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Dr. Charles Schepens Dies at 94
He was acclaimed as "The Father of Modern Retinal Surgery."

Dr. Charles Schepens

"He transformed a whole area of ophthalmology," says J. Wallace McMeel, M.D., president of Schepens Retina Associates Foundation, in speaking about Charles Schepens, M.D., who died of a stroke on March 28 at the age of 94.

Dr. Schepens helped to develop the study of the retina into a basic subspecialty within ophthalmology. His professional contributions include inventing the binocular indirect ophthalmoscope and developing the scleral buckling technique used to improve the retinal reattachment procedure.

In addition, he opened the first center for retina patients and related research. Later, the Schepens Eye Research Institute became affiliated with Harvard Medical School.

Dr. Schepens was also a war hero.

Years before his work on retinal reattachment, his actions during World War II saved numerous people from the Nazis. He was able to do this by using a lumber business in the Pyrenees mountains in France to help ferry people to safety.

After the war, Dr. Schepens and his family emigrated to Massachusetts. In 1950, he established The Retina Foundation in Boston, the first medical operation and clinical research institute dedicated to retinal care.

Dr. Schepens' research has led to the retinal reattachment rate increasing from 40% to 90%. In the 1960s, Dr. McMeel was at the Foundation with Dr. Schepens, and worked on what Dr. McMeel characterizes as "seminal research papers" on retinal reattachment.

"Dr. Schepens was a teacher. He wanted to create a breadth of knowledge that would be beyond him," asserts Dr. McMeel. "He created an environment where there was a much greater flow-through of work." Dr. McMeel estimates that the Foundation has trained more than 200 vitreoretinal surgeons.

Before Dr. Schepens' work on retina reattachment, the treatment was surgery, followed by having patients lie down for 3 to 4 weeks with sandbags on either side of their eyes in hopes of the retina reattaching. If success was not realized, the surgery was attempted again.

Carolyn Bellefeuille, director of development at the Schepens Retina Associates Foundation worked with Dr. Schepens for 18 years. 

"He had excellent bedside manner," says Bellefeuille. "I can't think of anybody who had a better relationship with his patients."

Dr. Schepens is survived by his wife, Marie, four children, eight grandchildren and four great- grandchildren.

GIVING BACK: A Surgeon's Commitment to Teaching
Dr. Stephen Lane: Educational Missionary for ORBIS International.
By John Parkinson, Associate Editor

The ORBIS DC-10 Flying Eye Hospital

"Give me a fish and I eat for a day. Teach me to fish and I eat for a lifetime." — Confucius

The quotation above has been used as a metaphor countless times, but if this old proverb could be altered to make the subject "teaching ophthalmic surgery" instead of fishing, then it would aptly fit the philosophy of Stephen S. Lane, M.D., in regard to volunteering.

Dr. Lane, managing partner of Associated Eye Care in St. Paul, Minn., and adjunct professor, ophthalmology, at the University of Minnesota, has always enjoyed teaching. When he heard how ORBIS International physicians traveled to developing countries to teach fellow ophthalmologists the latest surgical techniques, Dr. Lane knew it was the right fit for his volunteer efforts.

Dr. Lane wanted to be able to leave the host country's ophthalmic surgeons with the ability to care for the local population - who would still need professionally trained eyecare practitioners long after the volunteer physicians had left.

"It gave me an opportunity to continue to impart those kinds of skills, both in a didactic and a practical way in terms of the surgery," says Dr. Lane.

ORBIS International is a nonprofit organization that trains eyecare professionals, provides ophthalmic equipment, advocates for national and global policies and participates in new initiatives such as telemedicine for developing world countries.

Since joining the organization in 1991, Dr. Lane has undertaken more than 10 ORBIS missions to countries like Bulgaria, Lithuania, China, Mongolia, Cuba, Myanmar and Trinidad.

When Dr. Lane goes on a mission, he teaches the host country's ophthalmologists the latest corneal and cataract surgical techniques.

The Flying Eye Hospital

Patients rest in the recovery area of the ORBIS DC-10 eye hospital.

ORBIS has converted a DC-10 airplane into a flying eye hospital with two primary purposes. First, it serves as a public symbol for the organization. But more importantly, it is also home to a working classroom and surgical center used for missions. Visiting surgeons can operate on patients while host country physicians watch the surgery from seats in the front of the plane. After surgery, patients recover in a postoperative room.

Dr. Lane was on the inaugural mission with this plane on a trip to Beijing, China, and recalls it as his most memorable trip.

"I actually did the very first case in the operating room on the DC-10," recalls Dr. Lane. "We were treated very nicely [in China] and had dinner at the Great Hall of the People. Having that opportunity was pretty special."

Interestingly enough, ORBIS does not transport the volunteer doctors to the mission's destination. Rather, Dr. Lane and other visiting faculty volunteers fly in on their own at their personal expense.

The Mission

When Dr. Lane participates on a mission, he will work with two or three other visiting physicians. They will typically spend a week at the mission's destination.

He will begin the week by examining pre-screened patients in a cooperative effort with their home-country physicians. After seeing between 50 to 100 patients in about a half a day, Dr. Lane faces the biggest challenge of the mission.

"Out of those 50 to 100, you chose seven to 10 patients to operate on," says Dr. Lane. "It is always a very difficult decision to determine which patients get chosen and which ones don't. Doing the teaching and the surgery is easy compared to telling some people, 'yes, we can do the surgery, but no we can't do it for that patient.'"

He adds, "Hopefully, we have imparted the skills and concepts on the doctors that are watching, and that they can do it themselves once we're gone."

The criteria for picking patients for surgery include both the patient's potential to benefit from surgery and the ability of the case to present as a good teaching example. This way, the visiting faculty surgeon can make important didactic points, show specific skills and demonstrate different techniques to the physician audience during the procedure.

The plane has one operating room, so just one procedure is done at a time. Procedures take longer than usual because volunteer surgeons are showing the host country doctors various techniques.

Typically, Dr. Lane will perform two procedures per day. When he is not operating, he is teaching in the front of the plane. With the help of ORBIS' advanced audio and visual technologies, Dr. Lane can utilize PowerPoint presentations or show videos to the physicians while the next case is being set up.

"The doctors who are there for the experience are basically getting information either from lectures or from the live surgical procedure. As soon as that surgery is done, the doctor who performed it comes out and talks about the case. He is teaching while he is doing the case. He has a microphone on, and the observers can ask questions of him from the classroom."

There is also a peripheral classroom set up at the ORBIS destination's airport, so many more physicians can participate.

Throughout the trip, two doctors might be doing surgery on the plane and a third doctor could be doing surgery at the local hospital.

"You are in the operating room of the host surgeon, so they are in their own environment," states Dr. Lane. "In these circumstances, we act more as assistants. We let them do the surgery."

As these are developing countries, many have limited infrastructure. The visiting surgeons use what is available in the host country.

"We try to keep it at a level they have the equipment available to them, so that we are not showing things they cannot possibly do themselves," says Dr. Lane.

At the end of the trip, Dr. Lane and his faculty colleagues get together for a social event sponsored by the host country's doctors or ORBIS. This is an opportunity to socialize after a demanding week.

Dr. Lane (second from left) and local medical personnel on the ORBIS plane.

The Benefits of Volunteering

Dr. Lane has enjoyed all of the missions he has completed. They have given him an opportunity to see places he may not have experienced had it not been for his involvement with ORBIS. He says the relationships between the volunteer teaching faculty and the host country's doctors are always very cordial, with friendly give and take between them.

"We learn from each other. There are little pearls, techniques I have learned on several missions. Certain medications they might use for something that I wouldn't have thought of and that are successful."

Dr. Lane is able to get back to the basics of teaching and performing surgery during the missions without filling out coding paperwork or dealing with insurance issues. To leave behind these ancillary tasks normally associated with his practice back in Minnesota is a great secondary benefit of teaching abroad.

"It is truly the most gratifying week of the year I spend in ophthalmology — from the standpoint of being able to teach, to help people to give something back," concludes Dr. Lane.

IN THE NEWS

►Fungus outbreak. Ophthalmologists in primarily the southern part of the United States have recently been grappling with an
outbreak of fusarium fungus among wearers of soft contact lenses. The outbreak is being studied to determine if it may be linked to a specific contact lens cleaning solution.

The outbreak is a cause for concern because doctors normally only see fusarium keratitis fungal infections in patients who have suffered eye trauma that allows the fungus to penetrate the cornea.

In a move related to this outbreak, Bausch & Lomb said it temporarily suspended U.S. shipments of ReNu with MoistureLoc produced at its Greenville, S.C., manufacturing facility and asked retailers to remove the product from their shelves. The action does not affect any other Bausch & Lomb products.

B&L made its announcement following the release of a report by the U.S. Centers for Disease Control and Prevention (CDC) that it is reviewing 109 cases of suspected fungal keratitis. The CDC said many cases have yet to be reviewed, but of the 30 cases reviewed by mid-April, 28 involved contact lens wearers. Twenty-one reported using ReNu brand contact lens care products and five reported using a combination of ReNu and products manufactured by other companies.

The available scientific evidence doesn't show that ReNu is the cause of the fungal infections, Bausch & Lomb said in its statement.

"At the end of the day this was a voluntary proactive measure on the part of the company to try to address what they believe and we believe is a significant public health concern," Dan Schultz, director of the FDA's Center for Devices and Radiological Health, told reporters.

A similar fungal outbreak recently occurred in Singapore, Hong Kong and Malaysia. In that instance, sales of B&L ReNu multipurpose solutions were also suspended. The products were later deemed safe by the company.

Eduardo C. Alfonso, M.D., of Bascom Palmer Eye Institute in Miami is cautioning soft lens-wearers to clean their lenses well and not wear them while sleeping even if the lenses are approved for overnight use. The fusarium fungus can be treated with an anti-fungal drug called natamycin.

►LASIK-at-home hoax. The much talked-about Web site that offered a do-it-yourself LASIK kit for $99 an eye was just a clever April Fool's hoax. Though the site showed possibly professional knowledge of the items necessary to perform the LASIK procedure, the doctor, clinic and laser company referred to were all fictitious. In addition, any attempts to actually order the kit were rejected.

At least two minor consumer-oriented Web sites bit on the hoax and seriously critiqued the LASIK-at-home kit as possibly dangerous.

►Ophthalmology Web page. The American Academy of Ophthalmology has announced the launch of the new Ophthalmology Web page on the Centers for Medicare and Medicaid Services' (CMS) Web site. The page can be found at http://www.cms.hhs.gov/
MLNProducts/65_ophthalmology.asp# TopOfPage%20.

CMS has offered to host specialty-specific pages on its Web site to encourage collaboration between providers and the agency. Ophthalmology will be only the second medical specialty to produce a page for the CMS site. The shared goal of the page is to present all Medicare reimbursement information relevant to ophthalmology in one central location for easy access by ophthalmologists and their staffs.

The ophthalmology Web page includes Medicare physician fee schedules, CMS program transmittals, ophthalmology-specific CMS rulings (e.g., presbyopia-correcting IOL payment issues.), Coverage Decisions, Federal Register announcements, and other Medicare reimbursement information of importance to all aspects of ophthalmology. Other examples of helpful material include information on the low-vision rehabilitation demonstration, ophthalmology-specific physician fee schedule codes, and the new Competitive Acquisition Program (CAP) for drugs administered in a physician's office.

WORTH NOTING

►New post. Eve J. Higginbotham M.D., internationally known expert in the treatment of glaucoma, assumed the position of dean and senior vice president for Academic Affairs at the Morehouse School of Medicine (MSM) in Atlanta, Ga., effective April 24.

Upon her appointment in 1994 as chair of the Ophthalmology and Visual Sciences Department at the University of Maryland School of Medicine in Baltimore, Dr. Higginbotham became the first woman to head a university-based ophthalmology department in the United States.

►AMO wins customer service award. The Omega Management Group Corp., specialists in implementing loyalty management strategy programs that increase customer and employee satisfaction, said Advanced Medical Optics has won its NorthFace ScoreBoard Award for the sixth consecutive year. The award is presented annually to companies who, as rated by their own customers, achieved excellence in customer satisfaction during the prior calendar year.

Omega's methodology measures customer satisfaction levels for all clients on a five-point scale at least twice during the year in such categories as technical support, field service, sales process, customer service, product quality, account management and training.

►Appointed. WaveLight, Inc., has announced that Ralph Saettele will take charge of the company's U.S. subsidiary, pro tem, following the departure of Wade S. Tetsuka, former president, U.S. Operations. Saettele is the assistant to the CEO of WaveLight AG, Max Reindl, and has been responsible for business development of WaveLight, AG's ophthalmology division.

►New award. The American Glaucoma Society, the Helen Keller Foundation and Pfizer Ophthalmics have partnered to present an inaugural research award, the Helen Keller Foundation/Pfizer Ophthalmics Research Award, to Xuyang Liu, M.D., Ph.D., for his work in the field of glaucoma.

The award in the amount of $40,000 will go toward helping Dr. Liu, a scientist in the department of Ophthalmology and Visual Sciences at the University of Wisconsin, complete his research proposal, Modulation of Aqueous Outflow by Gene Therapy Targeting Actin.

In the March issue article, The Vast Untapped Market: Ocular Allergy, the quote by William E. Berger, M.D., on page 46 should read, "Although Patanol is the leader in market sales, Elestat and Optivar are accepted alternative first-line treatments for allergic conjunctivitis."