LUCY SCHULTZE

Ophthalmology will be buoyed by new technologies for helping people focus after age 40, but may also be threatened in the coming years by dwindling reimbursements, says a leading Mississippi eye doctor.

Dr. James Cook of Cook Eye Clinic in Vicksburg said he's excited about advancements that will provide benefits similar to no-line bifocal eyeglasses to patients through corneal implants and corrective laser eye surgery.

"Back when I got out of residency, I never dreamed that we would ever be cutting flaps on the cornea and putting prescription glasses on the eye," said Cook, who's been practicing since 1980. "Now they're coming out with multi-focal implants where you can see both near and distance."

The same concept will soon apply to LASIK eye surgery, the procedure which makes up about 60 percent of Cook's surgical practice. The remaining 40 percent consists mostly of cataract surgeries — just one area of declining reimbursement that has Cook joining the call for more fairness in compensation.

Over his years of practice in Mississippi, Medicare's reimbursement for cataract surgery has plummeted to about one-third of what it was in 1985, he said.

"I just don't know how doctors coming out of school and into the practice now will be able to buy all the equipment they need," he said. "That's one of my big concerns for the future."

A graduate of Tulane Medical School, Cook is named among LaserVision's top 100 laser eye surgeons in America. He has performed more than 4,000 radial keratotomy procedures since 1993, and more than 2,000 LASIK procedures since 1997. He uses the VISX Eximer Laser and Sunrise LTK Hyperion Laser, and has staff privileges at eight regional hospitals in Mississippi and Louisiana.

Cook is also the only ophthalmologist in his area performing corneal transplants, another procedure he expects to see change in the coming years. Chiefly, new techniques will make it possible to substitute laser incisions for hand-cutting.

"Right now, we have to hand-punch them and you have to sew them in," he said. "But with all the new laser technology, they'll be able to computer-cut corneal buttons that have flaps on the edge and may not even need stitches."

Cook is also looking for other solutions to the problem of loose stitches, especially in children, and expects some of the new tissue glues now used in other kinds of surgeries to eventually be applied in eye surgery as well.

Staying abreast of new technologies in his field has meant attending conferences and taking courses — but also, in Cook's case, trying them out from the patient's perspective.

In 1990, before laser eye surgery was available in the United States, Cook traveled to Vancouver, Canada, to have a doctor there perform PRK, the predecessor of LASIK, to improve his own farsightedness.
"That's how I first got interested in laser," he said. "Innovation is always a part of medicine."


July 2007