Members of our armed forces have givenand continue to givecourageously of themselves, and they dont to this to win awards and medals.

ECP in Glaucoma Treatment

I enjoyed reading Dr. Dennis Mathews article, Glaucoma: Drops or Surgery? Which Comes First? in the January issue of Review of Optometry.

He mentions endoscopic cyclophotocoagulation (ECP) as a laser therapy indicated in advanced or complicated glaucoma cases, but I have found that it works equally well in treating almost all types of glaucomas. I have routinely performed ECP with an endoscope-controlled diode laser, in patients with primary open-angle glaucoma, low-tension glaucoma, pseudoexfoliation and pigmentary glaucoma. Although it is certainly beneficial in cases that are refractory to medical and surgical treatments, it also benefits patients who have allergy or toxicity to topical medications; who cannot administer their own eye drops (due to arthritis, tremors or forgetfulness); who cannot afford the medications; or who just dont want to use medication. 

Also, I offer the procedure to all my cataract patients who have glaucoma. I use the laser immediately after the cataract surgery, performing two procedures during one surgical session. The laser only adds about five to seven minutes to my overall surgical operating room time. I have found this combined cataract/glaucoma procedure to be both efficient and effective, which is confirmed by a randomized prospective study that compares the efficacy of phacoemulsification with trabeculectomy vs. phacoemulsification with ECP.1 The investigators reported that 30% of subjects treated with phaco/ECP achieved IOP control (below 19mm Hg) without medication, and that 65% achieved IOP control with
medication. In the phaco/trab group, 40% and 52% achieved IOP control without and with medication, respectively.

I believe that optometrists should investigate the benefits that ECP (especially when done with cataract surgery) can bring their glaucoma patients.

Leonid Skorin, Jr., O.D., D.O.

Albert Lea, Minn.


Whole-istic Treatment Beyond Dry Eye

Its ironic how most of the optometrists (as well as ophthalmologists) in this country treat myopia, strabismus, amblyopia and convergence excess/insufficiency as separate entities; yet, on the cover of your February issue, you state: Look at the Whole Picture. On the contents page, it goes on: Treatment conducted in isolation, without the consideration of multiple causal factors, is often doomed to failure.

Why is this only thought of when treating dry eye?

Rick J. Morris, O.D., F.C.O.V.D., Boca Raton, Fla.

Hang Out the Shingle

I applaud Review of Optometrys Senior Contributing Editor Judith Lee for the well-written and truthful practice management article, How I Quit Corporate and Started Cold (February 2007)! Way to go, to all of those O.D.s who successfully realized their dreams.

I empathize with the motivation of the Wal-Mart optometrists, because I was a member of that chain gang for eight years. What started out to be a one-year contract turned into a career. My experience with most of the management was that they did listen, but many times, their agenda was different than mine. Most importantly, I was being held back professionally, since I was passing up other opportunities.

So, I planned to quit Wal-Mart and relocate locally. I discussed the relocation with folks that I trust, and we planned extensively. My goal of private practice soon became a reality.

But, I dont want to give the impression that it was easy. I credit all those that helped me creatively think outside the  big box. My friends helped me stay focused and offered great ideas. I owned the records, so my wife and I started a recall list for potential patients that we hoped would follow. Maintaining ownership of patient records was key to the successful relocation of my practice; its been three years since Ive relocated to two offices, and my patients have followed in droves.

I quit corporate, and so did thousands of my previous patients. Now I have a busy, fun, solo private practice that is booked two to three weeks out, year-round.

I love being an optometrist, but most of all, I appreciate the independent lifestyle that leaving Wal-Mart created for my family and me. My standard of living, quality of life and happiness have all increased. I am home with my family in the evenings and on weekends, and I have financial security and equity in my practice. I truly value the freedom and independence that I had sacrificed for so many years. I love where I am in my career and will never go back on the chain gang again! To O.D.s who are thinking of leaving corporate optometry: Stay true to yourself, set realistic goals and follow your dreams. Just do it!

A.J. DeVivo, O.D.

Ashtabula, Ohio


Montys Misnomer

First, let me preface this letter by stating that I enjoy Dr. Vickers column. In fact, it is one of the first sections I read when I receive the Review. However, I must correct him on his recent referral to a Medal of Honor recipient as a Medal of Honor winner (What Makes a Hottentot So Hot? February 2007).

No one wins this distinction; in fact, most Medals of Honor are awarded posthumously. Decorations are awarded to military personnel, and the military members are recipients. I have had the honor and privilege to have many Medal of Honor recipients as my patients. All were heroes, all gave something and some gave all, but none of them considered themselves winners of their decoration.

Thomas R. Maley, O.D.,

Lt. Col., U.S. Air Force, Retired


Dr. Vickers responds:

Many thanks to Dr. Thomas Maley, Lt. Col. (Retired), who helps us all with his perspective on my recent column about courage. Dr. Maleys instructive commentary truly underscores what the word courage means.

I want to offer my gratitude for his service to this country and to all who have served, especially to those who protect us today. These are folks like usour sons and daughters, dads and moms, brothers and sisters. They offer themselves for many reasons but with one purpose: to be a part of our countrys calling, freedom. They are the reason I am able to sit here in my office, practicing my profession.


1. Gayton JL, Van Der Karr M, Sanders V. Combined cataract and glaucoma surgery: trabeculectomy versus endoscopic laser cycloablation. J Cataract Refract Surg 1999 Sept;25(9):1214-9.

Vol. No: 144:04Issue: 4/15/2007