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Retrovir (Zidovudine)

###table###Retrovir(Zidovudine)
THE OPHTHALMIC CONTROVERSY OVER RADIAL KERATOTOMY
Several years ago in Marietta, Georgia, 32-year-old nearsighted Alfred Gresham, an engineer, underwent RK for his right eye. Gresham was ready to have his left eye operated on for curing his nearsightedness, but the man found himself caught in the middle of a small but polite war between his eye surgeon and the Georgia Ophthalmological Society. This professional body, warning of the danger of possible delayed side-effects from the RK operation which is spreading rapidly in the United States and overseas, persuaded Georgia state hospitals to temporarily ban the procedure in their operating rooms. Studies which by now have convinced most ophthalmologists that RK is a valid, safe, effective operation for permanent correction of nearsightedness had not yet been carried out.
Gresham told us then that he was “mad as hell” about the “medical politics” which might have prevented the operation on his right eye until the Georgia Ophthalmological Society conducted what could be a multi-year investigation “to determine the procedure’s effectiveness and safety.” This is still sometimes found to be the attitude expressed by some traditionalists in ophthalmology who don’t have training in performing radial keratotomy or the other breakthrough methods of high-tech vision improvement.
Until the fall of 1984, with presentation of the Prospective Evaluation of Radial Keratotomy, PERK study, the American Association of Ophthalmology (AAO) considered the RK procedure investigational rather than experimental. Surgeons who supported the procedure -numbering among them some of the nation’s most distinguished professors and eye surgeons, including one former president of the AAO – agreed that the answers won’t be all put together about side effects until patients have reached the post-surgery mark twenty years from now. But, based on experience with more-complex corneal surgery and with accidental corneal injury, they foresee no serious problems ahead.
Nevertheless, controversy in ophthalmology about refractive surgery continues. It is rife and disagreements are heated among eye physicians when it comes to RK. For example, Long Island, New York ophthalmologist Norman O. Stahl, M.D., was banned from doing RK at his hospital. He could not practice the procedure there and warnings came down from the administration office that he might be thrown out if he continued to try. Dr. Stahl responded by setting up a surgical suite in his private office. No one could stop him from performing the dozens of myopia-correction procedures there.
Since Dr. Stahl took this step, in fact, in-office surgery – called “office-based surgery” – not only for eyes but for a host of other body problems has become rather common. An entirely new medical industry to cut the cost of medical care by eliminating hospital expenses has arisen with the new office-based surgery.
At least four professional groups have been pooling data about RK in order to make some judgments about its safety and effectiveness. They include the National Institute of Health-funded multi-university study headed by George Waring, M.D. of Atlanta, Georgia; the National Refractive Keratotomy study group under the direction of Leo Bores, M.D., of Santa Fe, New Mexico; the Kerato-Refractive Society, under secretary Ronald Schachar, M.D., of Dennison, Texas; and the International Corneal Plastic Micro-Surgery Society, coordinated by Herbert L. Gould, M.D. of White Plains, New York. Additionally, the National Advisory Eye Council has put out a call to all patients who have undergone RK and to all optometrists who have refracted the eyes of such patients to report their observations.
The National Advisory Eye Council is the principal advisory group to the National Eye Institute. In order to discharge its responsibilities to the American public and to the scientific and health care community, the Council has acquired as much information as possible about the safety of RK on humans. The Council has urged people to share whatever information they may possess abut eye problems that have resulted from this surgical procedure.
In addition to complications of the cooperative effort itself, the Council members were looking for any secondary problems, such, as ocular rupture or perforation. Ronald G. Geller, Ph.D., Executive Secretary of the National Eye Institute, advises interested physicians and patients about his survey results. They indicate that no such problems or side effects exist for recipients of radial keratotomy.
Some opponents of RK have attempted to suppress the availability of the operation. They tried to institute a moratorium on the procedure to be done. They also encouraged health insurance companies not to reimburse patients who ordinarily would be covered for financial outlays.
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