NEWSLETTER - WINTER 2002 / SPRING 2003

Highlights

• Beautiful Brazil — Dr. Fine
• Dr. Fine Receives More Awards! — Sherrie Brunell, Administrative Assistant
• Tearing Nothing to Cry Over— Dr. Packer
• Fish Oil Good for Dry Eyes — Dr. Hoffman
• Beach Access
• Vision Benefits vs. Medical Benefits — Belinda Baldwin, CPC, Office Manager
• Testimonials

Brazil meeting faculty at rest.

During the second week in March, my wife Vicky, my assistant Laurie Brown and I traveled to Brazil to participate in the VII International meeting for Advances in Ophthalmology, co-sponsored by the Brazilian Society of Ophthalmology, the Brazilian Society of Cataract and Intraocular Implants, the Brazilian Society of Refractive Surgery, the Brazilian Society of Ophthalmic Administrators and the Medical Society of Maringa, Brazil.

On the first day in Brazil, after landing in Rio de Janiero, we were greeted by our hosts, Drs. Gilberto and Edna Almodin. That evening, they took us to a seven hour parade of the winning Samba school floats in downtown Rio de Janiero. We had front row seats, and we were dazzled by the spectacular costumes, elaborate floats and the inordinately beautiful dancers.

The second day we flew to the Pantanal, a seasonal flood plain in mid-south Brazil close to a town called Bonito. We spent two full days in this uniquely beautiful, unspoiled place, whose major industry is cattle ranching. It is also characterized by unusual natural resources. Among the most striking of the geographical features of the Pantanal are the enormous caves, filled with large stalactites and stalagmites, which were quite fascinating to see. They were the result of carbon hydroxide and water seeping through the soil, into the large open spaces to form candlelight projections from the ceiling and adjacent up from the floor. The caves are incredibly large, and require a great deal of energy and effort with which to climb in and out. In addition, there are beautiful natural springs that are derived from underwater aquifers, which bubble up through the sand.

The rivers are fairly cool in the tropical climate, and are fairly rapid, but they are totally without turbulence. Therefore, there is no stirring of the sediment, which sits placidly on the bottom of the water. The resulting clarity enables one to see seventy to one hundred meters through the river while snorkeling, as well as straight to the bottom of the river. We were provided with wetsuits, and air filled sandals, which enabled us to lie on top of the water to snorkel. We were then carried effortlessly by the current, able to relax and view the fish and underwater plants.

Following our two days in the Pantanal, we flew to Maringa for two days of meetings. We were able to demonstrate our clinical research in new phacoemulsification and intraocular lens technologies and techniques, and Laurie and I performed live surgery to demonstrate refractive lens exchange, utilizing new bimanual micro-incision phacoemulsification. We were also able to observe one of our past fellows, Dr. Leonardo Akaishi, perform his spectacular and flawless surgical technique. We take enormous pride in the fact that we had helped in the training of this young, especially talented and exceptionally goodhearted surgeon. We were so impressed with the work that he is currently doing in Brazil.

On the last night in Brazil, we were treated to an elaborate banquet, where I was celebrated as a special and honored guest of the Brazilian Society of Ophthalmology, which is given once a year to people as an equivalent to a lifetime achievement award. It was a grand manner in which to be celebrated, and we were humbled by the praise of my Brazilian colleagues. The final day was spent in Sao Paulo with friends from the United States. We went to a fauschwada restaurant for a long dinner, and then had an exhausting trip home. We are always impressed with the unique beauty and sweetness of the Brazilian people, and we look forward to a return trip every year. [ top ]

Dr. Fine Receives More Awards!
By Sherrie Brunell, Administrative Assistant

During his recent journey in March to Brazil to participate in the VII International Advances in Ophthalmology Symposium, Dr. Fine was recognized as a Special and Honored Guest of the Brazilian Society of Ophthalmology, in Maringa, Brazil. Dr. Fine was bestowed this great honor due to his tremendous contributions to Brazilian ophthalmology. Dr. Fine has worked with many physicians from Brazil, those who have come to Oregon on fellowships to our practice, as well as those who have learned new phaco techniques and technology by attending Dr. Fine's numerous teaching and lecture seminars held in Brazil during the past decade. By working extensively with the Brazilian Society of Ophthalmology, Dr. Fine has educated and trained many Brazilian ophthalmologists in cutting-edge surgical techniques, helping to bring sight to many in need. It is a wonderful honor to see Dr. Fine recognized by an ophthalmic community who has gained so much in the mutual friendship between our practice and the wonderful country of Brazil.

Dr. Fine was also honored by being invited to deliver the Paton Medal Lecture during the 18th Annual Cullen Course at the Cullen Eye Institute, Baylor College of Medicine, in Houston, Texas. The Paton Medal is awarded in honor of Dr. David Paton, a world-renowned ophthalmologist, whose contributions to the field have been vast, and who continues working toward his goal of eradicating curable blindness. Dr. Fine was delighted by this invitation, and his lecture, "New Perspectives in Cataract and Refractive Surgery", was received with great enthusiasm. A high point for Dr. Fine was being able to receive his Paton Medal from his good friend and colleague, Dr. Douglas Koch of the Cullen Eye Institute. Dr. Fine enjoyed his time in Houston, and he will always remember the honor of being asked to participate in such a prestigious gathering. [ top ]

Tearing Nothing to Cry Over
By Mark Packer, M.D.

Mark Packer, M.D

If tearing is accompanied by irritation or burning it often means that the oily layer of the tear film is deficient. Tiny glands along the eyelid margin produce a clear oil which coats and protects the surface of the eyes. These glands can become inflamed or clogged, so the oil cannot lubricate the eyes. This lack of lubrication causes a feeling of sand or grit in the eyes. The irritation sends a signal that produces reflex tearing. When irritation accompanies tearing the solution is often increased lubrication with artificial tears or quieting the eyes with anti-inflammatory eye drops.

When tears spill out of the eyes onto the cheek the problem may be sagging eyelids. The eyelids work like a pump to move the tear film across the surface of the eyes and down the tear duct into the nose. If the eyelid pump loses its vigor because of drooping lids the answer is often to correct the position of the eyelids. A variety of simple procedures are available to improve the pumping mechanism of the lids and get the tears where they are supposed to go.

Sometimes the tear duct itself may be blocked further downstream, causing overflow of tears. People with a history of sinus disease are more prone to develop a blocked tear duct, although it is often quite common among babies. Some babies are born without a fully developed tear duct. In these cases we can almost always open the duct with a simple procedure and eliminate the tearing. In adults a blocked tear duct has usually been bypassed by connecting the open portion of the duct directly into the nose. This procedure is called DCR (dacryocystorhinostomy). A new advance in DCR is the use of a laser to make the new opening. Using the laser means we don't have to make any incision into the skin or use any stitches, so the recovery time is reduced, and the operation can be completed in a small fraction of the time it used to take. We have been involved in the development of new instruments to make possible Endoscopic Laser DCR, and are very pleased to be able to offer this procedure to our patients.

If you have a problem with tearing, please come in and see us for an evaluation. We'll show you why tearing is nothing to cry over. [ top ]

Richard S. Hoffman, M.D.

The average American consumes an excess of omega-6 by eating milk, ice cream, hamburgers, steaks, and fried food. Unfortunately, omega-6 fatty acids have a detrimental effect on our bodies by increasing inflammatory metabolites. In contrast, omega-3 fatty acids have an anti-inflammatory effect within our bodies and offset the effects of omega-6. Omega-3 fatty acids have been shown to be beneficial to our cardiovascular system by lowering the bad (VLDL) cholesterol and triglycerydes while simultaneously raising the good (HDL) cholesterol. Omega-3 fatty acids can be found in flaxseed oil, salmon, sardines, herring, and mackerel - unfortunately, most Americans do not consume enough of these foods.

Fish oil supplements are rich in ecosapentanoic acid (EPA) and flaxseed oil is eventually converted by the body into EPA. EPA has a strong anti-inflammatory effect in the body and also blocks the conversion of omega-6 fatty acids into inflammatory molecules ultimately resulting in an increase in the production of anti-inflammatory prostaglandins. EPA has been shown to help treat rheumatoid arthritis and increase our natural tear production. It also has a beneficial effect in reducing the inflammatory eyelid condition termed blepharitis. Omega-3 has also been shown to improve the quality of the oil layer of our tears, resulting in less evaporation of the tear layer and an improvement in dry eye symptoms.
Flaxseed oil and fish oil supplements are taken orally by mouth and can be found in most natural food stores. Prolonged omega-3 supplementation can deplete vitamin E levels so it would probably be prudent to supplement this treatment with a daily vitamin E capsule. Patients who have had their gallbladders removed should consult their primary care physician before supplementing their diet with these fatty acids. [ top ]

Beach Access

Our goal at Drs. Fine, Hoffman & Packer is to provide the best in ophthalmic patient care possible. One way that we have strived to provide patient service is to have our world-renowned staff of physicians and ophthalmic technicians practice at our satellite office in the beautiful coastal town of Florence, Oregon. With Dr. Richard Hoffman providing service four times a month, Dr. Packer providing service two times a month, and Dr. Fine providing service once a month, the citizens of the Oregon coast are able to be seen by highly trained physicians in a location that is convenient and close to home. While the size of our branch office may sometimes necessitate a longer wait than usual in our home office, the wait is certainly worth it, considering the quality of care that we are able to provide on a weekly basis right in your hometown. We would like to thank all of our loyal patients for their patience! We feel privileged to be able to serve the coastal communities on a regular basis, and we hope that you will call for an appointment at our satellite Florence office if you are in need of our friendly, professional service without the long drive to Eugene. [ top ]

Vision Benefits vs. Medical Benefits
By Belinda Baldwin, CPC, Office Manager

In the insurance world, understanding your benefits can be very confusing. What provider can you see? Is there an annual deductible to meet before your insurance will pay? Will there be a co-pay or a percentage due at the time of service? Do you need a referral from your primary care physician in order for your insurance to pay?

In the world of ophthalmology, we add to that confusion by asking two more questions: “Are you using vision benefits or medical benefits?” “Is your vision insurance with a different company than your medical insurance?”

Drs. Fine, Hoffman & Packer are physicians and surgeons. If you have a medical complaint your claim will be considered medical unless—you tell us to use your vision benefits.

Why is it to your advantage to know your vision benefits vs. your medical benefits? There are several reasons:

1. Your claim will be filed with the right diagnosis and the correct insurance company from the start.
   
2. Your vision benefits might have less out of pocket expense, perhaps no deductible, or just a co-pay at the time of service. On the other hand, your medical benefits might have less out of pocket expense, perhaps with only a co-pay at the time of service. By knowing your benefit package you can make an informed decision on what is best for you.
3. Depending on your vision benefit package, you may be able to use it once every 12 months or 24 months WITHOUT a referral from your primary care physician.

There are many options to consider and these options change with individual benefit packages. We want to help make this process as easy as possible, but we may not know your particular benefit package. Help us to help you! Know your benefits package and let us know if you are using vision or medical benefits at the time of service. [ top ]

Life Changing
by Sharon Wagner

I am writing to let you know how my life has changed since I received my multifocal lens implants. First, I can see! I can see to thread needles, read a paper, read small print on documents, or look out my window at the fir trees and even the cones on them. I can see what kinds of birds are at the feeder, and read a road map while traveling. Recently, while trying to find an address, I was the one who saw a street sign first. I was never able to do that before; street signs were nothing but a fuzzy blur. Now I can do it without squinting. I just wanted to say how grateful I am to everyone at Drs. Fine, Hoffman & Packer. You have truly changed my life, and now I will never have to worry about cataracts. Thank you. [ top ]

Deep Thanks
By Sharlene Dirks

I had been wishing I could do something about my vision because I hated having to wear my trifocal glasses and could tell that my eyes were getting worse. My eyesight was so poor that, without my glasses, I could not tell whether or not my grandchildren were smiling at Grandma, even when I was holding them in my arms. I knew I had to do something. I had heard the radio commercial for Drs. Fine, Hoffman & Packer, so I called and made an appointment. I got to see Dr. Packer who he told me he could help me so that I would no longer be dependent on glasses. Of course, at that time, he didn't know that I would be one of his difficult patients, but he never gave up on me. It took over a year, and multiple surgeries, but he did it. I'm so thankful for him and his staff. They were always so positive, and I appreciate all of them so much. I do recommend Drs. Fine, Hoffman & Packer to my family, friends and anyone who needs an eye doctor. Thank you so much from the bottom of my heart. [ top]

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