At Press Time

Galveston Practice Recovers from Ike

Two Satellite Offices Are Largely Spared.

By Jerry Helzner, Senior Editor

■ Joni Schirmer, the longtime practice administrator at The Eye Clinic of Texas, has had a great deal of experience in preparing for hurricanes. Some of the storms have been big, most have been small and many of the threats never materialized at all. However, she says she learns something new each time.

"This time, I recognized that we shouldn't have left our computer servers in our main office in Galveston," she says. "We had all of our records backed up offsite, but the cost and time to retrieve them all from the back-up company would have been prohibitive. Fortunately, I was able to get to the Galveston office 3 days after the storm and take out the servers, which were undamaged. This is the big lesson that Ike has taught me."

The Eye Clinic of Texas is a relatively large practice, headed by Bernard Milstein, M.D., a much-honored Galveston ophthalmologist. The practice has six doctors and 27 staff, located in three offices.

There was significant water damage at the Galveston office.

"The Galveston office lost its roof and sustained much water damage," says Schirmer. "Our League City and Texas City satellite offices were somewhat out of the main path of the storm, so they escaped with almost no damage, although we had looting in our Texas City office. It was clear that the looters were looking for drugs, but they also took a laptop computer. There were no important records on that computer, so it was just a loss of the hardware."

Schirmer says that the partners closed the practice at noon on Sept. 11, with the storm surge scheduled to hit Galveston the next day.

"Everyone on the staff has a cell phone and most of us can text, which turned out to be a big advantage during the storm," notes Schirmer. "Sometimes, we were able to text when we couldn't communicate by voice."

The practice has already hired a contractor to repair the damage to the Galveston office and is hoping to reopen that location by the end of the year. Electricity to that office was restored 12 days after Ike hit. Meanwhile, all phone lines were quickly reset to directly reach the Texas City and League City offices.

"We couldn't see patients for a few days but we had one of the satellite offices operating the Wednesday after the storm hit," says Schirmer, "so patient care was fairly continuous."

The practice does not carry business interruption insurance because the premium for the Galveston area is huge. It does have wind and flood coverage.

"We feel that having the three offices gives us a cushion, so it is not likely that all three offices would be down at any one time," says Schirmer.

Schirmer, who herself owns two small businesses in the Galveston area, says that Galveston residents are willing to take the hurricane risks to enjoy the benefits of living on the coast.

"It was a bad one but you just have to pick yourself up, clean up the mess and get back to living your life," she concludes. OM

Canaloplasty Advances With New Approval

Glaucoma Treatment Could Be More Widely Adopted.

■ Glaucoma patients may have a promising new treatment option for the reduction of elevated IOP. Very small, complex catheters can now be inserted into small drainage structures within the eye, enabling glaucoma surgeons to enlarge these compromised outflow passages for the treatment of glaucoma. These microcatheters are measured in microns, or approximately the size of four to five human hairs combined.

iScience Interventional, Menlo Park, Calif., recently received expanded indications for use from the FDA for their microcatheters for specific treatment of primary open-angle glaucoma (POAG).

"We have been using the same surgical procedures for the last 50 years with only small modifications," noted Richard A. Lewis, M.D., past-president of the American Glaucoma Society. "Historically, we have been looking for ways to drain fluid out of the eye by using surgically created holes. A relatively new procedure known as the canaloplasty now rejuvenates the eye's natural system to lower pressure."

This minimally invasive surgical technique uses a 250 μm microcatheter to access the drainage channels and utilizes the eye's natural drainage system to remove fluid from the eye. This interventional procedure has been performed worldwide for more than 3 years.

Supporters of canaloplasty say that, much like its more advanced predecessors in interventional cardiology and interventional neuroradiology, canaloplasty is emerging as a practical alternative to more invasive surgical procedures. It is believed that canaloplasty will have its major appeal with glaucoma specialists who can master the learning curve for this demanding procedure.

Canaloplasty microcatheter and fiber optic illuminator.

"Canaloplasty strengthens ophthalmologists' options for patients with primary open-angle glaucoma," asserts Dr. Lewis. "Ophthalmologists have recognized for decades that the ideal solution to glaucoma would restore or maintain the eye's natural drainage system. The canaloplasty does just that."

Bradford J. Shingleton, M.D., of Ophthalmic Consultants of Boston and associate clinical professor of ophthalmology, Harvard Medical School, added, "The canaloplasty is a procedure that is grounded in high technology and science. Over the past several years, respected researchers in Europe, Canada and the United States have amassed clinical data that support the safety and efficacy of canaloplasty for patients with POAG, as well as the significant reduction of costly medications."

During a 30-minute canaloplasty procedure, the surgeon inserts a microcatheter through a small incision, enlarges the main drainage channel and places a small suture inside the canal to maintain the opening so it can function normally. Once completed successfully, this procedure ideally rejuvenates the native drainage system, thus lowering the pressure in the eye.