthritis and lupus -, the tear duct can be affected, decreasing tear production and leading to the syndrome of dry eye. This condition is really troublesome for the patient; its symptoms include the feeling of having a foreign body in the eye, dryness and even blurry vision, making the permanent use of artificial tears necessary. As regards their anatomy, tears consist, mainly, of three parts: a mucinic component, in charge of maintaining the adherence of the tear to the surface of the cornea; an intermediate part, mainly aqueous; and a lipid part, formed by fatty acids produced by the glands in the eyelids and whose function is to avoid the evaporation of the tear. Each of these three parts is a very important factor in its functioning; so, for example, palpebral inflammations – like blepharitis – alter the lipid component, and the tear evaporates producing corneal dryness or dry eye syndrome.

Up to 25% of tears evaporate through air.

Ophthalmological divulgation

Hope for the recovery of vision

He people in charge treated a total of 18 patients with age-related macular degeneration and Stargardt’s macular dystrophy, two incurable diseases of the retina that constitute the most common cause for blindness amongst young and adult people in developed countries. These patients received an injection of embryonic stem cells – able to give rise to any tissue in the body – turned into retinal pigment epithelium in the most affected eye, leaving the other eye without treatment. Out of the 18 patients treated, ten experienced significant improvement in their sight; some of them were even able to perform activities that were out of their reach up to that point, e.g. horse riding, telling the time, taking a plane or using a computer.

The results of a study performed in the US showing that a transplant with embryonic stem cells had restored the sight of several blind people was published in mid-October.

After decades of research in biotechnological therapies and three years of follow up of those patients who had received a transplant, the chief scientist of Advanced Cell Technology and assistant professor at Wake Forest University, Dr Robert Lanza, has published in ‘The Lancet’ - together with

a team of specialists from five ophthalmological centres from universities like Harvard or California - results that represent an enormous success and, in Prof Luis Fernández-Vega’s opinion, “hope for the recovery of sight in diseases where there was none so far”. However, the medical director of the Institute and president of the Spanish Society of Ophthalmology explains that: “clinical trials must be carried out before it can be clinically applied within minimum levels of efficiency and safety, and unrealistic expectations shouldn’t be risen until we don’t have the results”. Dr Lanza plans to launch these trials before the end of the year. However, Prof Fernández-Vega adds that, even though the study investigators chose two specific pathologies in stages that so far had no treatment, its research opens the door to apply them to other conditions where there is a need to give the organ or the tissue cells to replace the damaged ones or the cells that are not working.

Other research Currently, he reminds us, several investigations are being carried out in this field, like the research performed by a team belonging to Oxford University, which presented last January the results of a clinical trial on gene therapy for the treatment of choroideremia or, eye-wise, a clinical trial on corneal tissue engineering and medical treatments of cell therapy with limb stem cells which are already considered consolidated advanced therapies. “At the Fundación de Investigación Oftalmológica of the Institute we have focused on tissue engineering of the endothelium and stroma of the cornea, regenerative medicine with derivatives of autologous plasma rich in growth factors and the neuroprotection of ocular tissues such as the retina carried out by Dr Neville Osborne who, after heading the lab at Oxford University, is training a new generation of researchers in the field of neuroprotection at our Foundation”, explains Prof Fernández-Vega.

“Freedom is not only the act of choosing” Gustavo Bueno, philosopher. He speaks openly, laughs honestly, expresses himself with passion and always finds the way back to the answer to your question. With Gustavo Bueno (Santo Domingo de la Calzada, 1924) one gets immersed in the ramifications of every plot, and one is stunned to see how, just as one thinks that the plot of the initial story is lost, he comes back to it and everything makes sense. With a refined sense of humour and a spontaneous and elevated expression, he is serious when the explanation requires it; likewise, he shows generosity both in his time and his arguments. The only Spanish thinker alive that has developed his own philosophical system (“philosophical materialism”) was to be a physician according to family tradition. But for him, who went along with his father to see autopsies, “Medicine meant seeing dead people”. He didn’t like it. However, he did feel drawn to Severo Ochoa’s or Ramón y Cajal’s Biology, “but back then it wasn’t

They look kindly upon us

a degree, biologists were physicians”. A friend of the family for decades, Prof Bueno underwent cataract surgery with the Fernández-Vega’s nearly 30 years ago. “I think it was in 1985 – he remembers -, and sometimes I’m surprised to realise that I’ve been seeing properly for so long”.

Why did you study philosophy? I didn’t start Philosophy due to any existential reason, as was said later on, but because I had a Geology teacher at high school –a pharmacist in Zaragoza that came to class wearing a biretta and gown – who explained the Lepidoptera and all that, and said every so often “exceptions prove the rule”, and that made me crazy. What a contradiction! But listen, why? One would ask him a question on Lepidoptera and he would say yet again: “Because exceptions prove the rule!” and wouldn’t say any more. I became obsessed with that, I must have been 16 years old at the time and I asked where one studied that, I was told “That, in Philosophy”. That’s why I enrolled. Which was the main book of your childhood? I don’t think anyone has asked me that before. During my childhood I read Julio Verne’s stories and things like that. I loved it and I read everything. And then, when you became a young man? First of all I read Plato. I then discovered that my father had a cupboard theoretically allocated to drugs and medical equipment, full of forbidden books and booklets: Voltaire, Spinoza and the likes. And those forbidden books left an impression on you. Yes, to be honest I was looking for them. My family was a very Catholic family, like almost everyone in Spain, and it’s not that I was against religion, it was like the law of nature, one had to go to mass. Whenever I didn’t go my mother would say to me “You’re going to embarrass yourself”, and I was surprised by this reasoning, to me it seemed banal. What do I care about embarrassment? However, it was paramount. One of the reasons why we comply with practices is because they’re tradition. Which means that my mother was more right than I then believed. So, what I did in order not to embarrass myself was to take Spinoza’s Theological-Political Treatise, put it into a book of prayers and go to church. There was a public notary there who saw me and read out of the corner of his eye words in Latin and said to my father: “Wow, you’re child is doing really well, I think he’ll be a seminarian”. And everybody was happy.

You were very devout… Sure… That’s why when people say “Look at all that repression during the Franco regime,” I didn’t see it as repression. It was the norm and that’s all. Then, in Zaragoza, I met a group of individuals who thought alike, some very famous, like Lázaro Carreter, and in that environment there was no feeling of repression whatsoever - regardless of the fact that there was none. So, you didn’t believe that there was repression because for you it was tradition. Because it was tradition and because on top of this there were people within the order that was completely up to date. For example, I had a Philosophy teacher named Frutos, from Extremadura, who had been disciple of Ortega, and his wife was a friend of Lorca… That is to say that they were in another order. And he was a Falangist. And a poet. A very strange chap. He made us read Heidegger, Sartre… There we were, eight or ten individuals, in the 40’s, reading Sartre in a seminar in Zaragoza. Do we live more freely now or back then? It depends on what you understand by freedom. If you believe that freedom is that when you go to vote you can choose the ballot you prefer amongst ten… But, what is the scope of your vote and what you vote for? That is to say: freedom is not only the act of choosing. You don’t think that there are more possibilities in today’s society than when you were young? To be honest, I believe that it’s the same. I haven’t seen a significant difference. I am in the same situation I was when I was reading Spinoza in the Cathedral of Santo Domingo.

“One of the reasons why we comply with practices is because they’re tradition”.

They look kindly upon us

Tradition has held an important position during your entire career. Yes, of course. Tradition is everyone, in the best possible way. In my job, tradition is scholastic tradition, and I studied it a lot. I wasn’t a priest; I never set foot in a seminary and I left ordinary beliefs behind when I was quite young, shortly before discovering that the Three Kings were my mother and father. Scholastic tradition is still discredited as priests and friars’ business. But is it not good enough, priests and friars? When I started studying I was very impressed by what they said, by its accuracy. During the Middle Ages, scholastics were like philosophers in Greece. It’s a tradition that cannot be interrupted. First one has to know all the tricks of scholastic tradition. And that’s why I became a scholastic, and I became an expert in Duns Scoto and Saint Thomas. Saint Thomas is a figure that cannot be overlooked, like one cannot overlook Marx or Aristotle. They are there, they’re like monuments. I understand that what you love is knowledge, and here what is sought is people who belong to something or who defend some other. I’ve seen this with books I’ve published, which have had many printing editions and which have earned me archenemies. For example, one of the most disturbing was the one I wrote about Zapatero’s “pensamiento Alicia” (Alice’s way of thinking). People found this very disturbing, because the only thing many could think of was: “But where does he belong? Is his orientation left-wing (PSOE) or right-wing (PP)?” and they were not the least bit interested in the rest. You’ve met people of great intellectual relevance. Who do you admire? Many people. I studied in Madrid in the Faculty, which back then was like a seminary, because all the teachers were priests. We had Father Barbado, who taught Psychology, a very agreeable and erudite Dominican and a disciple of Cajal; Father Ceñal, a Jesuit who had translated Sartre. Father Daniel Ruiz, translator of the Iliad – we even thought of translating together Aristotle, - he was a great guy and we became friends. Relatively recently, 20 years ago, he had moved to Madrid I went to visit him. He had an impressive library. He was a man with whom, as soon as you had crossed two words

They look kindly upon us

with him, you found yourself in the middle of the IV century; that was his world. One day I got home and I found him sitting on a chair, he must have been nearly 90 years old, and he said to me: “Man! How happy I am that you’re here because I’m in the middle of a crisis!” “What’s wrong Mr Daniel?” “That I’m doubting that there’s a God” And I told him: “But Mr Daniel!” And I had to explain, at this stage of the game, Saint Thomas to him. You’ve told me that you’re a Marxist, Thomist, Aristotelian… Is there a word that defines you over the rest? The connection between all that. The conflict between all of them.

This guy’s

a fool

“I remember an anecdote with Ochoca many years ago. Severo Ochoa used to say ‘Everything is Chemistry’, and I would say to him joking ‘Mr Severo, then, this book is Chemistry?’ ‘Well of course!’ - he would answer. ‘An analysis is performed and it’s X% calcium, X% this other thing…’ So I opened a book and said: ‘So, if everything is Chemistry, this letter and this other, have ionic or covalent bonding?’ And he looked at me like saying ‘This guy’s a fool’ and I looked at him like saying ‘This guy’s a fool’”.

When you were growing up, did you miss any life-skills that your parents could have given you? No, absolutely not. It’s like rebuking Saint Thomas for being a Thomist. Each one of us does what one can at any given moment. Complete determinism. That’s why I find all talk about freedom so funny. I remember Lenin’s words: “Freedom for doing what?” I remember an incident at the Faculty during

the Transition. It was the time of Victor Manuel’s songs and all that. And I heard noise in the corridor and people shouting “Freedom, Freedom!” I asked them what did they want freedom for. Freedom was a completely confusing term that meant nothing at all. Freedom as an abstract term makes no sense. There are classic distinctions: freedom of (freedom of the bird, because one opens the cage and that’s freedom) and freedom to. To do what? Because one will have to want something that someone else has had before, one cannot make it up. If one does make it up, it’s creation. You don’t dissociate absolutely anything, for you everything is completely connected. Everything is historical determinism. We’re never nowhere. Could this help you to predict? No, because there are so many things operating that one cannot know what’s going to happen. It’s what happens with economists or meteorologists: they can explain really well why it rained yesterday but cannot tell if it’s going to rain tomorrow. Economists explain the Crash of 1929, but don’t

explain the one that’s going to take place now. Prove of this is the one we’re living now. What relationship do you have with the Fernández-Vega family? It’s a long-standing friendship. First as a client, many years ago, before the practice at Uría, I remember I went with my wife and my sister. Then I had a close relationship with Luis at University. Later, I underwent cataract surgery with them; and so did my wife. I think I underwent surgery in 1985, and sometimes I’m surprised to realise that I’ve been seeing properly for so long. Furthermore, there are the ties they maintain with Moradiellos, who’s now Professor in Caceres… This means that there’s always been a relationship of congeniality in everything we’ve done.

“sometimes I’m surprised to realise that I’ve been seeing properly for so long”.

“The idea of improving the medical system in the USA is very good, but there is dissatisfaction with the practical part”

Dr Eduardo Alfonso and Prof Luis Fernández-Vega, during the 90th Conference of the SEO.

Dr Eduardo Alfonso, President of the Bascom Palmer Eye Institute in Miami, attended the 90th Conference of the Sociedad Española de Oftalmología (Spanish Society of Ophthalmology), where he analysed the impact of the Obama Care in ophthalmology and where he took the opportunity to meet with the President of the SEO, Prof Luis Fernández-Vega, with whom he shares a close friendship.

Discussions with...

He has been ultimately responsible for the most important hospital in the USA for the last thirteen years and he’s the “everlasting” head of department in a country where this position is associated with a specified period of time; a fact that, in Prof Luis Fernández-Vega’s opinion, proves his “professional and personal worth”. The new Healthcare Reform Bill in the USA, signed and promoted by its President, aims to grant access to American individuals to quality medical insurance in line with their own financial possibilities, while at the same time reducing the healthcare expenditure of the country. An ambitious and complex plan that, therefore, has many nuances, which Dr Eduardo Alfonso tried to explain in order to offer an insight into what the future holds for ophthalmology in his country. “The theoretical idea is good, and therefore, everyone is very happy with the theory of making changes to improve the system. But what many people don’t like is the practical part of increasing the programme, people believed that they were going to obtain a healthcare insurance free of charge and they’re now realising that it’s not free, that they have to pay “X” amount out of their

salary or their pocket and they’re wondering why; especially younger individuals, who are the ones paying”, explained Dr Alfonso. This situation is generating dissatisfaction “because, furthermore, certain specialised treatments are expensive and no one wants to pay for them: not the Nation, not the individual, and not the private programmes. So there are cases where no one is covering certain treatment protocols and if one wants this type of protocol, one has to face the costs personally”. It is also true, he clarifies, that the healthcare system in the United States “has always granted access to all patients through an emergency-care system. If one has any medical problem and goes to the emergency room of a hospital, whether private or public, they must, by law, provide care without asking whether one can pay or not, and this individual cannot leave the hospital until the disease is stable. Otherwise, it constitutes a criminal charge against the hospital”, he adds. True enough, the invoice will arrive, but always once the ailment is over. Surgeon, professor, researcher and international expert in eye-related infectious diseases, Dr Alfonso

had time during the Conference to talk with the President of the SEO, Prof Luis Fernández-Vega, with whom he shares a close friendship and a professional respect that goes back as early as 1986, when they met in Boston, where Dr Alfonso undertook a fellowship in cornea. Ever since, they meet regularly. In fact, this last meeting has helped to formalise an invitation for next year to Luis Fernández-Vega to talk about the applications of the femtosecond laser, subject in which the Institute from Asturias is considered a benchmark. The complex ‘Bascom Palmer Eye Institute’ includes a public hospital, a private hospital, a Veterans hospital and a hospital for children, as well as four practices outside Miami and the one they’ll soon open in Abu Dhabi. Between them they see approximately 2 700 patients every day and perform close to 225 intraocular surgeries, as well as a hundred more that do not need an operating theatre. They have a total of 850 employees, of which over one hundred are physicians, mainly combining their clinical practice with research, area in which stands out the work they’ve carried out over the last years in gene therapy.

Dr Miguel Naveiras answers the questions of our patients regarding their eye care I’m 32 years old and my vision through one eye is suddenly blurred, especially on near vision. I’ve gone to the optician and I’ve been told that I’ve +0.75D of hyperopia, but I‘ve never had a prescription before. I’ve gone to the ER where I underwent an eye scanner; I was told that I have a condition of the retina due to stress. Will I see properly from that eye again?

Lets see

Dr Miguel Naveiras

According to this information, it seems that you have a Central Serous Choroidopathy. The test that helps us confirm this diagnosis is an OCT (optical coherence tomography) of the macula. Usually, its progression is benign and vision is recovered throughout the first few months, but it might need a specific treatment for the retina. Glasses aren’t usually necessary because, as the fluid accumulated behind the macula decreases, eye prescription also decreases. Most certainly, emotional stress can contribute to its occurrence.

I’ve had herpes in my left eye since I was twelve. Every year it got bad and I needed an ointment. I’m now 43 years old and I’ve been told that I’ve got an old scar that is impairing much of my vision. Is there any solution? Herpes simplex is a virus usually contracted during childhood that hides in a ganglion next to the brain. When your defences are low, during your menstruation period or even if you’re exposed to the sun for too long, the virus takes this opportunity to advance through the nerve towards the corneal epithelium of your eye. The repetitive reactivations have made your transparent corneal to become obscured. It is necessary that you prevent future reactivations with a specific pill treatment in order to be able to undergo a selective lamellar transplant (DALK) en el futuro. in the future. With this transplant we would be able to preserve the most internal layer of your cornea and to substitute the obscured layer for that of a donor.

I’ve been told that one of my eyes is very small and that I need laser to prevent glaucoma. One day, some years ago, my mother felt a lot of pain in one eye; she was sick and lost a lot of vision. I’m now 37 years old and I’m worried I’ll end up like her. What do you recommend me? What should I do? What they have suggested to you is a YAG laser iridotomy, which is used to favour the flow of fluid within the eye. As your eyes are small, the crystalline may eventually close the intraocular fluid drainage area causing pressure to increase notably. To prevent this situation it’s necessary to perform a painless exploration called gonioscopy; if it is proven that the iridocorneal angle is too narrow, a YAG laser iridotomy will be necessary to help prevent an acute glaucoma situation like the one your mother suffered.

Extra Virgin Olive Oils “Ad Salutem per Oleum” ( I ) Santiago Botas is an oil-taster and promoter.

Thanks to its exceptional gustatory and healthy qualities, extra virgin olive oils (AOVE in Spanish) are nowadays considered an extraordinary gourmet food, recommended by physicians and nutritionists, as well as by the top chefs from all over the world.

Gastronomy

The terminology defining the different varieties of oil obtained from olives is confusing, and therefore many consumers find it difficult to identify, appreciate and enjoy the best and most exquisite extra virgin oils. “Virgin” is the oil obtained cold by mechanical and physical means exclusively. In short, olive juice that retains the colour, aroma, taste and all the components of the fruit from which it derives. A 100% natural product.

“Virgin” is the oil obtained cold by mechanical and physical means exclusively.

“Virgin” oil is described as “extra” when, subject to the criteria of an official tasting panel, it is determined that its aroma and taste are irreproachable.

history of this several times over millenary foodstuff. Nevertheless, the manufacture of a great AOVE also requires knowledge, effort, care and a great deal of passion.

Numerous scientific studies support the healthy effects of the AOVE. Its therapeutic value results from its balanced composition of fatty acids and its minor components, mainly tocopherols and polyphenols, which are powerful antioxidants as well as responsible for its aroma and taste.

The best virgin extra oils, the most rich and tasty, shouldn’t be heated at high temperatures, as we would loose many of its aromas in the process; it is best to use them cold, as dressing - but we will talk about this further on our next issue of VEGA. Enjoy!

There is a great gustatory diversity among extra virgin oils. In Spain alone, approximately two hundred indigenous varieties are cultured, and its oils present strongly differentiated characteristics. Some are mild and delicate, with fruity notes that evoke the taste of apples, pears or bananas; others are more intense, smelling of recently mowed grass, green almonds, artichokes or other vegetables, and with notes of a pleasant bitterness and varying intensities of spice. Nowadays, the state-of-the-art farming and extraction systems enable us to obtain oils with a gustatory quality superior to any other in the

Gastronomy

Colin Firth Well-informed sources inform me that “metrosexuality” has died, that the trendy thing now is “neosexuality”. Therefore, gone are the sculpting of the body, the use of tight underwear and radical depilation amongst other variations of anatomical ostentation. Once his phase as a masculine icon is over, Cristiano Ronaldo can now devote himself exclusively to scoring goals. What defines a neosexual man is normality, to each his own, because it is indeed this new-style sincerity what wins over a woman’s heart. However, we shouldn’t get our hopes up: my sources add that this so-called normality must include certain exclusivity, at the same time discreet and attractive. The perfume, shoes, watch… make the difference when we talk about masculinity, in such a way that the most ordinary whatshisname will find the favour of his chosen woman if he goes to a date appropriately attired. Of course, this will be so as long as she is receptive to his alleged charms.

What defines a neosexual man is normality.

If there is an actor who represents normality, with an appearance oblivious to any ostentation and a head matching this spirit, that is Colin Firth, the prototype of the typical man elevated to the status of mature gallant. His facial expression, always at half-mast, is often that of he who is going to get his VAT papers in order with his tax advisor, or has just arrived from offering his condolences to someone. Great displays of teeth are few and far between, maybe the hint of a smile, a mild rictus that his intense and deep gaze charges with intention. Not even that mop of hair, sculpted with careful carelessness, has been designed to attract attention, least of all to excite envy - and I tell you this as a bold man. There are no sideburns that disturb or intimidate, strict shaving doesn’t exclude the occasional coquetry of a 2-day beard. He says about himself that he is part of a cast, not a movie star, and that he

Crossing of glances

would love to be seen as a classical actor. Maybe like Lawrence Olivier? However, I cannot help but see in Colin Firth (who after all was king George VI) a phlegmatic English landowner, a figure that, thanks to the cinema, we usually identify with a British lord, owner of lives and properties, of those who tone themselves mid-afternoon with two fingers of whisky. Those lords made a show of good nature that in reality was only patronising. Colin is normal, but not that normal. His tailored-cut suits, or the Italian chef that accompanies him during all his films, are the sophisticated addition that make his so-called normality a hardly feasible luxury. I might have to find myself a more accessible model.