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Letters
Difficult Explantation
The following reader/author exchange refers to "Oil Droplets on an IOL" by Lisa B. Arbisser, MD; Nick Mamalis, MD; Deepinder K. Dhaliwal, MD; and Christopher D. Riemann, MD. The article appeared in the "Cataract Surgery Complications Management" column in our March 2007 edition.
In her response to the case presentation, Dr. Arbisser states, "I could then completely open the bag and atraumatically remove the Crystalens [Eyeonics, Inc., Aliso Viejo, CA] through the original clear corneal incision." Having explanted one Crystalens, I can assure you that it is neither atraumatic nor easy to do. The polyamide loops bond very firmly between the capsular leaves. Particularly with an open capsule, it would be unproductive to attempt to perform viscodissection to force the capsular leaves apart. More than likely, the viscoelastic would simply go into the vitreous cavity through the open posterior capsule. The surgeons' only option, if they choose to explant the Crystalens, is to amputate the arms of the lens with scissors. I believe the only time a Crystalens could be atraumatically explanted would be in the first few weeks before the capsular leaves have bonded together.
John R. Wright, DO
Colorado Springs, Colorado
Dr. Wright is correct that the explantation of the Crystalens could be very challenging, although I would attempt it anyway. I think his recommendation to cut the haptics if they cannot be freed is appropriate. I believe that this is actually just the way the real case turned out. Dr. Wright obviously speaks with the voice of experience, and I appreciate his contribution to the subject.
Lisa B. Arbisser, MD
Davenport, Iowa
Industry's Influence on Medicine
The following reader/author exchange is in response to the editorial "Knowledge or Certainty?" by Stephen G. Slade, MD, that appeared in our May 2007 edition.
In his editorial, Dr. Slade recounted hearing a presentation of a multicenter, randomized, controlled clinical trial after which he heard other doctors dismiss the conclusions of the trial based on their own anecdotal experience. I believe incidents like this happen, because more and more ophthalmologists cannot believe the presentations and research they hear at meetings and read in journals from the leaders in our field. This is because the leaders in our field have become so corrupted by accepting large consulting fees from industry that they are no longer unbiased sources of information.
At this past ASCRS meeting in San Diego, California, almost all of our current "thought leaders" who spoke were consultants for one company or another. In listening to their talks, I noticed that, in all the comments they made, not one was the least bit critical about the products made by the company they were consultants for, whereas several comments were critical of their competitors' products. The P value for this happening purely by chance is much less than 0.01.
Last year, in 1 week, I had two drug representatives present "independent" data showing that their prostaglandin was better than their competitor's. The studies looked identical, except that the one performed by company A's consultant showed that company A's product was more effective than company B's, while the study from company B's consultant showed the reverse. Episodes like this make me feel that, since the research leaders in our field are so tainted by the money they accept from drug companies, I cannot rely on their research to direct my treatment of patients. I therefore am forced to try drug A on some patients, try drug B on others, and use my limited anecdotal experience to guide my clinical practice. It is a sad step backward for ophthalmology when, due to the corrupting influence of corporate consulting money, I feel anecdotal evidence is more reliable than clinical studies.
I would implore our leaders to do something about this sad situation. Please stop relying more and more on consulting fees for your income. You may not realize it or want to admit it, but it is having a huge effect on how you conduct your studies and what you say at meetings. It is also having a detrimental effect on our profession, because we now have nowhere to go to get unbiased medical information except to rely on our anecdotal experience. Please stop being drug representatives and return to being doctors. After all, that is why we all went to medical school in the first place.
Michael P. Graham, MD
Orlando, Florida
Dr. Graham raises an interesting point—basically, that of investigative bias. Consulting investigators have reported both worse (the Sunrise Holmium clinical trial)1 and better results than nonconsultants. Distinguishing between science and dogma or anecdotes, however, was the main point of my editorial. I was simply trying to make the case that science is not anecdotes or dogma, no matter who the messenger is, who is paying whom, and how often we forget this. Of course, if a given scientist does not tell the truth, or the "science," that is a different story and not the fault of the science. Certainly, such a sad example would not prove anecdotes or dogma superior to science.
In my example, the person who objected to the scientific findings was a highly paid consultant for his own competing technology and so was "tainted."
Stephen G. Slade, MD
Houston, Texas
Bravo!
The following letter is in response to the editorial "An Unlikely Hero" by David F. Chang, MD, that appeared in our June 2007 edition.
David,
I just opened up my copy of Cataract & Refractive Surgery Today and read your editorial. Bravo for recognizing Jennifer Staple and her passion Unite for Sight!
Having been on the medical board since nearly its inception as well as having spoken at all but this most recent Unite for Sight conference, I am very proud of her accomplishments.
She has faced much adversity as well as second-guessing by the "establishment." Nonetheless, she persisted with her dream and mission. She has motivated many, including myself and, it appears, you as well.
Thanks for the great article and the wonderful recognition that you gave to Unite for Sight and Jennifer Staple. I remain very proud to be on the board of CRSToday for its excellent work and truly pioneering spirit.
Shachar Tauber, MD
Springfield, Missouri
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