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DR. VIRGINIA LUBKIN: An Oculoplastic Surgeon for all Seasons

by: Perry Garber
Category: SASOPRS Article Blogs
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Feb
25

DR. VIRGINIA LUBKIN: An Oculoplastic Surgeon for all Seasons
By Perry Garber

Any tribute to women in Ophthalmic Plastic Surgery must start with Dr. Virginia Lubkin. Dr. Lubkin was one of two women to be a charter member of ASOPRS. She was truly a woman physician for all seasons, attending medical school when women in medicine were scarce and practicing Ophthalmology and Ophthalmic Plastic Surgery before Oculoplastics was a specialty.

Virginia Leila Lubkin was born in New York City on October 26, 1914. She attended New York University, graduating Summa Cum Laude in 1933 and graduating AOA from Columbia Physicians and Surgeons Medical School in 1937. After her internship, she completed her ophthalmology training at multiple hospitals in New York in the early 1940s, followed by ophthalmic plastic surgery training with Dr. Wendell Hughes. 

While she was a resident at Mount Sinai Hospital, an attending told her, “You will open the field of Ophthalmology to American women.”

Dr. Lubkin was in private practice and on the staff of Columbia Physicians and Surgeons and the New York Eye and Ear Infirmary (NYEEI) from 1945 to 1990. In 1978, she founded the Aborn Center for Eye Research at the NYEEI, which was renamed the Aborn-Lubkin Eye Research Lab in 2004 in her honor.

Dr. Lubkin was a clinician, teacher, and researcher with numerous eclectic interests. In 1959, she published a paper with Dr Hughes introducing a fornix conformer. Her interest in history and archeology led to an article summarizing the history of Ophthalmic Plastic Surgery from 3000 BC to 1000 AD. Her intense curiosity led her to numerous research projects in Ophthalmology and Ophthalmic Plastic Surgery, which was the reason she established the Aborn Center for Eye Research.

During my Oculoplastics Fellowship in 1975-76 and my subsequent years as an attending at NYEEI, Dr. Lubkin was always ready to teach and shared what she had learned and experienced in her many years of practice with the residents and fellows. At the time, she was involved in research regarding dry eyes and frequently discussed her work.

Dr. Lubkin was active nationally and internationally. She was active in the American Academy of Ophthalmology, teaching a course in “Complications of Blepharoplasty” during the 1980’s. Internationally, she lectured in many countries. Her energy and interests went well beyond Ophthalmology, encompassing history and archeology as noted above. She was also on the Board of Directors of The Jewish Guild for the Blind in NYC.
Virginia was a very upbeat person, getting involved in everything around her and ahead of her time. For her generation, it was unusual that she kept her maiden name, never changing it to her married name. And she effectively balanced a challenging professional career with a full family life. I remember her at many spring meetings, passing me on hikes, frequently with her husband, affectionately referred to as “Marty.”

When Virginia Lubkin died on May 5, 2004, her family consisted of her husband, four children, 12 grandchildren, and 10 great-grandchildren. She certainly led a prolific, energetic life, breaking barriers and being a role model for women in medicine. She played an important and integral role in the founding of our subspecialty.

Women and ASOPRS Margaret "Peg" F. Obear

by: Jemshed Khan
Category: SASOPRS Article Blogs
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Feb
25

Women and ASOPRS 
Dr. Margaret Obear

The story of women and ASOPRS* begins with Margaret (Peg) F. Obear 1906-2001), the senior-most member of the “Gang of Five” Oculoplastic surgeons (Charles Beyer, George Buerger, Thomas Cherubini, Robert Wilkins, and Peg Obear) from New York who founded our Society in 1969. All five were fellows of Byron Smith, MD. They met after hours at Donohue’s pub and restaurant on Lexington Ave in New York City to discuss cases and plot towards our specialty having its own society. Obear, transplanted from California to New York, was well-connected, and she enthusiastically lobbied the leading oculoplastic surgeons across the US to support their cause. The “Gang of Five” founded ASOPRS in 1969 as a nonprofit educational 501(c)(3). This was a time when Oculoplastics was deciding whether to form its own society or ally with larger specialties such as plastic surgery or The American Academy of Facial Plastic Surgery. Peg’s efforts at reaching out to the renowned oculoplastic surgeons of the time led to a seminal 1969 ASOPRS organizational meeting held at the Palmer House in Chicago; about sixty persons attended, bylaws were adopted, and Wendell Hughes, former President of AAOO was elected the first ASOPRS President.
Regarding Obear, another founder of ASOPRS, George F Buerger Jr wrote, “If it hadn’t been for (Obear’s) enthusiasm and hard work, the ASOPRS wouldn’t be.”  Obear then served on the first-ever ASOPRS executive committee and was elected President in 1972.  Unfortunately, Obear developed a serious illness and retired from Medicine in 1974, although she still attended some subsequent meetings. She died at the age 94. It would be two decades before ASOPRS elected its second female president, Bernice Brown (1990). Using the language of the times, both of these women were pioneers, blazing trails and clearing the way for those who would follow. As Bob Dryden once quipped at a lecture he gave in Kansas City, “Pioneers are the ones who take all the arrows, the settlers come later and take the land.” The careers of Drs. Obear and Brown, as well as female physicians in general, reflect the downstream ripple effects of US women having entered the factory and industrial workforce during WWII, thereby encouraging later generations to enter higher-paid professions.
 
ASOPRS Membership
Year Female percentage Female/Male Total Membership
1970 3.9% 2/49 51
1994 5.5% 18/309 327
2019 18.6% 154/674 830

During WWII, female employment jumped from 27% to 37%. These women were paid 55% less than their male counterparts. With America's WWII factories, civilian population, and electrical supply lines under no risk of aerial bombardment, the US tapped the female labor pool so as to ramp up military-industrial production. At the same time, European countries were busy bombing and sabotaging each other’s infrastructure and industrial capacity. Some things never change. The US emerged as the victorious superpower capable of projecting kinetic force anywhere on the planet.

Women’s entry into the workforce naturally spurred an interest in higher-paid professions. However, the female path to higher education was a bumpy ride. Since college tuition was expensive, many families in the 1950s only sent the boys to college. Women who attended college were often offered two options; nursing or teaching. Upon graduation, women received a lower salary than men for the same work, the argument being that men were supporting a family, but women would get pregnant and quit. "The pill" and declining fertility rates helped women pursue their goals of equal pay and legal protections.  Fast-forward to the Women's Movement of the 70's and 80's which favored women in career roles. Workplace female figures such as Mary Tyler Moore appeared routinely on TV and in movies. This encouraged even more women to enter into the educated workforce, where they demanded equal treatment. The net effect was a gradual acceptance of women in the workplace as co-equal to men (Traditional roles still play an equally strong and often fulfilling role in many women's lives). As a result, college-educated women in American society have achieved remarkable progress in creating a path into the once-hostile workplace, similar to the achievements of minorities and gays. Nonetheless, the gender-based pay gap still persists. As well institutional racism and sexism are still present, but they are no longer omnipresent and unchallengeable. Troubling and destabilizing class, gender, and race-based wealth inequalities are widening.

My medical class of 1982 was 45% female. OR signage back then indicated Doctors' Changing Room and Nurses' Changing Room. It didn't seem that big a deal to me at the time; it took decades for me to understand the institutionalized nature of sexism. It was against this background that I first attended an ASOPRS meeting in the late 1980’s. Though women were common in medical school, it was rare to see women in Presidency or upper leadership positions, but I remember many notable and esteemed exceptions such as Barbara Beatty and Eva Hewes of Hewes flap fame, charter member Virginia Lubkin, and of course, Bernice Brown. My interaction with Dr. Bernice Brown concerned my OPRS journal manuscript entitled "Does Decompression Diminish Dysthyroid Discomfort?" I was jazzed that every word in the title began with the letter "D." 

However, a senior reviewer rejected the manuscript, asserting that in his decades of practice, he had never encountered a thyroid patient with orbital discomfort. Undeterred, I immediately sent a letter to each study subject, explaining that OPRS had rejected the study because a senior reviewer didn't believe that they had experienced any discomfort. I asked each to describe in their own handwriting the discomfort they experienced. All twelve responded quickly in defense of their personal discomfort. I bundled the descriptions and mailed them to Dr. Brown, receiving, shortly thereafter, an acceptance. That experience convinced me that being right and marshaling facts and logic could win the day. My respect for Bernice Brown was bolstered by her valuing scientific merit over the opinion of a senior reviewer.

In closing, the movement of women into higher paying male-dominated professions has taken centuries, culminating in our modern capitalistic society which combines the benefits of traditional male employees with the added bonus of a highly educated female employee pool. This effective doubling of workforce creates a sustainable competitive advantage for the US, whose financial and military dominance depends upon labor supply, economic power, and intellectual capital. While our specialty was begun by white male military WW2 surgeons, ASOPRS was founded by five members, possibly the most important of which was Margaret “Peg” Obear. She and four other Byron Smith fellows envisioned and championed our Society. Peg Obear navigated the traditional and sexist boundaries of her time to manifest her vision for ASOPRS.  We are all beneficiaries of that vision and enthusiasm. It would take another two decades before ASOPRS elected another female president. Was that sexism or demographics? Regardless, as the number of females in ASOPRS rose, female leadership became normalized. We are a microcosm of society at large, subject to the same philosophical differences, prejudices, and disagreements. While it is easy to focus on our storied individuals, there have been many women in ASOPRS who have quietly contributed. It is important that we honor our collective past-- all of it, and no one part at the expense of any other.
 
*Much of the biographical information and quotes for this article were derived from David Reifler’s ASOPRS 50th anniversary book: https://issuu.com/nextprecisionmarketing/docs/asoprs_50th_anniversary
 

Trailblazing Her Path: Meet Duke's First Female Ophthalmology Resident Christine C. Nelson

by: Rob G. Fante
Category: SASOPRS Article Blogs
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Feb
25
Trailblazing Her Path: Meet Duke's First Female Ophthalmology Resident Christine C. Nelson
Among the great and remarkable people in our field, Dr. Christine Nelson has a place of honor.  She currently holds the Bartley R. Frueh MD and Frueh Family Professorship in Eye Plastics and Orbital Surgery at the University of Michigan, where she has an appointment as both a Professor of Ophthalmology and a Professor of Surgery Section of Plastic Surgery. She is the Director for one of ASOPRS’ longest-running fellowships, with dozens of grants, scores of peer-reviewed publications, and hundreds of lectures and visiting professorships.  But the path to such impressive success has not been easy, and Christy has had to overcome many challenges, including being a woman.

Dr. Nelson grew up in Switzerland and chose Wellesley College for her re-entry into America.  After completing her BA in Biology and completing medical school at the University of Cincinnati, she matched in ophthalmology at Duke University.  Christy was the first woman to be a resident in ophthalmology at Duke.  She remembers that some of the faculty greeted her with “hi… we wanted a man.” The Chair, Robert  Machemer, was supportive, but others were not happy.  She found that she was on call every holiday in the 1st year, as she gradually won their trust and respect.

Christy became passionate about oculoplastics and began looking for a fellowship. She learned which ones would not take a woman (e.g. Dick Tenzel); and along the way, she met with Joel Glaser who offered her a neuroophthalmology fellowship at Bascom Palmer which she took 1983-84, immediately following residency.  The following year, she ended up at UCSF as one of the 1st women (Bernice Brown was the first) with Crowell Beard, Earl Rathbun, and John Sullivan in what they called the “freeway fellowship” for 12 months in 1984-85.    

After her graduation from the oculoplastics fellowship, Christy joined the faculty at the University of Michigan, Ann Arbor.  She felt like she had a lot to prove, as very few women had gone before her.  Perhaps because the only previous woman faculty quit after one year, her chairman, Paul Lichter, offered an extension to achieve tenure – it’s unclear if he thought she was not ready, or it was male prejudice, but she didn’t need the extension.  She found it harder to get asked to be on committees, to be invited to collaborative meetings, or to be invited to speak.

She remembers that her husband Willis was always there supporting her as they raised their two daughters.  For the first 10 years, she was frequently working or on call.  But they always made time for dinner together even if one of them had already eaten.  She remembers telling herself: “you can have it all, but not all at once”.  She remembers that “once I got tenure, I didn’t care about becoming full professor because I wanted to be with the kids.”  She and Willis tried to alternate days on primary duty for childcare.  Christy says now, “my children are proud of my working – they say it made them more independent, and they admire me as a role model.  I just did what I had to do.”  Willis has passed away, and her oldest daughter, Elizabeth, lives in Ann Arbor while Catherine, her second daughter, lives in Texas.

Christy got involved in Women in Ophthalmology early in her career.  She started in the 1980s and got great advice from other women about tactics to enhance her trajectory.  They told her that if you wanted to be on an AAO committee, she should write to several of the chairs.  She tried it and remembers that “One never answered, and another replied, ‘why would I want you?’”  Ultimately, the third took her.  Later, she became vice chair of that committee.  Now, she enjoys mentoring and would be happy to chat about ideas and guidance with interested young oculofacial plastic surgeons.  Among her pearls of wisdom: Be open to opportunities that come along.  Some are unplanned but many can be pursued.

Christy’s work as an educator and researcher has been prodigious.  In 2010, she was the first woman to be invited to give the prestigious Wendell Hughes lecture (a combined AAO-ASOPRS honor).  She chose the topic: “From Bench to Bedside: Genetics of Congenital Anopthalmia,” reflecting her work with a gene associated with retinol binding protein transporter that led to a novel treatment for children with MAC (microphthalmos, anophthalmos, coloboma) spectrum of congenital disease.  Her research interests have ranged from periocular malignancies to thyroid eye disease, but most recently, she has become very active in organizing and writing about global ophthalmology.

About 15 years ago, Christy began to be very active in the international community, initially with the International Council of Ophthalmology and later the World Association of Eye Hospitals (she is the Chair-elect at present) and the ASOPRS Global Opportunities Committee.  Since 2015, she has been the co-director of the Kellogg Eye Center for International Ophthalmology and has worked assiduously in Ethiopia at St Paul’s Millennium Medical College in Addis Ababa. Her goal has been to help them establish an academic department and research program.  She describes this as “Very exciting!  It has been wonderful to share the fun and awe.  To use the old adage, we’ve tried to “teach them to fish instead of giving them fish.”  The western allopathic ideas around medical ethics, fair compensation, and peer-reviewed scientific publications were mostly new to them. She recalls that there were just over 70 ophthalmologists in the entire country when she started, and now they have opened more residencies, and the total is around 140 ophthalmologists.  In addition, fewer are leaving the country as the community has become stronger.  Dr. Nelson was given the Humanitarian Award by Women in Ophthalmology in 2022 in recognition of this work.  Half of the Michigan ophthalmology residents are involved in this outreach program so Christy’s work is likely to continue when she retires. (In fact, one of them did a survey showing that residents are more likely to stay involved in global humanitarian work if they participate in residency.)  She has recently been invited to try to get something similar going in Nepal.

Dr. Christine Nelson’s evolution from a ground-breaking female resident at Duke to a ground-breaking Hughes' lecturer to a ground-breaking global educator has been remarkable.  Her academic work, together with her teaching, mentoring, and leadership, has inspired and propelled many young women (and men – including me) to pursue similar interests over the past 30 years. 

Multigenerational Physician Families in Shifting Times

by: Jemshed Khan
Category: SASOPRS Article Blogs
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Feb
25

Editorial by Jemshed Khan

In the eighties ASOPRS was smaller, more like a family. Spouses volunteered to assist with meeting registration. Children frolicked poolside at Spring Meetings, splashing and laughing and running. Over decades one watched them grow. Some of the generations of ASOPRS physicians that I observed included the Buergers, Schaefers, Epsteins, Rootmans, Katowitzes, Tses, Gavarises, Hollstens, Perrys, Solls, Stephensons, and Stasiors.

Studies of children who follow a parent into medicine reveal several common factors at play. The children recall visits to the medical workplace where enthusiastic coworkers asked if they planned on becoming a doctor too. The seed was planted. Inevitably, odd medical artifacts made their appearance in the home: a specimen in formalin, a bag full of sheep eyes, a glass prosthetic eye. These bizarre occurrences seemed normal in medical families. 

Nature and nurture influence career choice in physician offspring. Physicians are often competitive and intelligent: both traits favor a career that demands much sacrifice and effort, but also provides ample rewards. Physician households can bankroll tuition costs that would bankrupt middle class families; Ivy League tuition can exceed $90k/year. The intellectual and emotional challenge, altruism, income, and social status associated with being a physician all motivate career choices in multigenerational physician families.

Following a parent into Oculoplastics was easier when medicine was mostly solo or small group private practice.  Back then, after residency one either "hung out a shingle," or went on to a fellowship. Most preceptors were private practitioners who helped at the University. Private practice was a small business enterprise built upon personal excellence, local relationships, and patient care. The physician of that era was a highly autonomous being whose expertise spanned several domains, whose level of education often exceeded that of other health care workers, and whose judgement and skill would routinely make the difference between life and death. 

Much has changed. Especially the decline in solo practice, the increasing expertise of other health care workers, and the loss of status afforded physicians. Most of all, institutional and government policy is now driven by corporate rather than public interest. Let's explore these changes and how they relate to physician families.

For millennia, human offspring worked alongside parents and acquired their skills. This specialization of labor yields profitable efficiencies or "comparative economic advantage" (Ricardo's theory).  This advantage was passed down the family tree; offspring would inherit a parent's trade or practice without having to build a business from scratch. As privilege, power, wealth and skill accumulated across generations, they were subject to race and gender-based barriers. Fortunately, those barriers are breaking down. Unfortunately, transfer of business and skills across generations has become difficult because private ownership is being replaced by profit-driven corporate and institutional control. Let's examine the financialization of the medical sector; why it happened: in doing so, we can understand how medicine has changed.

Beginning with Medicare, American medicine became increasingly regulated, specialized, and bureaucratic. The real client was the third-party payor rather than the patient. Physicians responded by forming partnerships and groups to dilute overhead and centralize onerous insurance tasks. This led to formal compensation plans and detailed revenue statements. 

Group practice Profit & Loss statements were the beginning of the end because they attracted the attention of venture capitalists (VC). Venture capitalists feed off surplus capital generated by inequitable Federal tax policies and obscene tax favoritism (e.g., carried interest, long term capital gains). VC examined practice profitability and began acquiring practices. They folded practices into publicly traded entities whose stock then traded at multiples of earnings. Most private group practices could not resist the immediate personal wealth generated by selling out to private equity. Thus, between institutionalization, onerous regulation, and financialization, the practice of medicine was forever changed. Given the Federal tax policies at play, physician's taxed at 40% personal rates had zero chance of prevailing against VC on such an uneven playing field.

Some private equity physicians still enjoy practice, but many find the patient load, time demands, and loss of autonomy to be extremely stressful. Many employee-physicians and university physicians have been relegated to line-worker status. They function as relatively powerless and easily replaceable widgets in a profit-driven system that is evolving to provide efficient care at the lowest cost to maximize financial return.

In some places medicine has been dumbed down to the point that the doctor just needs to perform their assigned task. Shift work. This is reflected in Medical School acceptance criteria that no longer prioritize predictors of academic performance such as standardized testing. The knowledge and judgement that physicians once held in their heads is being replaced by AI, practice patterns, and non-physician providers. Diagnosis and treatment are relegated to algorithm. The patient's perception of their encounter and of their provider is often more important than tangible health benefit. Why? Because if the patient doesn't complain, management is free to demand higher productivity and insist that doctors smile through gritted teeth. Fortunately, the pendulum always swings.

In our own field we have seen fellowship oversight outsourced to AUPO. In effect, training has been transferred from a preceptor-centered model to a department-centered model.  This reflects the underlying migration of physician practices from solo to group to corporate/institutional. While this is contrary to the autonomy of our specialty, the younger generation faces a different future and seems willing to offload the administrative burden of fellowships to prioritize other unspecified goals.

The next generation of physicians will look at medicine as a less daunting occupation. They will gravitate towards definable hours and life-work balance. Medicine will become more of a nine-to-five job and less of a career. Many will favor institutional and organizational prestige over personal merit and will be required to demonstrate group allegiance rather than exceptional performance. Allegiance will shift from the patient and the profession to the employer. This is an intended and socially managed outcome designed to maximize shareholder wealth.

For sure, earlier times required a different level of commitment, a different mindset. Nowadays a career choice in Medicine is less influenced by family interests. Many young doctors aspire to executive or corporate leadership positions. Direct patient care to them is menial. Despite all of this, I would never discourage a career in medicine. It is a broad enough field that one can still carve a rewarding and challenging personal path while providing excellent personalized care. Old school for sure. But how is this not the highest calling for those who wish to better the lives of others? We are fortunate to have practiced through the best of times.  BACK TO Newsletter

Atta Girl”: One Unconventional Journey Begets Another

by: Tamara R. Fountain
Category: SASOPRS Article Blogs
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Feb
25

Bernice Z. Brown, M.D.

 “Atta Girl”: One Unconventional Journey Begets Another
by Tamara R. Fountain

Do you know who Bernice Z. Brown was?  Well, let me tell you about this woman who left a lasting mark on the field of ophthalmic plastic and reconstructive surgery.  Born in Altoona, PA, she headed west and never looked back. After a BA from UCLA, she went across town to USC for her MD and stayed on as the first woman accepted into ophthalmology residency at USC/Doheny Eye Institute.  She pursued oculoplastics training with two of the founders of the field: Crowell Beard at UCSF and Alston Callahan in Birmingham, Alabama.  

Many in our ASOPRS community are familiar with her accomplishments – Inductee of Phi Beta Kappa and Alpha Omega Alpha societies, Lester T. Jones Anatomy Award recipient, co-editor of Ophthalmic Plastic and Reconstructive Surgery, and President of ASOPRS in 1990. She was a Clinical Professor of Ophthalmology at USC and was actively teaching the next generation of oculofacial surgeons until her death in 2004.


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ASOPRS JOURNEY IN THE WORLD OF ADVOCACY: MY QUEST

by: Stuart R.Seiff
Category: SASOPRS Article Blogs
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Sep
05

ASOPRS JOURNEY IN THE WORLD OF ADVOCACY:  
MY QUEST
Commentary by Stuart R.Seiff


As I began my career in medicine, I never thought that I would be sucked into the world of medical advocacy.  But I guess stranger things have happened. Don Quixote sought to save the world by slaying windmills.  Such has become my fate as well.
 
My first role was as an associate preceptor (program director) and then as a preceptor.  Somehow, I was asked to chair the Preceptors Committee, which got me a non-voting role on the Executive Committee, followed by a job as Secretary of Meetings.  From there came the three-year Presidential track, followed by the Chair position on the Committee for Government and Intersociety Affairs (a 10-year term). All of this provided me with a window seat on the EC for over 2 decades.
 
When I first entered ASOPRS in the late 1980’s, oculoplastic surgery was finding its way among the plastic surgery specialties, and it seemed that our relationship with ophthalmology and AAO was a bit of a ball and chain.  Facial Plastic Surgery was successfully battling general Plastic Surgery for its share of the pie. Although the AAO had recently brought all of ophthalmology under one umbrella, there was a sense ASOPRS needed to break free.  With the success of Facial Plastics in establishing a Board, such talk started among ASOPRS members as well in an effort to get the recognition we wanted among other specialties and the public.
 
Under the leadership of such luminaries as Mike Hawes, Bill Nunery, Russ Gonnering, Brad Lemke, Ralph Wesley, Chris Fleming and others, Board Certification became the holy grail.  We learned that this would need to be blessed by the ABO.  After many requests, Dennis Oday, then chair of the ABO, finally agreed to look at options for Board Certification of “Oculoplastic Surgery” if we could get buy in from the “Greater House of Ophthalmology”.  This meant approval by the AAO Counsel.  Our leadership group learned to advocate and “work the room.”  We next needed an ACGME curriculum, which was spearheaded by Bryan Sires.  We were successful and the curriculum, with positive modifications, still exists and is the model for our ASOPRS fellowships.  We were slowly learning how to advocate for ourselves in a very big house of medicine.
 
Roger Dailey took on ASOPRS Advocacy as his AAO LDP project and brought home the concept that “if we are not at the table, we are on the menu.”  Our destiny was cast.  We continue to struggle with the Board Certification issue, but that quest illustrates our need to establish relationships within and outside of ophthalmology.  Roger, Chris Fleming, Bob Kennedy, Jeff Nerad, and I really pushed that envelope.  This led to the creation of the Committee for Intersociety and Government Affairs that I had the pleasure to chair for 10 years.  I passed the chair to Mark Mazow, who has incredible insight into how to navigate the waters of organized medicine and government.  With this Committee, ASOPRS had the advantage of “institutional memory,” and we were able to engage medicine and government on many levels on behalf of our members.
 
A glimpse at what ASOPRS has accomplished is impressive. 
 
Roger Dailey encouraged us to become a part of the Physicians Aesthetic Coalition (PAC).  This enabled us to meet and find common ground with our aesthetic surgery Core 4 partners.  These contacts have been invaluable as we navigated the troubled waters of regulatory medicine.
 
ASOPRS became involved in the Surgical Scope fight because optometry perceived eyelid surgery to be an area where Ophthalmology might let them get a surgical foothold.  Their first win was New Mexico, and since then, ASOPRS has been at the table with AAO fighting, state by state, with impressive success to date.  However, I think we need to be flexible in this fight moving forward. 
 
The bundling of ptosis and blepharoplasty was clearly a blow to our members.  Although we have not been able to overturn this, our Society has provided members with work arounds.  That said, when CMS decreed that a Medicare beneficiary could not undergo a cosmetic procedure as part of a functional procedure, ASOPRS and AAO leadership, along with a coalition of our plastic surgery colleagues, promptly got this overturned.  These relationships are invaluable.
 
ASOPRS has worked with our AAO colleagues to limit Medicare RAC and SMRC audits.  We continue to try to reduce the burden of prior authorization, as well as these audits, in many areas of our field.
 
When COVID struck, ASOPRS and AAO worked with Congressional contacts and, ironically the restaurant industry, for modifications to PPP Loan rules that allowed a larger percentage of the loan to be used for operating expenses. We also worked with our colleagues in the House of Medicine to modify FDA limitations on office compounding of drugs.
 
The role of an organization such as ASOPRS is to provide education and advocacy for our members and patients.  However, advocacy is a bit like Don Quixote’s quest to make the world a better place.  Slaying windmills is a good place to start, but beware that even when many of the windmills are eliminated, more will grow.  Thus, as our Senior members fade into the sunset, ASOPRS needs the next generation to pick up the torch and protect the interests of our members and patients. BACK to Newsletter
 

SASOPRS Jonathan J Dutton Interview

by: John Woog, MD
Category: SASOPRS Article Blogs
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Sep
05
SASOPRS Jonathan J Dutton Interview
Interviewed by John Woog, MD
SASOPRS:  Jonathan, we understand that your professional trajectory has been somewhat unusual, in that you had an illustrious career prior to pursuing medicine and oculofacial surgery, serving as an internationally renowned paleontologist and evolutionary biologist and a named Professor in the former field at Princeton University. How did you become interested in evolutionary biology?
J. Dutton:  In college, I became close to the chair of biology and a herpetologist, and I spent many evenings on Long Island observing, catching, and raising frogs, salamanders, and various snakes with him and his family. I volunteered as a research assistant at the American Museum of Natural History and spent several summers at the Museum’s research station on LI.  Because of my published research on fish behavior, I was awarded a fellowship at Harvard for PhD studies.  After a year with the icons of evolutionary biology and paleontology at Harvard, I decided to major in vertebrate paleontology and evolutionary biology and spent years collecting and studying fossils in East Africa. Princeton offered me a position as Sinclair Professor of Paleontology and Director of the Princeton Natural History Museum, which I accepted in 1970.

SASOPRS: We've heard that visiting your home is a little like visiting the Smithsonian, with a collection of fascinating artifacts from your paleontology-related travels around the world. What were some of your most unique destinations and most memorable academic paleontology projects?
J. Dutton: During my expeditions to Africa, I became fascinated with primitive art, which was used by the local peoples for social functions, religious symbolism, functionalism, and utilitarianism rather than purely creative purposes. I acquired many pieces from the local villages and from the doctors at a small one-room hospital near Lake Turkana in Northern Kenya who often collected artifacts in exchange for medical treatment. My most memorable project was working with Richard Leakey as co-investigator of several National Geographic-sponsored expeditions to Lake Turkana.  For my PhD thesis, I spent 14 months outside the US, traveling around the world studying fossils in 18 countries.

SASOPRS: Can we ask what motivated you to pursue a career in medicine, given your tremendous accomplishments in paleontology and evolutionary biology? And how did you come to choose ophthalmology and oculofacial surgery? 
J. Dutton: Fieldwork in East Africa was in the deserts where midday temperatures reached 120° F.  We always returned to camp for a few afternoon hours where most of my colleagues and staff took a nap.  Harvard had an intensive 2-week medical course for faculty and fellows who would be working away from medical help.  So, I was the medical officer for the expeditions.  While everyone else napped, I treated local tribespeople who came into camp with infections, spear wounds, cobra bites, and occasionally crocodile injuries. After doing this for five years, I decided that this was what I wanted to do. 

SASOPRS: You are known as an innovator in the discipline of oculofacial surgery. You developed an ocular oncology clinic, for example, and served as one of the principal investigators in the COMS (Collaborative Ocular Melanoma Study) study, the largest NIH-funded ocular oncology study to date, when this was not a common practice focus area for oculofacial surgeons. What prompted your interest in ocular oncology?
J. Dutton: I was on the faculty at Duke University in 1985 when the COMS study was created. Duke was asked to participate, and my chairman asked me to be involved since I took care of other ophthalmic malignancies.  I became the Duke COMS PI until 2000 and then moved to the University of North Carolina where I continued COMS participation.

SASOPRS: You've also made major contributions in thyroid eye disease, serving as board member and President of the International Thyroid Eye Disease Society (ITEDS) and founder of the ITEDS Tissue Bank. Can you tell us a little about the background and goals of this initiative?
J. Dutton: The International Thyroid Eye Disease Society (ITEDS) was originally founded in 2006. Since then, it has expanded to include members from nearly every continent. The goal of ITEDS is to promote and facilitate collaborative interactions among authorities to define clinical disease parameters, understand pathogenesis, and develop tools for the assessment and treatment of thyroid eye disease. Members of the society are interested in studying TED from basic science and clinical perspectives to evaluate patient-centered outcomes and foster therapeutic advances. The ITEDS Tissue Bank was created in North Carolina in 2013. The bank collects, characterizes, annotates, stores, and distributes biospecimens for research purposes to help support better understanding, education, and research for TED. 

SASOPRS:  On behalf of ASOPRS/SASOPRS members and oculofacial surgeons worldwide, we’re pleased to celebrate the 15th year of your service as Editor-in-Chief of our flagship journal, OPRS. What have been some of the most notable challenges, rewards, and changes that you've experienced during your tenure as Editor?
J. Dutton: I was exceptionally fortunate to stand on the shoulders of five extremely talented previous Editors of OPRS who set the stage for OPRS being an outstanding international journal for oculofacial ophthalmology. During my tenure, the number of annual manuscript submissions more than doubled to more than 900 today. As with all medical journals, a major challenge is getting peer reviews from experts in the many subfields in our discipline.  Editors need to try to envision the future of their discipline and help direct it to some extent by the selection of key papers to publish. Readers need to be assured that the editor makes well-grounded and unbiased decisions. The rewards for me have been a contribution to the education of our colleagues around the world and in turn to help improve patient care, and help authors improve their publications.

SASOPRS: To close with an easy question, there has been a lot of excitement regarding the potential impact of AI on biomedical science and medical practice (topics that have been the subject of recent publications in OPRS). Can you share a couple of ways in which you feel AI may be particularly impactful in the field of oculofacial surgery?
J. Dutton: There is no question that AI is here to stay and will undoubtedly increase to become a major component of our personal and professional lives. The major beneficial impacts on biomedical science are already being felt in making clinical systems and administrative functions faster, smarter, and even more efficient. For many diseases, based on vast datasets, AI has been shown to improve diagnosis, both from clinical findings and imaging studies and to help with treatment planning. In research, AI can help in paper writing, constructing outlines, checking spelling and grammar, and verifying references. As with any new technology, AI also poses threats if used inappropriately.  These include information biases, inaccuracies, and possible violations of patient privacy, depending on the experience and care of the model creators.  BACK to Newsletter

Meet the Schafers...Three Generations of ASOPRS Members

by: Dan and Jamie Lea Schaefer
Category: SASOPRS Article Blogs
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Sep
05
Three Generations of ASOPRS Members
By Dan and Jamie Lea Schaefer
Featuring Drs. Arthur, Daniel, and Jamie Lea Schaefer were inducted into ASOPRS in 1973, 1989, and 2020, respectively, and two Past Presidents of ASOPRS, Arthur in 1988 and Daniel in 2019.
ARTHUR J. SCHAEFER, MD, FACS 
Dr. Arthur Schaefer was born in Buffalo, New York, in 1923, the son of an Optician and professional musician.  He helped pay his way through Canisius College by working as a lab instructor, a shoe salesman at Sears, and a pianist in a band.  Before Frank Sinatra became famous, he asked them to perform a song or two with his band, but since he was unknown to them, they did not know if he could sing, and he was not from Buffalo, so his request was denied.  Art graduated from SUNY at Buffalo Medical School in 1947.  He completed his Residency in Ophthalmology at E.J. Meyer Memorial Hospital, now Erie County Medical Center (ECMC).  He did his informal fellowship with Dr Bryon Smith, where every several months, he would fly to NYC to spend the day in surgery picking Byron’s brain and again while dining with him that evening.

In postwar Korea, he served as a captain in the Army Medical Corps and as Chief of Ophthalmology at the 121st Evac Hospital, where he worked with and taught the Korean army’s chief eye surgeon, among others.  He was then transferred to Japan, where he was appointed Chief of Ophthalmology at the 8169th Hospital in Zama, Far Eastern Army Headquarters, where he also taught the Japanese Ophthalmic Surgeons.
 
Art established Buffalo’s first Oculoplastic Surgery Clinic in the early 1960s. 

He was a clinical professor of ophthalmology and a clinical assistant professor of otolaryngology at the University at Buffalo School of Medicine and Biomedical Sciences. He was also a consultant at several hospitals in the area and served as director of ophthalmic plastic and reconstructive surgery at ECMC and the Buffalo General Hospital.

In 1995, he was the 22nd individual and first Buffalonian to receive UB’s Lucian Howe Award and medal for his contributions to ophthalmology.

He was a Canisius college regent and, with Betty, his wife, established a Scholarship Fund at the college to assist pre-med students.

Art and Betty were recipients of the Knight and Lady of the Equestrian Order of the Holy Sepulchre of Jerusalem.  In 1994 they were awarded Christ the King Seminary’s Cure of Ars Award for “faith-filled and dedicated service to others.”

He received many other awards and honors for his volunteer involvement from his alma mater, high school, college, medical school, religious organizations, and hospitals.  
His wife of 50 years, the former Elizabeth Ann “Betty” Cain, was his scrub nurse, surgical assistant, and office manager for 35 years. She should be an honorary member of ASOPRS for her support of society over the years and for running the registration desk for the Spring and Fall Meetings with some of the other spouses until the management teams take over.
DANIEL PAUL SCHAEFER, MD, FACS
Dr. Daniel P. Schaefer is a native of Buffalo, New York.  He graduated from Canisius College with a B.A. in Biology and received his Doctor of Medicine degree from SUNY at Buffalo in 1981.  After serving his internship in Internal Medicine at the University Program, SUNY at Buffalo Affiliated Hospitals in 1982, he completed his residency training in ophthalmology at the New York Eye and Ear Infirmary in 1985. He was elected and served as Chief Resident from 1984 to 1985.  An American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) sponsored a fellowship training program in Oculoplastic, Orbital, and Reconstructive Surgery, which was completed at the Wills Eye Hospital and Jefferson University, Philadelphia, PA. 1985 to 1986 under the preceptorship of Dr. Joseph C. Flanagan.

Dr Schaefer joined the Department of Ophthalmology, SUNY at Buffalo, New York, in 1986 and was promoted to Clinical Professor in 2001. He was appointed Co-Director of the Oculoplastic, Orbital, and Reconstructive Surgery department in 1989 and promoted to Director from 1997 to 2022 while maintaining a private practice in Buffalo, New York. He has served as the Chief of Ophthalmology at St. Joseph Intercommunity Hospital for over 20 years and served as its President of the Medical Staff from 2001 to 2003.

Dr. Schaefer has served as Visiting Professor and lectured throughout the United States, Central America, South America, Africa, and India, has written numerous chapters and articles in the field of Oculoplastic, Orbital, and Reconstructive Surgery, and has traveled frequently to several countries in Central America, South America, Africa and India, lecturing, providing medical services and surgeries in the field of Oculoplastic, Orbital, and Reconstructive Surgery for those in need, while also teaching the local Ophthalmologists.

Dr. Schaefer was a member of the ASOPRS Education Committee 1991 to 2002, and its Chair 2000 to 2002, and CME Committee 1991 to 1998 and its Chair 1994 to 1998, Chair of the Committee for Transition of ASOPRS to Board Certification/Equivalency 2002 to 2009, was on the ASOPRS Foundation Board, President of the ASOPRS 2019, President of the Upstate New York District #1 American College of Surgeons and has served on its Committee for Membership Applicants since 1996 for 25 years, has been on the Medical Advisory Board of the American Society of Ocularists  1992 to 2009, was elected Chief Resident at the New York Eye and Ear Infirmary in 1984 to 1985, received the SUNY at Buffalo, New York Ophthalmology Resident Teaching Award five times, was presented the 4th Kanchan Memorial Oration Award from the Kanchan Eye Hospital and Research Center, Murlidhar, Hyderabad, India in 1994, Recipient of the Signum Fidei Award from St. Joseph’s Collegiate Institute and inducted into the Society in 1999, Marlene and he were Bestowed Knighthood in the Equestrian Order of the Holy Sepulchre of Jerusalem in 2001 and advance to its highest order of Knight of the Grand Cross in 2011, received the Caritas Award from St. Joseph Intercommunity Hospital in 2002, received the Lifelong Education for Ophthalmologist Continuing Education Recognition Award and Achievement Award from the American Academy of Ophthalmology, and inducted into The American Ophthalmological Society in 2008.

He was also very honored that his father had the pleasure of inducting him into the society when Art was President of the ASOPRS and presenting the ASOPRS diploma to him at the Business Meeting in Las Vegas on 10/7/88.  I just missed that honor with my daughter during my Presidency of ASOPRS in 2019.  My daughter, Dr. Jamie Lea Schaefer, finished her ASOPRS-approved Fellowship on 6/30/19.  She was the first and only third-generation ASOPRS member in 2020.

Dr. Schaefer is married to Marlene Ann Schaefer, and they have three daughters, Dawn Marie, Jamie Lea, and Alyce Daniela. They enjoy flying single-engine airplanes and motorcycles, scuba diving, snorkeling, traveling, sports, and music.  

JAMIE LEA SCHAEFER, M.D. 


























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My Father...Dr. Alston Callahan

by: Michael Callahan, MD
Category: SASOPRS Article Blogs
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Sep
05
My Father, Alston Callahan, MD
by Michael Callahan, MD
My father, Alston Callahan, was raised by my grandmother Effie, essentially as a single parent, as my grandfather passed away in an accident at an early age. She was a very stern and strict woman who lived in a small apartment in Vicksburg, Mississippi, and pushed Dad academically so that he finished high school, Mississippi College, Tulane Medical School, and residency training younger than most students.  One of his favorite professors at Tulane was Dr. Mims Gage, who endeared himself to students by teasing them about their errors in presentations and sometimes giving them nicknames.  My Dad’s nickname became “Mr. Edema” after misdiagnosing an osteogenic sarcoma of the leg.  This was not a form of belittling but rather a way of prodding students to do their best.  This professor-student relationship came back to assist Dad years later.

At the age of 26, my dad’s first job was joining his half-brother Edley Jones, MD, in an EENT practice in Vicksburg, Mississippi.  However, he soon began yearning for a bigger challenge and moved to the big city of Jackson, Mississippi.  This was 1937, and my dad was a single man living in a YMCA apartment while practicing ophthalmology, which mainly consisted of performing refractions with loose lenses.  In 1938, he became the first ophthalmologist in the state of Mississippi to become certified by the American Board of Ophthalmology.
In 1941, Dad married my mother, and by this time, war was raging across Europe.   Even though the United States was officially neutral following Pearl Harbor, President Franklin Roosevelt declared war on Japan, and World War II began.

Dad enlisted in the U.S. Air Force but soon learned that the U.S. Army was to implement specialty care hospitals across the country to handle the head and neck casualties from the War. He knew he wanted to be a part of this medical network, and he set his sights on Northington General, located in Tuscaloosa, Alabama. It was slated to be a Southeastern tertiary care hospital with 400 beds for facial, head, and neck plastic casualties.

The dilemma was that he was in the Air Force, not the Army, and had to somehow get transferred to the Army. After much consideration, he concluded that the only way he could do this was to tell his commanding officer that he was afraid of flying (even though he had previously earned a private pilot’s license). Word spread down the line that Callahan was trying to bamboozle the armed services, and because of this, his new commanding officer decided to deploy him to the South Pacific to punish him.

Looking up and down the chain of command, he realized that the superior commanding officer in his district was none other than his Tulane professor, Dr. (now Colonel) Mims Gage, who fondly remembered “Mr. Edema” and who conveniently outranked the army officer who was sending Callahan to the South Pacific. So, Dad appealed to Gage to intervene and reverse his orders, and this came through just in the nick of time, so he was placed in the U.S. Army Hospital in Tuscaloosa, Alabama, instead of the South Pacific.  This event altered his future forever. 

Now in Tuscaloosa, married and a father, Dad, and his colleagues worked furiously in surgery three days a week; the clinic was also three days a week, and there were conferences on Sunday. Patient presentations were enhanced by illustrations and photographs that the Army photographers took of the injuries, often with preop and postop results.  This was a kind of “grand rounds” and Dad and his colleagues confronted each other just as fiercely in this arena as the soldiers did on the battlefield.  I once asked Dad just how busy he was. He responded, “Mike, the wounded soldiers were shipped in so rapidly that we could hardly catch our breath.  The plastic surgeons and oral maxillofacial surgeons did not have time to handle many of the patients, so we ophthalmologists began to learn how to best care for various orbital and adnexal injuries.  Because of the volume, we could try various techniques to see which one was the best, so in short order, we learned how to repair these injuries in as few steps as possible.”
Wounded soldiers from all over the world were sent to Northington, one of the most technologically advanced Army hospitals of its time, for operations that most hospitals were not capable of performing. Word spread around the medical core that groundbreaking work produced never-before-seen outcomes in Tuscaloosa, and many senior ophthalmologists began to desire Dad’s position.  Competition was so intense that pressure was applied to Colonel Gage to have Dad replaced.  Colonel Gage requested that Colonel Derrick Vail (who, after the War ended, would become the editor-in-chief of the American Journal of Ophthalmology and a revered figure in ophthalmology in Chicago) evaluate Dad’s work.  Colonel Vail spent a week in Tuscaloosa, literally buried in work with all the surgeons, and reported back to Gage that no one was better qualified to lead the team in Tuscaloosa than Dad.  Later, Vail put into action a brilliant order for the Chiefs of the various eye hospitals to organize an oculoplastic symposium in Cleveland, Ohio.  These other regional ophthalmologists were none other than Crowell Beard, Byron Smith, Merrill Reeh, Charles Iliff, and Wendell Hughes.  This symposium, one of the very first meetings of those war-trained physicians, served as a catalyst for those who would later become known as the forefathers of the American Society of Ophthalmic Plastic and Reconstructive Surgery.

Following the surrender of the Axis Powers, my dad, who was located in Birmingham, Alabama, was offered the Chair of the Department of Ophthalmology at the University of Alabama School of Medicine.  It was soon apparent that a private eye hospital, much like what was created in the Army, could prosper and become more efficient, separate from the University. The Eye Foundation Hospital was created and admitted the first patients in 1963. An ophthalmology residency was approved by the American Academy of Ophthalmology in 1965.  In 1999, the Eye Foundation Hospital was named the Callahan Eye Foundation Hospital. 

Crowell Beard, MD

by: Joe Arterberry
Category: SASOPRS Article Blogs
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Mar
26

Crowell Beard, MD

Crowell Beard is renowned as one of the three major founders of Oculoplastic Surgery. His career accomplishments include helping found ASOPRS, developing Oculoplastics as a specialty, authoring the first definitive textbook on ptosis, training many of the second generation of Oculoplastics preceptors, and developing the eponymously named Cutler-Beard staged bridge flap. 

Beard was one of three sons of J. Edgar Beard and Mabel Crowell Beard. The Beards were an early pioneer family in the Napa Valley and co-owners of the Thompson, Beard & Sons mercantile store in Napa.  Crowell was born in Napa, California, on May 23, 1912.   He attended the local schools in Napa for his early education and, as a member of a musically talented family, learned to play the violin.  Following his father’s pathway, he attended the University of California at Berkeley, initially studying Chinese, economics, and statistics before changing his major to pre-medicine. At UC-Berkeley Crowell transitioned from playing violin to playing the banjo on a weekly half-hour radio show in Berkeley.

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Byron Smith and His Fellowship Prior to ASOPRS

by: John Burns
Category: SASOPRS Article Blogs
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Mar
21

Byron Capleese Smith was a renowned pioneer in Oculoplastic Surgery. Born in Tonganoxie, Kansas, in August of 1908, he received his B.A. and M.D. from the University of Kansas in 1931. Early in his career, he trained in psychiatry at Topeka State Hospital from 1931-34.  Knowing his personality, I suspect that he quickly realized psychiatry was not his calling. Byron continued on to New Haven Hospital, completing a residency in general surgery in 1938. Finally, he completed a two-year residency in ophthalmology at The New York Eye and Ear Infirmary in 1940.

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Special Guest SASOPRS Member: Richard Angrist, MD Interviewed

by: John Woog
Category: SASOPRS Article Blogs
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Mar
21

 For the Love of the Game...

SASOPRS: I understand that you’re a big baseball fan. When did your interest in baseball begin?

Richard: My interest in baseball began when I was about seven years old.  My first baseball game I attended was in 1963 at the old Polo Grounds. The Mets were playing the Cardinals that day, and, of course, lost. I began collecting baseball cards.  In those days, we would put the cards in the spokes of our bicycles, use them to "color", trade, etc. I remember attending about 20-25 NY Met games a year at Shea Stadium with my father who was a Deputy Chief Inspector in the NYPD.  My father commanded half the precincts in Brooklyn.  We would go on "rounds" after the game and officers in the precinct stood up and saluted him when he entered.  We would then go to either Peter Luger Steak House or Crisci's restaurant for dinner. I remember car rides with my dad. We would talk about current events and other topics and really "bond." 

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SASOPRS...What is it? What’s in a Name? Why is it Needed?

by: Michael Hawes, MD
Category: Sponsored Lectures
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Nov
20

Senior American Society of Ophthalmic Plastic and Reconstructive Surgery (SASOPRS) is two years old. It was started of a concern for the needs of ASOPRS members who have contributed much over the years to ASOPRS but who are sometimes forgotten as they age or feel they don’t fit in with the active clinicians.

“Senior” admittedly is a loaded word. While the dictionary says a senior is one who is “more experienced,” some may equate senior to “senile,” “retired,” or “old and out of touch.” But those of us who are more experienced beg to differ. We still have something to offer!



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