Eyedea magazine - Winter 2011

published by

Eyedea A BoozmanHof Quarterly Magazine Winter 2011

Patients Report: Some of the Best Things in Life Are Seen - page 6

(others are still tasted)

Eye Care Evolves - page 4

Cassie’s Thoughts on Cataract Surgery - page 9

02 n Eyedea

To Our Readers

Good News:

Doctors

Even More Vision Correctable

by Refractive Cataract Surgery

S

ometimes people think they have problems with “a stigmatism” when actually the condition is called “astigmatism.”

That seems to be the way things go with astigmatism: it has always been a misunderstood vision problem, and even treatments until recently have left something to be desired.

Until now.

Recent toric intralocular lens (IOL) options have become available that have almost doubled the amount of astigmatism we can treat with lenses at the time of cataract surgery—to currently about 95% of people who have astigmatism.

It is simply a wonderful piece of news that has happened in our world of refractive cataract surgery, and we’re enthusiastic to spread the word and treat more patients that need this kind of lens help.

We’re also excited to welcome Daniel Sines, M.D., aboard BoozmanHof, as his

talents as an occuloplastic surgeon are surely needed in our Northwest Arkansas region. Further, we’re delighted to introduce Cassie Schroeder, our refractive specialist.

In this issue of Eyedea, we explore vision in a new light—from patient

experiences after both LASEK and cataract surgery.

Their tales remind us all about what it means to have the gift of sight, and we thank them immensely for sharing their vivid experiences. Thank you Sheila, Jim and Emily.

We also explore thoughts on advanced surface ablation and even leadership—from the point of view of those working at our ambulatory surgery center (ASC).

Our esteemed medical coder, Janis Geary, once again demystifies that increasingly complex world.

And we’re excited to feature our friends at Parenti-Morris Eyecare as part of our valued network of stellar eye care providers in Northwest Arkansas.

As always, we like to update you on cool stuff in terms of technology we’re working with and thinking about. And Dr. Jim Myers shares his thoughts on complex contact lens fittings.

We hope you find this issue of Eyedea valuable, as we believe—from refractive cataract surgery to LASEK to all other eye care services— that you deserve the very best.

Sincerely,

Randall E. Cole, M.D. President, BoozmanHof Eye Clinic Medical Director, BoozmanHof Eye Surgery and Laser Center

C. William Hof, M.D. Randall E. Cole, M.D., F.A.C.S. Randall O. Bell, O.D. Darren L. Brodie, O.D. Leah B. Cate, O.D. Jim S. Myers, O.D. C. Scott Woodward, O.D.

Website www.boozmanhof.com Eyedea published by

Editor and Publisher Matt Young Copy Editor Hannah Nguyen Designer Winson Chua

Cover Image: Jack and his Guinness Copyright © 2011 Painter: Dennis Young www.dennisyoungarts.com Media MICE Pte Ltd 6001 Beach Road, #19-06, Golden Mile Tower, Singapore, 199589 Phone: +65 8186 7677 Fax: +65 6298 6316 E-mail: enquiry@mediamice.com This publication is published by Media MICE Pte Ltd who is solely responsible for its editorial content.

All rights reserved.

In this Issue...

05 Cataract surgery is cheap compared to a car

06 Patients praise new vision

10

11

Leadership values from a

What’s better than laser

leading medical center

eye surgery?

Eyedea n 03

O.D. Corner

Advances in Contact Lens Technology

By Jim Myers, O.D.

O

ne of the few good things about being old is that you have lived long enough to see many great technological advances in our profession.

Some of these are in the area of contact lenses. When I was in training back in the early 1970s, the primary contact lens that we fit was an old hard PMMA lens.

It was non-gas permeable and it was common to see severe corneal edema and emergency room visits secondary to hypoxia.

During my training, Bausch & Lomb (Rochester, New York) launched the original soft contact lens with 3 base curves: F (flat), N (normal), and S (steep). It was soon understood that even the flattest base curves were not flat enough and the original B, F and J series were introduced.

In the late 1970s, I began to fit the first stable hard gas permeable lens on the market, which was put out by Polycon.

This was a huge advance in contact lenses, reducing most of the overwear and hypoxia problems. At that point, even though the soft lenses were improving, the stability of a toric lens left a lot to be desired and we used to call them “snowflake lenses” because no two were alike. The reproducibility was horrible.

Along with the first generation of refractive surgery—radial keratotomy—

there came huge advances in the quality of corneal topography, which greatly helped us in contact lens fitting, especially with the complex fits, such as keratoconus, pellucid marginal degeneration, corneal trauma and postsurgical complications from primitive refractive surgery.

Today, with the new generation of silicone hydrogen polymers, reverse geometry design, and third generation hybrids such as the SynergEyes (Carlsbad, Calif.) lenses including KC and ClearKone, we have much better options for fitting difficult corneas.

However, I do sometimes fall back on some of the older fitting methods, such as Rose K2 designs or even sometime piggyback fits.

Overall, it’s great to live in a day when you do have an option for fitting these complex patients.

New Doc Tackles Tough Cases

D

octors’ offices all too often are full of bad news.

“A lot of times in the medical field, you give patients the bad news and there’s nothing you can do about it, but in ophthalmology, you can,” said Daniel Sines, M.D., the new fellowship-trained occuloplastic surgeon at BoozmanHof. “One of the things that I enjoy is helping people with skin cancer on their eyelids.”

When patients come to Dr. Sines, he helps reconstruct both a good, functioning eyelid and a cosmetically pleasing one as well.

“These are usually scary times for patients,” Dr. Sines said. “They don’t understand what’s going on. You need to spend extra time with these patients.

People are very concerned about this area because it’s on their face.”

Providing exceptional care first, and foremost, is on Dr. Sines’ priority list.

“You want it to look as nice and normal as possible,” Dr. Sines said. “We can do things to make scars as minimally noticeable as possible or hide them entirely.”

It’s common for Dr. Sines to work on eyelid malposition, bow lift, and more complex problems involving the eye socket.

“That’s something most ophthalmologists don’t do,” Dr. Sines said. “I treat tumors behind the eye and in the eye. I also treat orbital fractures from trauma.”

That makes Dr. Sines a great addition to the BoozmanHof surgical family.

Dr. Daniel Sines (left) with his wife and child.

(Right) A favorite pastime: fishing.

“You’re looking at a couple hours by car to get to anyone else that does what I do,” Dr. Sines said.

Considering how bustling Northwest Arkansas has become, it’s a good thing indeed that Dr. Sines has the unique eye care expertise that he does, and has found a home in Rogers.

04 n Eyedea

Refractive

Evolution

lowest enhancement rate and no flapantiquated procedure these related problems. days, as lasers have taken “You don’t transect the cornea, you over the marketplace. But avoid cutting the nerves, and there’s BoozmanHof’s experience in no dry eye,” Dr. Cole added. “You don’t the procedure testifies to their get diffuse lamellar keratitis (DLK), toxic early knowledge in the field. photosensitivity syndrome, or late flap “The problem was with complications.”

RK, it was dependant on the The only downside to ASA is the surgeon,” Dr. Cole said. “It slightly slower visual recovery time. required the surgeon to have “On day one with ASA, walking good hands and technique to out of the laser room—boom—patients get good results. That affected can see,” Dr. Cole said. “As the cornea predictability, although we Dr. Randall Cole (left) and Dr. C. William Hof (right) with a building contractor in an earlier era at BoozmanHof resurfaces, vision drops off, so at got very good results with RK one week postoperatively, vision in our practice with several s it turns out, the spirit of might be 20/40. At two weeks, vision thousand procedures.” refractive surgery was within returns to 20/20. And ultimately, In the 1990s, BoozmanHof BoozmanHof before the clinic results are the best with fewer higher participated in the evolution of even existed. order aberrations. LASIK flaps induce refractive surgery.

Charles Casebeer, M.D., was an aberrations, as you would guess.”

“We went from using the early, pioneering advocate of radial LASIK flaps also can respond in Automated Corneal Shaper [Chiron keratotomy (RK). scary ways to trauma.

Inc., Irvine, Calif.] with the Hansatome “He put together a system of RK “Yesterday, the craziest thing [Bausch & Lomb, Rochester, N.Y.] that improved predictability,” Dr. Cole happened,” Dr. Cole said. “I saw a to progressing to advanced surface said. “And it was Charles Casebeer’s patient that had LASIK in Boston five to ablation (ASA),” Dr. Cole said. uncle that [BoozmanHof co-founder] six years ago. He came in and said, ‘A He explained that although LASIK is Fay Boozman actually acquired his kitty cat scratched my eye two weeks a great procedure, there is a small subset original practice from.” ago. I haven’t seen right since then.’” of patients with suboptimal results.

It’s a little piece of BoozmanHof The patient had blurred, double “But if you’re doing something trivia perhaps—almost inconsequential vision as a result of a lacerated LASIK elective in the realm of refractive on its own—but it’s an early marker flap. Epithelial ingrowth occurred surgery, you have to get in the mindset of the direction the clinic has been through the scratch down into the of no problems,” Dr. Cole said. taking ever since: one of paramount interface beneath the LASIK flap.

That is essentially what has importance in refractive surgery.

“His eye won’t ever be the same,” happened with the transition to ASA, C. William Hof, M.D., co-founder Dr. Cole said. “Instead of being a simple Dr. Cole said. of BoozmanHof, also trained in abrasion of the cornea, 5 years after a “By avoiding the flap, you avoid RK in Russia with ophthalmology LASIK procedure, you have epithelial 90% of the problems or complications giant Svyatoslav N. Fyodorov, M.D. ingrowth under a flap. He will probably from LASIK,” Dr. Cole said. “It’s a small Randall Cole, M.D., medical director, end up having a corneal transplant.” percentage, but a small percentage of BoozmanHof Eye Surgery and Laser people in a large number of procedures Center,meanwhile, met Dr. Fyodorov each year creates in Florida, where Dr. Cole learned RK a significant fundamentals. population.”

“In 1985, we were the first practice Dr. Cole in Northwest Arkansas to do RK,” Dr. explained that Cole said. “I had RK in my own eyes in ASA yields 1991. I still see 20/20 uncorrected for patients the best distance.” vision with fewest RK sounds like such an complications, An eye that underwent RK (left). An eye that underwent LASEK (right)

Photo credit: Matt Poe, COA

A

Eyedea n 05

Dollars & Sense

The Declining Cost of

Cataract Surgery I

n the 1980s, while Randall E. Cole, M.D., was performing cataract surgery in central Florida, he was impressed by the cheaper business model in play.

Hospitals were charging a $5,000-per-eye facility fee at the time.

But at his practice, run by James Gills, M.D., cataract surgery was performed outside the hospital quicker, more easily and with less expense: a $2,300 per eye surgeon/facility fee.

So the combined payment at Dr. Gills’ practice was half of what the hospitals were charging for the facility payment alone.

“Today a procedure which is much more advanced and much more predictable has gone to where the surgeon fee paid by Medicare is under $700 and the facility fee is about $950 per eye,” Dr. Cole said. “In 20 years, notwithstanding inflation, I can’t think of anything else where prices have become so much less in terms of things getting better and better. ” Cars, houses, appliances… prices have indeed gone up for most consumer items, while cataract surgery has become an incredible value. And it’s incredibly life-enhancing.

“It is the most life-changing procedure and device patients will encounter,” Dr. Cole said. “Nothing else comes close. “ That’s because after the procedure, a 70-year-old can quite possibly see better than ever before in life. We’re talking about sight—one of life’s most precious gifts.

“At age 70, there’s not anything mentally or physically that people can do that compares to what they can do

at their apex,” Dr. Cole said. “But what we do with modern cataract surgery gets people to a level that they can see or function visually that exceeds what they have ever experienced in their life at any point at any age. And it’s less expensive than 20 years ago.”

Hence, Dr. Cole calls modern cataract surgery one of the best values not just in medicine, but in any industry today, and he’s not alone.

“Compare cataract surgery to another common ‘purchase,’ a Ford Taurus,” Edward J. Holland, M.D., president the American Society of

By Matt Young Eyedea editor Cataract and Refractive Surgery, wrote in an August press release. “[It’s] hardly a luxury car, but a necessity for the activities of normal living in the U.S. In 1990 the cost of the car was $12,600, and the cost of cataract surgery was $1,500. In 2005, the average cost of the car was $20,830, a constant dollar increase of 9% while the fee for cataract surgery was cut 71 percent to $684.”

That’s quite some value for what Dr. Holland calls “one of the miracles of modern medicine.”

$20,830

$12,600

$1,500

$684

Ford Taurus

1990

Cataract surgery

Source: Edward J. Holland, M.D., president, American Society of Cataract and Refractive Surgery

Ford Taurus

2005

Cataract surgery

06 n Eyedea

Cover Story

In Their Own Words: Pat

By Matt Young, Eyedea editor

I

“ The only way my nerdy

mind could handle that [reading glasses] development was I picked a pair that looked just like the ones William Shatner wore in Star Trek II when the aging Kirk character had to admit he was getting old…

”

– Jim Berger

t’s easy to take sight for granted.

For instance, did you know that your eyes process 36,000 bits of information per hour? They also blink more than 10,000 times per day and contribute toward 85% of your total knowledge.

We often overlook how precious our eyes are, and that’s ok. The best of sight functions seemingly flawlessly.

But those who have had surgery to restore vision or improve upon it know what many of us don’t: how amazing vision truly is, and how far sometimes one needs to go to get it.

Up until his LASEK procedure, 46-year-old Siloam Springs resident Jim Berger relied on optical correction nearly his whole life. He was in glasses in the 3rd grade, contacts in high school, and reading glasses in adult life.

“The only way my nerdy mind could handle that [reading glasses] development was I picked a pair that looked just like the ones William Shatner wore in Star Trek II when the aging Kirk character had to admit he was getting old,” Mr. Berger recalled.

Because of Mr. Berger’s thick prescription, he learned he was not a candidate for LASIK, a laser vision correction procedure.

“Then one year my optometrist said something different and I was

stunned,” Mr. Berger said. “He said recent developments in procedures held the potential that even with my poor vision I might be a candidate for corrective surgery. He encouraged me to check things out and recommended BoozmanHof to me. Sure enough they ended up telling me I was just barely in the eligible range for LASEK. I learned how it was more specialized and more specific to my needs than LASIK. And I remember having to explain ‘IK’ versus ‘EK’ to my family and friends as I told them I was considering it.”

In 2004, Mr. Berger planned to have the surgery done at the end of the year to use the Christmas to New Year’s break to recover.

“We worked to set aside the money and the excitement grew,” Mr. Berger said. “I switched from contacts to nothing but glasses in preparation.

But in the last months leading up to the procedure I got cold feet. I canceled my agreement and spent New Year’s wondering what it would have been like.”

But Mr. Berger kept hearing good things about LASEK, an epithelial laser technique less invasive than LASIK. “With a clearer understanding of what lay ahead I again made end of the year plans,” Mr. Berger said. “But this time I kept them!”

Eyedea n 07

ients Praise New Vision

“ The first thing I noticed

was if I looked at the sky with my recently operated eye, the sky was blue and the trees against it were green… If I looked with the eye that had yet to be done, everything was sepia tone.

”

– Sheila Gallagher

, COA

Going on six years after LASEK, Mr. Berger still enjoys unaided sight.

“All year long, but especially during the fall, I enjoy sunrise and sunset both,” Mr. Berger said.

“Whether out walking for my health in the morning or driving home from an occasional late ending to the work day, I like to look at the trees—those fleeting moments when they are intricate black outlines backlit by the orange and pink and golden sunlight. They look like some amazing artists pencil drawings. And I can see every detail to my delight. If I remember right, I was probably the poorest vision numbers Dr. Cole had ever worked on to that

point. I’m so thankful that he did. I still tell folks it was one of the best health choices I ever made.”

Sheila Gallagher experienced a similar world opening up before her eyes after cataract surgery.

Ms. Gallagher, now 72, wore glasses since her early 30s when she was reading a lot as a graduate student at Notre Dame.

“My eyes got pretty well used,” she quipped.

Earlier this year, she had cataract surgery at BoozmanHof in one eye, and had it in the other eye some time later.

She explained what it was like to have her vision back in the first eye.

“The first thing I noticed was if I looked at the sky with my recently operated eye, the sky was blue and the trees against it were green,” Ms. Gallagher said. “If I looked with the eye that had yet to be done, everything was sepia tone. I already immediately after the first eye noticed a level of detail, brightness in my vision, and perception of colors that I really did not know I had lost. When you realize that you had lost something and now it’s back, it literally is eye-opening.”

Ms. Gallagher penned a letter of thanks to BoozmanHof afterwards.

“You and your clinic staff make excellent care into a routine without

Photo credit: Matt Poe

In December 2006, Jim Berger and his family traveled to Little Rock for a Trans-Siberian Orchestra concert, which he described as a “fusion of hard rock and Christmas music.”

It was a year after Mr. Berger’s LASEK procedure at BoozmanHof to restore glasses-free vision.

“The arena show boasts an amazing light and pyrotechnics display,” Mr. Berger wrote in a letter to Randall E. Cole, M.D., and BoozmanHof. “As I sat watching every laser beam and explosion with incredible clarity, I honestly said a prayer of thanks for you and my procedure.”

Sheila Gallagher with Dr. Randall Cole

Continued on page 8 >>

08 n Eyedea

“ When I’m up tight and nervous about what I have to go through and those taking care of me are happy and relaxed, I find myself laughing too!… It’s hard to be fearful when you’re laughing!

”

– Emily Crofut >> Continued from page 7

“ Dr. Cole had just come

back from vacation. They called him. He worked me in and did [a vision procedure] for me so I could go back to Texas.

”

– Emily Crofut

treating a patient as just one more pair of eyes,” she wrote. “That can’t be easy, considering the hundreds of people you see in a week. You know the bumper sticker that says, ‘Commit a random act of kindness’? ‘Random’

After her suboptimal result after cataract surgery in Texas, she travelled all the way back to BoozmanHof for care she could trust to restore her vision.

“Dr. Cole had just come back from

doesn’t work in health care. Instead, you deliver an ‘organized act of kindness’ in your service to patients. I will think of you all warmly, even after that last eye drop goes in.”

In fact, 73-year-old Emily Crofut traveled with family after her original cataract procedure in Texas to Rogers, Ark. just to have some additional cloudiness in vision removed.

Ms. Crofut formerly lived in Arkansas where she had been receiving eye care services from BoozmanHof.

vacation,” Ms. Crofut recalled. “They called him. He worked me in and did it for me so I could go back to Texas.”

In a subsequent letter to BoozmanHof, Ms. Crofut wrote how appreciative she was of the jovial staff.

“When I’m up tight and nervous about what I have to go through and those taking care of me are happy and relaxed, I find myself laughing too!” Ms. Crofut wrote. “It’s hard to be fearful when you’re laughing! P.S., the bonus is I can see a whole lot better.”

Working Together to Advance NW Arkansas Eye Care

D

r. Pete Parenti, O.D., has been practicing in Benton county longer than any other eye care professional.

“I’m a few months older than Bill Hof,” Dr. Parenti chuckled, knowing full well that’s a jab in good jest.

Over the years, Parenti-Morris Eyecare has had an outstanding relationship with BoozmanHof for several reasons.

“They’ve done a really magnificent job working with optometry,” Dr. Parenti said. “I have always had a high degree of comfort in contacting them about patients. I’ve sent my own family members there for surgery that I

couldn’t handle guys at BoozmanHof are in my own clinic. committed to.”

They’ve also solved Dr. Alex Bell, O.D., some problems as has a particularly far as my eyes.” special relationship with Dr. Chris Morris, BoozmanHof. O.D., also in practice “My father is an with Dr. Parenti, said optometrist there: Randy he needed someone Bell,” Dr. Alex Bell said.

(From left to right) Dr. Alex Bell, Dr. he could trust in “So my relationship with Pete Parenti, and Dr. Chris Morris handle specialty care. those docs has gone “As optometrists, we need back for a long time, as I pretty much surgical care to be a team concept,” grew up around all the docs there. They Dr. Morris said. “There’s care I am produce an excellent situation as far as not going to physically provide, but I partnering and patient care.” am well educated in terms of what to Added Dr. Parenti in good humor: recommend and then we can follow“The second best Dr. Bell works at up so that our relationship with the BoozmanHof.” patient continues. That’s what they

Eyedea n 09

W

hen a lot of medical coders think of dry eye, they think of Sicca. But “Sicca” is not always the best code to use. A lot of times there are other things associated with dry eye, like punctate keratitis.

In fact, the most common diagnosis code associated with dry eye is 375.15 (Tear film insufficiency, unspecified).

Ask

anis J

Veteran medical coder provides answers to your ophthalmology management questions

Another common diagnosis code associated with dry eye is 370.33 (Keratoconjunctivitis sicca, not specified as Sjogren’s).

A final common diagnosis code is 370.21 (Superficial keratitis without conjunctivitis; punctate keratitis).

Caution: If a patient presents with punctate keratitis, you need to determine the cause.

• If dry eye syndrome is the cause use code 375.15 • If dry eye syndrome is NOT the cause use code 370.21

In other news, Medicare will not cover a therapeutic contact lens (92310); it is included in the eye exam.

A lot of times, patients come in and have a corneal ulcer. Sometimes they purchase expensive contact lenses, but these are not covered. Instead, bill for the eye exam and include the contacts bundled into the visit.

Use procedure code 65435 for Rust ring Removal (Removal of corneal epithelium; with or without chemocauterization [abrasion,curettage]). There are so many different foreign body removal codes, but this code most accurately describes this type of removal.

New Glaucoma codes added to the CMS Web site effective October 1, 2011.

365.01 was REVISED to the following: Borderline Glaucoma; open angle with borderline findings, low risk.

Meet

B

Cassie

y the time someone is 70, they’re clearly at a visual disadvantage,

and cataract surgery can make all the difference.

“A lot of people don’t realize what they are missing in life until they have cataract surgery and correct the cataract, astigmatism, and visual acuity problems,” said Cassie Schroeder, BoozmanHof’s refractive surgery scheduler and patient consultant.

So even before surgery, Ms. Schroeder feels it is paramount for

NEW CODES include: 365.05 – Borderline glaucoma; open angle with borderline findings, high risk 365.06 – Primary angle closure without glaucoma damage 365.70 – Glaucoma stage, unspecified 365.71 – Mild stage glaucoma 365.72 – Moderate stage glaucoma 365.73 – Severe stage glaucoma 365.74 – Indeterminate stage glaucoma.

patients to choose the right lens

For the final full set of ICD-9 code changes visit the CMS Web site. Since the new codes took effect on October 1,2011, CMS only adds new ICD-9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.

Physicians should start documenting clearer diagnosis now to prepare for ICD-10 coding.

For example, coders and billers will have a difficult time determining the most accurate ICD-10 code when a physician writes OAG (Open Angle Glaucoma) with no additional detail.

Hopefully, the coding tidbits are helpful enough to keep in your office for quick reference.

Don’t forget, if you have further questions related to this or any other medical coding issues, call me at 479-246-1700, or email me at jgeary@ boozmanhof.com.

nearly everything

Janis Geary, ACS-OH, is the BoozmanHof business office director.

“This is a very rewarding job on every

option, and she helps them with that.

“I love that I get to talk to patients about the different lens options they have to choose from to help make cataract surgery benefit them the most,” Ms. Schroeder said. “I enjoy seeing patients that have had the ReStor lens [Alcon, Fort Worth, Texas] or toric lens and are so excited to tell me that they can see without glasses.”

Ms. Schroeder also has witnessed visual transformation on other levels.

“When I was a technician for [BoozmanHof’s] Dr. Woodward, I really enjoyed watching children that were unable to read the visual acuity chart before glasses transform into confident and assertive children with their glasses,” Ms. Schroeder said. level.”

Photo credit: Matt Poe, COA

Photo credit: Matt Poe, COA

Did you Know?

10 n Eyedea

Surgery Center Update

Leadership Philosophies Buttress Surgery Center

BoozmanHof staff at the opening of the ambulatory surgery center (ASC)

D

onna Acord was 31 years old with a newborn baby and a kindergartener when she signed up to be director of BoozmanHof’s new ambulatory surgery center (ASC) in 1996.

“I don’t know how I did it,” said Ms. Acord, now 48.

But she does know what informed her leadership style to help make the ASC an incredibly successful, problemfree place to have surgery.

Books.

“I was required in school to write a nursing philosophy,” she said, and despite being married with children, that’s when her love affair with management books began.

One of her favorites is Nuts!

Southwest Airlines’ Crazy Recipe for Business and Personal Success.

Ms. Accord particularly likes how they “set up and led a company,” and that’s understandable by reading the intriguing book description: Herb Kelleher reinvented air travel when he founded Southwest Airlines, where the planes are painted like killer whales, a typical company maxim is “Hire people with a sense of humor,” and inflight meals are never served--just sixty million bags of peanuts a year.

Today, Southwest is the safest airline in the world and ranks number one in the industry for service, on-time performance, and lowest employee turnover rate.

“I have read a lot of John Maxwell, The Management Methods of Jesus, Robert Barner… I have a whole bag full of books,” Ms. Acord said. “It is nuts.”

What has she learned after so many cover-to-cover nights?

“From a philosophy standpoint, I believe that successful leadership is dependent on congruent goals,” Ms. Acord said. It sounds pretty deep, and what she means is that goals must be aligned among leaders of organizations.

Leaders include owners, managers, physicians and even government board members, she said.

“They can be met in different ways,” Ms. Acord said. “But if goals are not aligned, you will find yourself frustrated.”

Successful leadership also is built upon high quality, self motivated employees—people you work with on the front lines who are willing to take a risk, she said.

“It’s more important that you have solid front line,” Ms. Acord said. “My job is much easier if people that work under me are self-motivated, quality-

oriented, type A. It’s hard to find, but you do find that still in a lot of people.”

Asked how she hopes she is viewed as a leader, Ms. Acord is humble, and for a reason.

“Servant leadership would be how I hoped I’m viewed,” Ms. Acord said. “I am not going to ask you to do anything that I’m not willing to do myself. How one performs a task sets the tone for the remainder of the team. If I expect you to do something meticulously, correctly, and perfectly, then I need to emulate that expectation.”

Ms. Acord’s reading habits, thoughtful introspection, and leadership experience have helped make BoozmanHof’s ASC what it is today: a huge success.

“Ophthalmology is the biggest offender [in medicine] for wrong site surgeries,” Ms. Acord said. Since opening, the ASC hasn’t experienced one such problem, she said.

There also has only been one late-onset endophthalmitis in 29,000 cataract surgeries, which is among the best infection rates anywhere.

The first ambulatory center of its kind in northwest Arkansas, the ASC also has received national recognition as a Center of Excellence.

And most importantly, more people pass through the ASC each day, and more come out with incredible new vision.

Staff at a recent festive sweater party

Eyedea n 11

Cool Stuff

Lens Over Laser

W

hat could be better than quick laser eye surgery?

For some, a phakic intraocular lens (IOL) could be better.

That’s because laser ablates corneal tissue, and some patients with high dioptric corrections just can’t undergo too much ablation. The laser procedure just won’t work well that way.

Enter the Visian ICL (STAAR Surgical Co., Monrovia, Calif.), a lens that is implanted into the eye to correct vision.

It’s not an IOL that replaces the natural lens, so it’s not the same device used in cataract surgery.

It’s much more minimally invasive than that, according to STAAR Surgical. It can be removed, for instance. And it can be inserted through a tiny 3 mm opening rather than utilizing a 7 to 9.5 mm corneal flap like with LASIK. “It is a good option for people too nearsighted for LASIK,” said Randall E. Cole, M.D., medical director, BoozmanHof Eye Surgery and Laser Center. “You can correct higher amounts of myopia without damaging the cornea like you would with a LASIK flap.”

Worst Nightmare Eliminated

Waiting in the Wings: ECP

I

I

n LASIK surgery, flap complications and related infections are worst-case scenarios. And indeed, they are pretty bad.

In LASEK surgery— which does not involve the creation of a stromal flap, but rather involves more superficial epithelial removal—worst-case scenarios involve the formation of haze and resulting unclear vision.

Now, the advent of mitomycin C (MMC) has reduced the incidence of haze to 0 at BoozmanHof. Essentially, what MMC does is create a level playing field in terms of patient healing response to LASEK, explained Randall E. Cole, M.D., medical director, BoozmanHof Eye Surgery and Laser Center. Although each person’s biological system responds differently to surgery, MMC reduces that variability after LASEK. “I use it with every LASEK patient,” Dr. Cole said. “It’s a low concentration of mitomycin C for the last 30 seconds of the procedure. There’s no scarring and no haze. And when you look at the corneas—from an aesthetic point of view from the slit lamp—it’s like stealth surgery. You can’t see anything has been done. These corneas are crystal clear.”

magine a fiber optic probe with a laser at the end of it.

It could see something in the body and zap, laser something away if necessary.

The tool already is available in the form of endoscopic photocoagulation (ECP), which has been used in glaucoma surgery. The aim is to search for anatomical processes creating aqueous and pressure buildup and destroy them.

In fact, it has been around at least 10 years, but C. William Hof, M.D., co-founder, BoozmanHof Eye Clinic, believes it needs to be further refined.

“Of all the surgical procedures for glaucoma, it has the most long-lasting effect,” Dr. Hof said. “But it creates a lot of inflammation inside the eye.”

Dr. Hof is considering re-looking into ECP to see if the technology has advanced further, but at the moment is reserving judgment on this innovative, but still evolving procedure.

12 n Eyedea

We Value Our

Relationship with You W

hen you send patients to BoozmanHof Eye Clinic, you can be confident that your patients will receive the very best care, with the latest technology, from experienced skilled physicians. We will work closely with you and your staff to ensure that your patients obtain the best possible results. Once a treatment plan is formulated, our surgical counselors will work with your office in arranging the return to your care.

Since its beginnings as Boozman Eye Clinic in 1977 and later as BoozmanHof, our practice has endeavored to offer the latest innovations in ophthalmic surgery.

We offer the precision of wavefront-guided LASEK and a full range of new lens options for cataract patients, including apodized diffractive optics technology (the AcrySof IQ ReStor) and accommodating IOL technologies (Crystalens).

Our fully accredited, Medicare-approved surgery center accommodates every outpatient procedure we perform, including cataract surgery, LASEK, glaucoma and oculoplastic surgery. Staffed with experienced eye care professionals, our facility offers the very best in ophthalmic surgical technology in a comfortable, patient-focused environment.

We look forward to working with you and your staff!

BoozmanHof Eye Surgery and Laser Center offers: • Experienced surgeons and staff • State-of-the-art operating room and laser suite

Our Surgeons

Dr. C. William Hof, M.D.

Dr. Randall E. Cole, M.D.

If you have any question or if there is anything that we can do for you, please don’t hesitate to give us a call at 800-428-3937 or 479-246-1700, or email us at info@boozmanhof.com.

Visit our website at www.boozmanhof.com

• An inviting, spacious clinic • Comfortable reception and recovery areas

Procedures include: • • • • • •

Advanced Surface Ablation (LASEK) Astigmatic keratotomy Avastin/ Lucentis intravitreal injections Blepharoplasty Botox/Juvederm Cataract extraction with intraocular lens implantation (lifestyle, toric and aspheric lenses available) • Ciliary body destruction (endoscopic cyclophotocoagulation) • Corneal transplants including DSEK

• Ectropion/Entropion repair • Endothelial keratoplasty • Excision of pterygium with conjunctival flap • Focal Grid Laser • Iris repair • Laser peripheral iridotomy • Nd:YAG capsulotomy • Panretinal photocoagulation (PRP) • Removal of skin lesions

• • • • • •

Repair of laceration of cornea or sclera Repositioning of the intraocular lens Scleral reinforcement with graft Strabismus surgery Temporal artery biopsy Trabeculectomy (with Mitomycin C or Ologen) • Visian ICL (Implantable Collamer Lens) implantation • Vitrectomy