TWO DAYS TO A RENEWED SENSE OF PURPOSE

BY ASHER KHAN, OU, MS4

Recently, we at Dean McGee Eye Institute (DMEI) in Oklahoma City were fortunate enough to give back by participating in a unique volunteer opportunity. Remote Area Medical (RAM), a non-profit provider of free, mobile medical clinics for underserved individuals, invited us to provide eye care at a pop-up clinic they were hosting in Weatherford, Okla. (about one hour west of DMEI). Our group consisted of 11 University of Oklahoma medical students, two DMEI residents and two DMEI ophthalmologists.

Before the first clinic day, patients wanting to be seen lined up in the parking lot of the Southwestern Oklahoma State University event center at midnight the night before. The clinic opened at 6 a.m. and did not end until we had seen all the patients needing eye care, which was around 6 p.m. on Saturday and 2 p.m. on Sunday.

We performed hundreds of refractions. Patients then selected frames and received their spectacles on site, if possible, or they were mailed to them. RAM’s optical section made and dispensed glasses to the patients free of charge. Additionally, we checked visual acuities, ocular motility, visual fields, IOP and pupils. If indicated, patients also underwent slit lamp and dilated fundus examinations. Patients requiring further workup for complex pathology were set up for free appointments at DMEI. The clinic ran for two days.

A FEELING OF FULFILLMENT

At the end of each clinic day, our feelings of renewed wonder and gratitude trumped our physical exhaustion. Many of our patients had received their first-ever pair of glasses. They could now see the world more clearly.

At the end of the two days, on our drive home, we reflected on the impact we had made. We had been reminded of exactly why we do what we do. Practicing ophthalmology is a privilege in which one can help prevent blindness and preserve eyesight. And then, we received the text from RAM: “With your help, we were able to serve 333 patients and provide $246,114 in services!” It was so worth it.

For more information about RAM “pop-up” clinics, visit their website (www.ramusa.org ).

Asher Khan, BS, OU, MS4 is a fourth-year medical student at the University of Oklahoma. He has special interest in vision research and completed a dedicated year of research at Dean McGee Eye Institute during medical school. He grew up in Oklahoma and aspires to continue his training as an ophthalmologist.

REIGNITE YOUR PASSION FOR CARE

BY TAMMY L. YANOVITCH, MD, MHSC

As a faculty sponsor for this RAM event, I feel incredibly grateful. There were so many positive aspects of this trip, some of which I honestly did not expect: the opportunity to serve so close to home, the convenience of having infrastructure and support through RAM, the ability to work with outstanding medical students who brought abundant energy and enthusiasm, the opportunity to interact with an old mentor and friend and to develop relationships with local providers. If you are looking for a way to reignite your love for ophthalmology, you don’t have to look too far. Consider “giving back in your own backyard.”

MEDICAL MISSIONS: GIVE AND RECEIVE

BY HUGH BERCKMUELLER, MD

“Tomorrow, and tomorrow and tomorrow, creeps in this petty pace from day to day to the last syllable of recorded time …”

Maybe you remember this line from Macbeth — but are you familiar with the feeling? Are you content, gladly practicing day to day? Maybe you’re fretting through your career — not unhappy, but in some way searching for something, or content but still searching.

PRACTICE AS IT SHOULD BE

Healthy vision is a blessing yet often taken for granted in the United States — how many visual complaints involving lost golf balls have you heard? But we all remember that patient, so thankful after surgery for a hand-motion cataract — they can see again! You know how you felt: magical.

Wouldn’t you want to share that with someone in need, even for free? Would you pay to make it happen? How far would you go to help the blind see?

One of the great things about volunteer work, especially mission trips, is that it crystalizes the practice of medicine. It’s a mix of the passion you felt early in medical school and the wisdom that comes with age. Monetary concerns, insurance hassles and prior authorizations are stripped away, and it’s just you and the patient — as it should be.

THE GIFT OF TRAINING

I’ve had the good fortune to make several mission trips through Christian Eye Ministry (christianeyeministry.org ) to Ghana in West Africa. It’s a beautiful country, with friendly people but with an unfortunate shortage of ophthalmologists. My first trip was 20 years ago, and with each visit I find that “something” I’m searching for.

My initial presumption for these trips was of course to do as much cataract surgery as possible. Generally, over the course of 2 weeks, we’ll try to perform upwards of 100 surgeries. But recently, I’ve had the opportunity to assist an ophthalmologist, at the surgical scope, in her transition from manual SICS to phaco surgery. Switching roles is initially unnerving, but in the end, more rewarding. I’ve now come to realize that it’s equally important, if not more so, to educate and train the Ghanaian surgeons themselves to reduce the need for outside assistance. Training is the future.

Thomas Aquinas said, “Charity brings life again to those who are spiritually dead.” Everyone has gifts they can share — sometimes overseas and sometimes in our own neighborhoods. I encourage you to give back where you can; find that thing. You will always get back more than you put in.

People often ask me why I go on missions. I tell them the obvious answer — to help people see. But really, I know I go for myself.

Hugh Berckmueller, MD, practices comprehensive ophthalmology in Newport News, Va. He’d like to thank his wife Janet, who looks out for their eight children when he’s away. He can be reached at eyehomeschool@cox.net.

GLAUCOMA CARE IN AN UNDERSERVED REGION

BY PETER T. CHANG, MD

Despite a high prevalence of glaucoma, West Africa suffers from a profound shortage of glaucoma care, which results in a high rate of blindness and severe pathology. To help bring some relief to this region I’ve been blessed to work with the Christian Eye Ministry, headed by Dr. Donald Budenz, for the past 8+ years at the Tema Christian Eye Centre in Ghana.

During the week-long trip, we volunteers see countless patients in the clinic for pre- and post-operative evaluations as well as glaucoma consultations and perform approximately 20-25 cases each day, including cataract, trabeculectomy and tube shunt procedures.

Thanks to generous donations from many companies, including Alcon, Allergan, New World Medical and others, we are able to provide the highest-quality ophthalmic care in the most remote locations of Africa while keeping the complication rate to the level that can match that of the best academic centers in America.

DELIVERING EDUCATION AND CONTINUITY OF CARE

While it can be daunting to care for so many patients with severe glaucoma, many of whom are already monocular, our work has provided much needed tertiary-level glaucoma care to the underserved area in addition to the opportunity to educate the local eye-care providers, both optometrists and ophthalmologists, who soak up every clinical and surgical pearl.

Returning to the same clinic each year has provided an opportunity to provide continuity of care and to see the positive impact our work can make to the local community. For me, it also emphasized the importance of working with the local care providers, especially when treating glaucoma patients, for whom education plays such an important part of their long-term care. It is imperative for the patients to understand that glaucoma treatments do not improve their vision but merely preserve their remaining vision, unlike the cataract surgery. We begin that message during the preoperative visit and the local team of doctors continue to emphasize this message after we have gone.

FIND THE MISSION FOR YOU

For other ophthalmologists who are thinking of volunteering, I have several recommendations. First, actively look for opportunities by engaging with the mentors who are already volunteering, through the Academy and local societies, Orbis International and Mercy Ships. Ophthalmology provides ample chance to volunteer, more so than perhaps any other fields of medicine.

When looking for opportunities, ensure that they match your skill level. Some provide opportunities for doctors of all levels, including residents and fellows; others are more appropriate for seasoned surgeons who are capable of dealing with challenging environments.

In addition, look for well-organized entities that have a strong track record of providing volunteer work and that have worked closely with a community to build trust and relationship, which are so vital to a successful mission. Talking with doctors who have engaged in medical missions will help you find effective groups.

Peter T. Chang, MD, is an associate professor in the ophthalmology department at Baylor College of Medicine, Houston, and director of the glaucoma fellowship.

CHARITY BEGINS AT HOME

BY CYNTHIA MATOSSIAN, MD, FACS

The medical community is a very special microsphere where most physicians are dependent on each other to provide appropriate care for their patients. We refer within the ophthalmology subspecialties — whether glaucoma, retina, neuro-ophthalmology or oculoplastics — and outside of ophthalmology to rheumatology, neurology and endocrinology, to name a few.

Yet, focusing on the greater local community is critical to ensure new patient referrals as well as the creation of a positive reputation for the practice. As such, at Matossian Eye, we did a huge amount of outreach to the communities surrounding each of our three offices.

Local Artist program: We turned the walls of our reception room into an art gallery. We invited local artists to exhibit their paintings and drawings for a 3-month period. All pieces of art were for sale, and 100% of the proceeds went to the exhibiting artist. We did an e-blast to our patient base encouraging visitors to our office. In addition, we invited patients to vote for their favorite piece among the displayed items. We featured the artist and the winning piece on our website. This created a real buzz among the local community. We had over a one year wait period since we featured four artists per year.

Vision screening for the homeless: We worked with a local agency to do vision screening for the homeless on a semi-annual basis. For those who needed glasses or in whom we detected pathology, we referred them to the local hospital eye clinic, which was staffed by physicians who took call at the hospital.

Soup kitchen: Every November, we placed a large basket in each office and asked staff and physicians to contribute cans or boxes of food from a list provided by the local soup kitchen. Different volunteer staff then delivered the basket, brimming with edible products, to the shelter Thanksgiving week.

Spectacle collection boxes: We partnered with local chapters of the Lions Club and placed boxes to collect spectacles from patients who either no longer needed glasses after cataract surgery or wished to change their frames to a different style. The boxes, filled with old spectacles, were collected on a regular basis and used in charity vision clinics within the United States.

We interact with our local communities on a regular basis to give back and show our gratitude to our patients and the local administrators. We post photos of our charity work in our monthly e-newsletter to patients, who enjoy them and comment on them when they come into the office. So our good deeds also create good will for Matossian Eye!

Cynthia Matossian, MD, FACS, is the founder and former medical director of Matossian Eye Associates, an affiliate of Prism Vision Group, with multiple offices in Pennsylvania and New Jersey. She specializes in refractive cataract surgery and dry eye disease.

“WHAT IF I WERE ABLE TO HELP?”

BY ALEXANDER HATSIS, MD

In the book Letters to Juliet co-authored by sisters Lise and Ceil Friedman, grandmother Claire reads ‘The Letter’ aloud. She says, “There are two words, what and if, which alone have no meaning but together create a very powerful question.”

What and if, as in “what if you lived in a country that offers no access to medical care? What if you were born into a culture where a cross-eyed child was shunned because it meant he was ‘touched by the devil?’ What if an otherwise healthy 55-year-old is so blinded by cataract that he becomes a nonproductive burden to the family?”

Think how powerful the words “what” and “if” can be when said together. “What if I were able to help? What if I were part of a team that makes a blind man see or that allows a child to go to school and have a normal life?”

Medical missions answer the “what if” question for doctors, nurses, technicians and assistants by providing care for those less fortunate. It’s a way to use your knowledge to help desperately suffering needy people without regard for yourself.

ANATOMY OF A MEDICAL MISSION

For more than 20 years, my wife Jo Ann and I traveled abroad once or twice a year on medical missions. The groups we’ve had the privilege to work with include: Surgical Eye Expeditions (Santa Barbara, Calif.), the Volunteer Health Program (New York City) and Alliance of Jamaican and American Humanitarians (Los Angeles). I go for a week-long mission while Jo Ann and other RNs usually leave a few days earlier to organize the location and prepare for our arrival.

The techs and nurses are the mission’s backbone. They set up the clinic instruments and arrange the operating rooms. They check the equipment and supplies needed to examine more than 1,000 patients during the week. They help in the clinics and assist physicians performing an average of 350 surgeries during the week. The 12- to 14-hour workdays are long and exhausting, but somehow very gratifying.

Once home, the mission team immediately begins preparing for the next trip. Volunteers work throughout the year to collect and inventory donated supplies, organize fundraisers and screen applicants. Mission organizers communicate with volunteers abroad to inform the patients of the mission dates and at times arrange for transportation to the clinics.

Our volunteers here in the States collect the documents requested by the countries’ Ministries of Health to verify physician Board Certification and nurse’s licenses.

WHAT’S IN IT FOR THE VOLUNTEERS?

What do volunteers get from these trips? We get the memories of the smiles, hugs and blessings of those whose lives we’ve changed. We get a heightened level of skill as we treat the most complex surgical cases without hesitation. We get the comradery of some of the most talented people in the world. We get the knowledge of a job well done — and we get the answer to that question, “What if I were able to help”?

Alexander Hatsis, MD, specializes in cataract, cornea and external diseases as well as laser vision correction at SightMD New York in Rockville Centre.

MAKE YOUR OWN NON-PROFIT

BY OMAR E. AWAD, MD

Ophthalmology is a generous specialty. Our training has given us the skills to restore, preserve and enhance vision, and many patients consider their vision as one of the most important senses. We are fortunate to be practicing ophthalmology in the modern era of medicine, and we can use our talents to give back to our community.

I am the president of the Minnesota Eye Foundation, a non-profit organization created in 2005 by a dedicated group of ophthalmologists to enrich the quality of lives in our community through charitable outreach and education. Our foundation developed a program called “The Vision Project” in which volunteer surgeons and our cornea and glaucoma fellows provide no-cost cataract, glaucoma and corneal surgery to low-income, uninsured patients in our community who otherwise would not be able to afford this necessary surgical eye care. We partner with doctors in the referral community to assist an underserved population and have an application process to verify financial need.

A HOME-GROWN MISSION

Our program includes an annual two-weekend event. Most recently, we performed 30 surgeries on two Saturdays using volunteer staff and surgeons. In addition, the program has grown to a year-round initiative that can accommodate more urgent cases as well as non-urgent procedures. This year, we performed 37 additional procedures — both urgent and non-urgent — done during regular weekday hours.

Our foundation also provides support for our cornea and glaucoma fellow to travel to Honduras annually as volunteer surgeons and mentors to the local eye doctors. This year we worked with the local Honduran ophthalmology staff and residents to complete more than 70 corneal, glaucoma and cataract surgeries.

I’m in my second year as foundation president, and I have learned much about non-profit organizations. From the physician standpoint, the most important part is the delivery of the care for a patient in need. But so many other factors are involved in coordinating a team of volunteers: providing the supplies and medications, postoperative care, reviewing patient applications and raising funds. We are fortunate to have a part-time administrator, which has proven invaluable in the coordination of the foundation services.

FUN FUNDRAISERS BRING THE COMMUNITY TOGETHER

Our main fundraiser for the program is Strides 4 Sight, which includes a 5K run/walk and a kids fun run. This is a special time to bring together our team members, community doctors and their teams and families, sponsors and community members alike. The event is hosted at one of the beautiful lakes in the Twin Cities metro area, and a silent auction is held to raise funds to support The Vision Project.

My work with the Minnesota Eye Foundation has allowed me to increase my impact as an ophthalmologist. Ophthalmology has been generous to us, and in turn we can be generous with our skills and resources to help our communities. OM

Omar E. Awad, MD, specializes in corneal diseases, cataract removal and refractive treatments at Minnesota Eye Consultants, in Woodbury, Minn., and is an assistant clinical professor of ophthalmology at the University of Minnesota, Minneapolis.

GIVNG THE GIFT OF SIGHT

BY ROBERT P. LEHMANN, MD, FACS

I founded Lehmann Eye Center in Nacogdoches, Texas, in 1977, and at that time I would occasionally encounter a patient who badly needed cataract surgery but had no means by which to get it. Our “State Commission for the Blind” would help some individuals who could rejoin the work force with renewed eyesight, but others would not qualify for any sort of assistance. Our two hospitals would occasionally bend to my pleading and allow us to do “free” surgery when we could show dire need.

A CHARITY IS BORN

In 1992 my partner (and wife) and I opened our ophthalmic surgery center; soon after, we established one dedicated day per year, the week of Thanksgiving, to perform cataract surgery for those in need and without means to pay. We called this day our “Gift of Sight” and for two decades thereafter, industry was very cooperative in donating the lenses and supplies, including cassettes, viscoelastic, all disposables and even kits and drops. We worked with our IOL and phaco reps who handled our requests. Toward the end of the program, we had to deal with each vendor’s indigent care department.

We did our best to include those who were truly needy and without means, and never charged them a nickel or accepted any third-party payments. The day was without doubt the most gratifying — and often tear-filled — surgical day of the year for all of us working at LEC.

BEWARE BUREAUCRATIC BURDENS

Since then, our traditional program fizzled when regulations became increasingly burdensome. Approximately 12 years ago, the companies started coming under more scrutiny for possible quid pro quo situations, and were compelled to provide documentation. (The upshot: No more sticky notes with a company logo — the reps are now using our pens rather than dropping off theirs!)

Additionally, the extra work involved to document that prospective patients’ incomes fell below the poverty line was time/labor intensive; the red tape became intolerable.

While we still perform occasional pro bono surgeries, two national efforts have become great alternatives: the AAO’s EyeCare America (https://www.aao.org/eyecare-america ) and ASCRS’ Operation Sight Volunteer (https://ascrs.org/foundation/operation-sight/operation-sight-volunteers ). These programs have been excellent options for participating in sight-restoring procedures for the underserved. I would certainly encourage others to seek the opportunity to give a hand up and be blessed in doing so. Nothing has ever brought more joy and reward to our doctors and staff than our pro bono surgeries. OM