O.D. Scene

THE ENTERTAINING SIDE OF OPTOMETRY

O.D. Scene creator, writer and editor Jack Schaeffer, O.D.

As I was compiling the interviews for this month’s “O.D. Scene,” I started thinking about the other O.D.s I’ve interviewed for this department. I realized that “O.D. Scene” has not only revealed the personal sides of optometrists, it has also shown the diversity of our profession. Thus far, I’ve talked with contact lens specialists, sports vision professionals, residency directors, retinal specialists and now doctors of optometry who specialize in diabetes: Paul Chous, M.A., O.D., F.A.A.O., and Jeffry Gerson, O.D.

Diabetes is the leading cause of new cases of blindness among adults ages 20 to 74, reveals the American Diabetes Association. For example, between 2005 and 2008, almost 30% of those age 40 and older who had diabetes developed diabetic retinopathy (DR). Of this group, close to 0.7 million, or 4.4%, developed advanced DR.

Optometry plays a significant role in the management of this disease. The ability to positively affect the visual and medical wellbeing of our patients is the most rewarding aspect of our profession.

To find out why both docs are so passionate about helping those who have diabetes, read on. Also, be sure to check out Dr. Smick’s report on his trip to Morocco.

Key Opinion Leaders Weigh in…

Paul Chous, M.A., O.D., F.A.A.O., Tacoma, Wash., and Jeffry Gerson, O.D., Leawood, Kan.

Q: Why did you decide to become an optometrist?

PC: I experienced severe vision loss from proliferative diabetic retinopathy with a vitreous hemorrhage while in graduate school studying political philosophy. My older brother was in optometry school and helped me get treatment from a local retinal specialist who literally saved me from blindness. I became very interested in eyes and the possibility of helping others after this experience.

JG: When I was pretty young, even before high school, I knew I wanted to be an optometrist. The O.D. I saw as a child was a good friend of my family’s. I liked that he had good working hours, drove fancy cars and owned a racehorse. As I got older, I took note that he did not have to deal with blood — another plus — and that people were happier when they left his office than when they got there.

Dr. Chous having a glass (or three) of wine with Dr. Gerson in Willamette Valley, Ore.

Q: Where did you go to optometry school/residency?

PC: I went to UC Berkeley School of Optometry. I did not complete a residency.

JG: I graduated from the IU school of optometry in 1997 and went on to do a residency at the Kansas City VA. The residency had an enormous impact on my life: My residency director/mentor made me think in ways I never had before: I learned to focus on not only the science of being an optometrist, but also on the art. My resident advisor really helped me to become the doctor I am today. I continue to be friends with him and speak with him regularly.

Q: Can you describe your practice?

PC: I am in a group private practice located near a large endocrine clinic serving Tacoma, Wash. The majority of the patients I see have diabetes, pre-diabetes and/or Metabolic syndrome. My focus is on preventing, diagnosing and managing ocular sequelae of diabetes, which includes, very importantly, educating my patients about strategies for good metabolic control.

JG: I’m in between practices right now.

Q: Who has shaped your optometric career the most?

PC: My father, an English teacher, who was the best teacher I have ever had, and my big brother, who saved me from losing my vision by dragging me to a retinal specialist. Within our profession, many have shaped my optometric career, including Larry Alexander, O.D., F.A.A.O., Lou Catania, O.D., F.A.A.O. and Lee Scaief, O.D., F.A.A.O.

JG: My residency mentor, Tim Harkins, O.D., really changed the way I think and made me a much better optometrist and person. Also, I have been very fortunate to have many other mentors — too many to name — who have been so willing to share their advice and experiences with me. I feel lucky to have been able to learn from so many great optometric leaders and hope that I will one day have an impact on somebody’s career the way I have been affected.

Q: Why should an O.D. consider ORS membership?

PC: I am not an ORS member, but I should be. This group includes many of our brightest colleagues, and it is devoted to maximizing the knowledge and savvy of its members and the entire profession regarding the diagnosis and management of retinal disorders.

JG: The ORS is an important organization, especially for retina-focused O.D.s. It offers an opportunity for incredible education, camaraderie and ongoing professional development. Another reason to consider membership: The core group is not that big, so it is easy to become involved and make a difference for yourself, your patients and the profession.

Q: Why are you so involved with the care of diabetes patients?

PC: I developed type 1 diabetes at age 5 and rarely received any real guidance from my healthcare providers about diabetes management and the prevention of disease-related complications, such as retinopathy, kidney disease and the like. In optometry school, I remember a professor saying how frequently he had seen people who had diabetes lose their vision and lives and, no joke, who also said more often than not ‘nothing could be done.’ I knew from reading the Diabetes Control and Complications Trial and the Early Treatment of Diabetic Retinopathy Study that this was balderdash. As a result once I became an O.D., I committed myself to educating and empowering my patients, regardless of whether they had diabetes. I had not originally intended to focus on diabetes in my practice, but after five years, I discovered that I was seeing more of these patients because they had heard from others that I had the condition and was really passionate about helping other patients who have diabetes. Ultimately, my own endocrinologist asked me to move near his practice so he could more efficiently refer his patients to me for eye care, and my own practice took off after that.

JG: We are all seeing an increase of patients who have diabetes in our offices. This is due to the increasing prevalence of diabetes in the United States and around the world. It truly is a global catastrophe in the making. I absolutely think that O.D.s not only have a dramatic effect on ocular outcomes, but also on systemic outcomes of the disease. When we realize, and get our patients to realize, that the eyes are a part of the body and that when one body system is sick, it is likely that the rest will follow; we can help our patients to “see” how important it is to control their overall diabetes.

Dr. Gerson and wife Karen in Bermuda.

The Chous at Walt Disney World.

Q: What new advances do you see in the diagnosis or treatment of retinal disease secondary to diabetes?

PC: I see advances on multiple fronts. Early diagnosis has been facilitated by using retinal imaging, including widespread use of (especially red-free) digital photography, ultra-wide field retinal imaging and OCT. Multiple research institutions are working on devices that allow for the early detection of metabolic abnormalities caused by diabetes within the retina itself, such as retinal flavoprotein autofluorescence. Interestingly, a device that enables early detection of diabetes through glucose-induced lens autofluorescence is already on the market and should help us prevent or delay diabetic retinopathy.

As for treatment, the demonstrated efficacy of anti-VEGF agents for DME has greatly improved visual outcomes, as have improved vitrectomy techniques, such as small gauge vitrectomy instrumentation. Speaking as a patient who has had PRP and struggles with field constriction and poor night vision, I am also excited about the possibility of a micro-pulse laser, which may yield equivalent efficacy to traditional, high-energy photocoagulation without common side effects, such as poor night vision and visual field loss.

In the future, I think we will see increased use of retinopathy risk calculators and the genetic assessment of individualized risk, much like in the AMD arena. Moreover, I think nutritional and small-molecule therapies for prevention and mitigation of DR may play a prominent role quite soon.

JG: The injectable anti-VEGF medications have made a real difference. I think that devices like the GoogleX contact lens, if it makes it to the marketplace, will allow for huge improvements in care. Any system that provides blood glucose measurements, or something that can be approximated to it, without the actual taking of blood will be a game changer in the management of the disease. I am hopeful a topical anti-VEGF medication to decrease patient burden will soon become a reality.

Dr. Chous “channeling my inner rebel.”

The Gerson clan on top of a look-out tower at a local park.

Q: What is the most interesting diabetic case you’ve had?

PC: First, I hate the use of the word “diabetic” when it comes to describing human beings. People are not their diagnoses, and we would all do well to remember that. To answer the question, I have had dozens of clinically challenging cases through the last 24 years, so picking one is hard. That said, the one that comes to mind is the case of a 19-year-old female who had all the ‘classic symptoms’ of diabetes mellitus, though it turned out to be diabetes insipidus secondary to a craniopharyngioma with iatrogenic hypothalamic obesity, and then she developed diabetes mellitus after surgical intervention.

JG: I saw a female patient who was a nurse. She taught me that just because somebody is a healthcare professional, that doesn’t mean they understand their disease or even think rationally about it. It is often up to us, their healthcare provider, to educate them in a way that can help them understand the importance of treatment — both ocular and systemic. This patient has had more than 20 injections between both eyes, complete PRP and multiple vitrectomies. She is still able to see 20/25 OU centrally.

Q: What advice do you have for new optometry school graduates to enhance their ability to handle patients who have diabetes?

PC: Learn as much as you can about the diagnosis and management of systemic diabetes: Eye complications associated with diabetes result from systemic dysmetabolism and vascular compromise, so you must know how to counsel patients and intelligently work with other members of the diabetes care team. Know the eye stuff cold, but also understand the disease; the fundamentals of good diabetes management, and stay on top of the current literature. Scaring and insulting patients generally doesn’t work, so always speak like, act like and be an advocate for your patients.

JG: You can already do it. Just ask questions, listen and be compassionate.

Q: If you could have dinner with anyone living or deceased, who would it be and why?

PC: Mark Twain. He was brilliant, funny, and he loved cats. (My family has two cats.)

JG: My grandmother. She taught me so many life lessons, such as to not to hate anybody. I would want her to see that she had such a positive influence on me.

Q: Who are the members of your family, and what do you like to do for fun?

PC: My wife, Elizabeth, and two boys, Atticus (age 13) and Charlie (age 9). My wife is also an O.D. and my practice partner. We love going to Disney theme parks and Kauai. For fun on my own, I love reading, shooting hoops and playing acoustic guitar.

JG: My wife, Karen, and our sons, Gilli (age 10) and Eitan (age 4). We have been spending a lot of time at soccer games for our older son, and his little brother is his biggest fan. We like going on family vacations. For fun on my own, I like to compete in triathlons, including a 1/2 iron-man triathlon, and I enjoy working out.

Drs. Chous and Gerson filming a diabetes education series for Optspace.com.

Q: What is your favorite movie, book, band and adult beverage?

PC: Movie: The Graduate; Book: It’s a three-way tie: Adventures of Huckleberry Finn, To Kill a Mockingbird and Henderson the Rain King; Band: Virtual Erect Image (an optometry school band I sang for) and Del Amitri; Adult beverage: Jameson Irish Whisky over ice with a lime twist (thanks to Dr. John Amos for this…)

JG: Movie: The Hangover; Book: The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care and Coffee Lunch Coffee: A Practical Field Guide for Master Networking; Adult beverage: a good pinot noir.

Q: Any final comments?

PC: Thanks to Dr. Jack Schaeffer for making me feel important.

JG: I think it is an exciting time to be in optometry. For me personally, I have the great honor and pleasure of frequently lecturing with Dr. Chous on the topic of diabetes. We have great fun, and I hope we get to continue to do this for a long time. Lastly, I really think in general, there are so many things we (O.D.s) can do to help patients and not only satisfy our patients, but have real job satisfaction. There are opportunities to be taken.

Travel, Food & Wine

Here’s Looking At You, Morocco

A trip to Rick Blaine’s stomping grounds and more…

Kirk L. Smick, O.D., F.A.A.O., Morrow, Ga.

My wife and I wanted to visit someplace off the beaten track, and Morocco fit the bill. We arrived in Casablanca, the city made famous by Humphrey Bogart and Ingrid Bergman. We had a driver and very knowledgeable guide for the entire trip.

A religious experience

While in Casablanca, we visited the Hassan II Mosque. It holds 25,000 worshippers in its great hall with another 80,000 on its outside grounds. In addition, its minaret (tower) is the tallest in the world at 689 feet.

The Hassan II Mosque.

Unchanged by time

Our next destination was the Atlas Mountains. We were awe-struck by the natural scenery and its rural mountain dwellers. These individuals live in mountainside villages of 30 to 50 families with no electricity or any modern conveniences. We noted the women washing clothes in the region’s rivers and carrying firewood for miles, while walking alongside donkeys. The rural mountain dwellers have maintained this simple lifestyle for thousands of years.

At the top of the mountain range, we spent a couple of nights at Kasbah Tamadot, Sir Richard Branson’s famous oasis inn.

Film locations

From the Atlas Mountains, we went to the Ouarzazate Province, which is famous for the filming of several movies, such as Lawrence of Arabia.

The great bazaar

Now, it was time to visit Souk, or the great bazaar, in Marrakech. It contains an indoor labyrinth of hundreds of small shops going in all different directions, as well as a great outdoor plaza that has individual tents and stalls set up each afternoon and evening. Hundreds of thousands of people mingle shoulder to shoulder, and an array of cobras can be seen dancing to the flutes of snake charmers.

Moroccan cuisine

Tagines, or shallow cooking dishes that have tall, conical lids, cooked most of our meals. Couscous, the national grain, accompanied many of them.

Visiting this country was an adventure we’ll never forget. I would recommend this destination to any of my friends.