Letters to the Editor

Glaucoma surgery in Asians; New nationwide voice for MDs

Two-minute Peripheral Iridectomy in Asian Patients

■ I strongly agree with Dr. Piltz-Seymour on the need for gonioscopy (“The Case for Gonioscopy,” February 2011). I see mostly Asian patients in my practice. One can easily be fooled into assuming the patient has open-angle glaucoma because of the deep central anterior chamber. But upon gonioscopy, one sees PAS consistent with chronic narrow angle glaucoma. I find it fairly easy to do laser peripheral iridectomies on these and other brown-iris patients. Most of the techniques I learned in residency, and which are still being taught, are erroneous. One does not need pilocarpine, stretch burns or completion with a YAG laser.

I use an argon laser set at 0.2 sec/50 microns/1200-1400 mwatts, making sure the spot size is in perfect focus. I set the slit lamp to bright light to shrink the pupil, thereby stretching the iris. I aim the laser spot 1-2 mm from the limbus, usually at the level of the second crypt. Do not go to the far periphery, where the iris is thicker and where an arcus may block the view. Go straight in, use about 50-75 burns, burn in an oval pattern with the long axis perpendicular to the limbus (like a spoke) and that should do it for most cases.

In the 10-20% of cases where I have only gone through partially, rather than applying more burns or switching to a YAG, I have them return to do the second eye and touch up the first eye at the same time. At that visit, it is easier to do both the second eye and complete the first eye. In fact, because of the natural miosis and dilation of the pupil, the spoke pattern partial iridectomy on the first eye may spontaneously complete itself, or require only a few laser shots.

—Raymond Fong, MD, New York City

A Nationwide Voice for Physicians

■ I was very interested in your article, “Are Medical Societies & MDs Out of Sync?” (March 2011). I think it is self-evident that while individual societies may be successful in advocating for members on a local or subspecialty level, representation of doctors at the national level is absent. Vital issues affecting every physician, such as the SGR and tort reform, were not addressed in the PPACA, and yet the AMA supported its passage. It is clear that doctors never had, yet desperately need, a strong, unified voice on a national level.

I believe that Docs4PatientCare is that voice. Born out of the call to oppose PPACA because of its destruction of the doctor/patient relationship, it has grown into a respected, effective organization whose goal is to truly represent the interests of physicians on a national level. I urge your readers to explore www.Docs4PatientCare.org. It arms physicians with facts and provides resources to give them a national voice on issues critical to our profession.

—Marci Krop Cook, MD, FACOG