To the Editor
I would like to congratulate Mark Abelson on his thought-ful article, "Iodine: An Elemental Force Against In-fection" (May 2009). He did an excellent job showing the importance of Betadine (povidone-iodine) in the prevention of endophthalmitis.
However, the patent literature shows us that a much weaker solution is equally as important and that a neutralized solution is equally as effective. It is certainly a benefit to the patient to avoid the secondary keratitis that can occur in some cases.
Neutralized betadine eradicates keratitis sicca as well as foreign body sensations caused by cataract surgery. The only remaining causative factor for keratitis seems to be preservatives in the postoperative drops.
These facts and observations suggest that we should neutralize betadine from a pH of 3.5 to 4 in preparations currently available to a pH of 7. The formula we developed to neutralize betadine is currently available on our website at stlukeseye. com/professionals. (I do have a patent pending on neutralized Betadine.) This neutralization process will reduce the incidence of keratitis following cataract surgery and improve patient comfort.
James P. Gills, MD
Tarpon Springs, Fla.
To the Editor
As respectful readers of Review of Oph-thalmology, we appreciate the article entitled "Is It Time to Retire the Trabeculectomy?" in the June, 2009 edition. We agree with the author, Michelle Stephenson, that it is appropriate to consider alternative procedures to trabeculectomy due to the invasive nature and the potential for complications involved with this current option.
However, we must respectfully point out an omission in your review of alternative procedures. Excimer Laser Trabeculostomy is a novel technology with proven clinical success and excellent postoperative results in treating phakic and pseu-do-phakic eyes and combined with phacoemulsification in patients with open-angle glaucoma.
The stealth nature of the ELT technology means that there is minimal inflammation and scarring, no blebs or foreign body implants, with proven clinical effects equal to and verifiably longer-lasting than the technologies which were described.
The next generation ELT device further im-proves efficiency with software image processing for localization of target areas, feedback sensors to enable depth control, and imaging to deliver real-time guidance.
The readers of your journal deserve the most up-to-date information regarding current and future options for the treatment of glaucoma, which does include the omitted ELT procedure. Perhaps you will consider including ELT in a future edition.
Ryan Fraiser, BA, and Grace Wong, BM, MM
Glaucoma Institute of Beverly Hills
To the Editor
I expect partisan, economically uninformed editorials on health-care reform from the likes of The New York Times or MSNBC but not from the editors of journals who presumably represent medical doctors. This is, however, precisely what I encountered in "Health-Care Reform Takes the Summer Stage" in the July 2009 issue. I would like to refute several points made in this piece.
First, the figures cited regarding the un-insured are misleading. To state that the uninsured have "swelled" from 30 million to 50 million in the past 20 years in disingenuous. Two important factors are disregarded: population growth and an honest breakdown of the most recent estimate of the uninsured. The population in 1989 was 246.8 million, meaning 12.2 percent of the population was uninsured. Fast forward to 2007 when the Census Bureau calculated the uninsured to be 45.7 million and that percentage "swelled" to 15.1. An increase of 2.9 percent does not pack the punch of 20 million. More important, the inaccurately bandied "50 million" figure fails to mention that 15 million were young and healthy or made over 300 percent of the poverty level and chose not to buy insurance; 10.7 million were eligible for Medicaid or did not admit already participating in a federal program; and 9.3 million were non-citizens. Even if we readjust this data to accommodate current unemployment, this number represents a significantly smaller segment of the population.
Second, you state that "we can debate the wisdom later of whether or not we're moving too fast [on health-care reform]." Our president and congressional leaders are proposing a de facto irreversible change in the delivery of medical care sure to effect generations to come and you would forgo an extended discussion until after the fact? Everyone agrees we need reform but there are vastly different opinions about how this should be ac-complished. Would it not be prudent to examine all the options, the cost and the benefits before blindly plunging our nation down an irreparable course?
Finally, your "hopes for … whatever bill emerges" are ill-conceived and counter-productive. Man-dating that insurance be sold to individuals regardless of medical history will certainly raise premiums. The Council of Economic Advisors in 2004 found that charging premiums irrespective of medical history increased premiums 20.3 percent to 27.3 percent. Furthermore, they calculated that forcing insurers to provide universal coverage despite pre-existing conditions, as is done in New Jersey, raised rates $113 a month. I can only assume from the subtext that you also support a public option. This, too, will inflate the cost of private insurance, if not bankrupt it altogether. Rationing and price controls would undoubtedly run rampant with government the sole provider. The quality, efficiency and efficacy of our medical system would be fatally hobbled. Lastly when you refer to the "wasteful administrative costs" in private industry while implicitly endorsing a government-run option, the irony is staggering. Government perpetually proves itself inefficient and wasteful. Also, would a public option truly have lower administrative costs? After accounting for the cost shifts to medical providers, tax collection for maintenance, special interests' lobbying for funding, patient costs in terms of extended wait times and, consequently, lower productivity and lower quality of life, I believe the answer is a resounding no.
There are without doubt flaws in our health-care system. However, the remedies you endorse would do more harm than good to the current system and its beneficiaries. If we are serious about reform, we need more thoughtful, well-designed solutions than these.
David. F. Vazan, MD