Eye Physicians and Surgeons and Manpower Surveys

AMERICAN JOURNAL O F OPHTHALMOLOGY Editor-in-Chief 233 East Ontario St., Chicago, Illinois 60611

FRANK W . NEWELL,

EDITORIAL BOARD Mathea R. Allansmith, Boston Douglas R. Anderson, Miami Crowell Beard, San Jose Bernard Becker, Sr. Louis Benjamin F. Boyd, Panama Charles J. Campbell, New York Ronald E. Carr, New York Thomas Chalkley, Chicago Claes H. Dohlman, Boston Sir Stewart Duke-Elder, London Fred Ederer, Bethesda

Published Directors: A.

J. Terry Ernest, Chicago DuPont Guerry III, Richmond Paul Henkind, Bronx Robert W . Hollenhorst, Rochester Herbert E. Kaufman, Gainesville Arthur H. Keeney, Louisville Bertha A. Klien, Tucson Carl Kupfer, Bethesda James E. Lebensohn, Chicago Irving H. Leopold, Irvine A. Edward Maumenee, Baltimore Irene H. Maumenee, Baltimore Edward W . D. Norton, Miami

G. Richard O'Connor, San Francisco Arnall Pätz, Baltimore Steven M. Podos, New York Albert M. Potts, Louisville Algernon B. Reese, New York Robert D. Reinecke, Albany Marvin L. Sears, New Haven David Shoch, Chicago Bruce E. Spivey, San Francisco Bradley R. Straatsma, Los Angeles Gunter K. von Noorden, Houston

monthly by the Ophthalmic Publishing 233 East Ontario St., Chicago, Illinois 60611

EDWARD MAUMENEE,

President;

W . D . NORTON, DAVID SHOCH, B R A D L E Y

FRANK W. N E W E L L ,

Company

Secretary and Treasurer;

EDWARD

R. S T R A A T S M A

EYE

PHYSICIANS AND S U R G E O N S AND M A N P O W E R S U R V E Y S The report of the Institute of M e d i c i n e to T h e House Committee on Appropriations provides interesting data. In one study the Institute of Medicine asked a group of eight or nine experts in health care in the states of Arizona, Oregon, Michigan, and Georgia i f they thought there were too many, too few, or an appropriate number of specialists available in their respective states. T h e experts thought there were too many eye physicians and surgeons in each o f the four states. 1

Arizona and Oregon have 6.3 ophthalmologists per 1 0 0 , 0 0 0 population, while Georgia and Michigan have less than 4 . 6 ophthalmologists per 1 0 0 , 0 0 0 population (4.6 is the national average). T h e 4 . 6 ophthalmologists per 1 0 0 , 0 0 0 population is more than the number of ophthalmolo421

gists listed by the American Board of Ophthalmology but presumably includes all who specialize in diseases of the eye: ophthalmologists, otolaryngologists, noncertified ophthalmologists, individuals yet to b e certified, and retired physicians. With the population of the United States at about 2 1 0 , 0 0 0 , 0 0 0 this average indicates that we have about 9 , 5 0 0 ophthalmologists providing eye care in this country. (Other studies suggest the number is closer to 11,000.) The final report of Westat, I n c . , concerning the prevalence and e c o n o m i c and social costs of visual disorders and disabilities gives some impression as to what eye physicians and surgeons do each year. There are more than 5 , 0 0 0 , 0 0 0 patients seen annually with newly diagnosed " a c u t e " conditions of the eye varying from chalazion ( 2 8 5 , 0 0 0 ) , to macular degeneration ( 1 6 5 , 0 0 0 ) , conjunctival hemor2

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AMERICAN JOURNAL OF OPHTHALMOLOGY

rhage (178,000), and amblyopia (135,000). E a c h year there are 1,724,000 patients with new cases of chronic abnormalities of the eye. O f these an estimated 1,532,000 consult an ophthalmologist initially without referral by another physician. T h e disorders range from cataract (829,000) to strabismus (373,000) to glaucoma (146,000). Moreover, 1 0 , 6 5 9 , 0 0 0 individuals are seriously disabled because of impaired vision, the leading cause of which is cataract (1,670,000), followed by glaucoma (1,070,000), and retinal disorders (739,000). O f the 1,483,000 people severely disabled by visual impairments more than half are affected by retinal disorders, glaucoma, and cataract. Retinal disorders are the most common cause of blindness in an estimated 4 6 8 , 0 0 0 legally blind people. T h e experts from the Institute of Medicine did not have these figures concerning the incidence and prevalence of ocular disease and visual disability when they indicated their reasons for declaring some specialties in excess supply and others in short supply. Inasmuch as Congress is not likely to investigate the reliability of the Committee's conclusions, the report could well lead to a restriction o f the number of available ophthalmologists. In a reversal of classical economic theory the United States as a matter of national policy is now undertaking an experiment by limiting the number of specialists in all categories in the hope that scarcity will cause a decrease in prices and that individuals will consult family practitioners, internists, and pediatricians, rather than specialists. T h i s is a great pity because the United States was approaching an ideal in which serious disease would be recognized and treated promptly by one skilled in its management. Instead we are in danger of committing ourselves to further expedients in the vain hope that the untrained

MARCH, 1977

can be taught to recognize and treat disease in all organs. F R A N K W.

NEWELL

REFERENCES

1. Medicare-Medicaid Reimbursement Policies. Social Security Studies Final Report, submitted by the Institute of Medicine to the Subcommittee on Health of the Committee on Ways and Means, U.S. House of Representatives. Washington, D.C., March 1, 1976. 2. Westat, Inc.: Final Report. Summary and Critique of Available Data on the Prevalance and Economic and Social Cost of Visual Disorders and Disabilities. Bethesda, Maryland, National Eye Institute, 1976.

CORRESPONDENCE Letters to the Editor must be typed double-spaced on 8V2 x 11-inch bond paper, with 1'/2-inch margins on all four sides, and limited in length to two manuscript pages.

Combined Phacoemulsification and Scleral Buckling Operation Editor: Recently, we performed phacoemulsification on a 30-year-old mentally retarded woman suffering from mature cataract. At the end o f the procedure we noted that the fundus reflex was abnormal, greenish rather than red. Ophthalmoscopy showed a total bullous retinal detachment. T h e 2.5-mm limbal incision was closed with one 8-0 silk suture. Using the binocular indirect ophthalmoscope and scleral depression, we thoroughly examined the fundus. After finding a retinal tear in the superonasal quadrant and considering the excellent visibility o f the fundus, we decided to repair the retinal detachment immediately. W e performed scleral buckling by using a 9-rrim wide intrascleral silicon implant and a 2-mm wide circling band. T h e retina reattached after drainage