Download Northwest Eye Surgeons Honors a Visionary

Insight
October 2013
Northwest Eye Surgeons Honors a Visionary
In the early 1980s, Dr. Michael W. Field had a vision. He witnessed firsthand the strengths of a balanced
contribution to eye care from optometry and ophthalmology in his early years as an eye surgeon. After his
ophthalmology residency and glaucoma fellowship, he practiced at the Naval Regional Medical Center in
Oakland and later at a multi-disciplinary Kaiser Permanente medical center in the Bay area.
From the Bay Area to the Pacific Northwest
After relocating to the Pacific Northwest, Dr. Field’s passion to develop a respectful and strong collegial
relationship between the professions and to benefit patient care was realized. In 1986, he partnered with Drs.
Bill Hancock and Steve Brown to form the first co-management center in King County, initially known as
Northwest Eye Center.
Dr. Field Announces Retirement
After more than 35 years in practice,
Dr. Field announced he will be
retiring from surgical practice at the
end of 2013. Dr. Field represents
one of the pillars of our organization
and he will be sorely missed.
Next steps for Northwest Eye
From our photo archives: the original partners, Drs. Brown, Field and
Hancock in 1993 as we moved our North Seattle office to a new location.
We are interviewing prospective
cataract and glaucoma surgeons.
Dr. Field agreed to help the
transition by staying at Northwest
Eye Surgeons in Seattle until a
replacement is identified. Drs. Bruce
Cameron, Audrey Rostov, and Victor
Chin will be adjusting their
schedules at our North Seattle office
to help accommodate cataract
consultations. Dr. Cameron will
remain available at both our Renton
and Seattle offices for surgical
glaucoma consultations. Dr. Field
intends to shift his focus to medical
and laser glaucoma management
later this year and into 2014.
Finally, as a tribute to Dr. Field, we
can say that he saw things
differently as a young surgeon. He envisioned improved communication and collaboration between the
professions. Cooperative surgical and medical co-management remains one of our bedrock principles at
Northwest Eye Surgeons. If you have time to send him a note before his retirement in 2014, we are sure he
would appreciate hearing from you!
Should I Remove that Corneal Suture?
By Landon J. Jones, OD, FAAO
We have all found ourselves behind the slit lamp asking “Should I remove that corneal suture?” Let’s review the
primary clinical indications for suture removal and as importantly, outline common suture materials and
surgical use.
Suture Purposes and Complications
Knowing when and why corneal sutures were used on your patient is key. The most common type we come
across are peripheral corneal sutures after cataract surgery. The majority of our postoperative cataract patients
will have undergone clear-corneal-incision cataract surgery not requiring a stitch.
Occasionally a surgeon will reinforce one of these incisions with a small limbus-to-peripheral corneal suture to
ensure that the wound does not leak. Keep in mind that its presence does not indicate that there was a
perioperative complication. It is now recommended that these sutures be removed no sooner than one month
after surgery to avoid a wound leak. Some surgeons say the sutures can remain indefinitely but most studies
recommend removal before two to three months.
Many sutures become brittle over time and can break on attempted removal. If a suture fragments and stays
subepithelial, it does no harm and can be left alone. Sutures inducing corneal astigmatism may require more
prompt removal.
More Reasons to Remove Sutures
Loose or eroded sutures notoriously cause sharp ocular pain and incite an urgent request to be seen. They
should always be removed with forceps unless there is concern about inducing a wound leak. Multiple or larger
sutures securing a bigger surgical wound require more patience and chair time. It is suggested in these
circumstances that sutures be removed in slow succession, such as one per month.
Call your surgeon when in doubt. Untreated eroded or broken sutures can lead to microbial invasion through
the defect with resultant ulcer or infiltrate. This clarifies why three to four days of prophylactic antibiotic
treatment is suggested following removal.
Suture materials and removal
Most corneal sutures we see are monofilament nylon sutures. This
suturing material has a characteristic black and shiny look. They are
used commonly as peripheral corneal sutures for cataract surgery,
interrupted radial sutures for penetrating keratoplasties, and flap
sutures for trabeculectomies. These sutures will weaken with time
but do not biodegrade.
Cataract surgeons sometimes use alternative dissolvable sutures
such as polyglactin (Vicryl) that are later reabsorbed by the body.
This material is also used within the conjunctiva for combined
glaucoma surgeries and on the eyelids after blepharoplasty. These
have more of a dull, violet hue and are less rigid than nylon. When
these dissolve, they can sometimes unravel or loosen, creating mild
foreign body sensation and may, therefore, require removal.
Nylon corneal sutures used for an IEK.
Co-managing patient sutures
Corneal sutures following cataract surgery are often co-managed by a patient’s optometric physician. If you
have questions regarding sutures or suture removal, we recommend contacting us. If preferred, we are happy
to assist you with managing these patients.
Farewell from Dr. Field
Dear Colleagues:
Beginning January 2014, I will be reducing my schedule to two
days a week in Seattle, through the summer. I would like to
take this opportunity to say a few words. Perhaps a heartfelt
and poignant way to sum up my medical career is to
paraphrase one of my patients. He approached me in the
waiting room and in a very loud voice, quite spontaneously but
very sincerely, thanked me “for taking such good care of his
family,” and wished me a happy retirement. I was somewhat
surprised and mildly embarrassed, but when I thought more
about it, I realized that is why I wanted to be a doctor. It is also what I enjoy. The compliment
summarized my thoughts about my life and career.
It is difficult to imagine life without the routine of practicing ophthalmology. My work has
introduced me to wonderful colleagues, surgical challenges, grateful patients, and a committed
and supportive staff.
I especially want to thank my partners and associates at Northwest Eye Surgeons. We have built
an organization that makes me proud. The relationships we have developed with our optometric
colleagues, through co-management and education, is one of the highlights of my career. Our
mutual patients have benefited.
While there still is much more to do to enhance the landscape of optometric practice, change
takes time. Ideologies and acceptance of this new culture of responsibilities, while slow to be
accepted, is a concept that was long overdue. I am proud to have participated in this evolution of
enriched collaboration between the two professions.
We all have people or colleagues who have influenced our decisions and careers. I want to
personally thank Dr. Scott Jamieson’s father, Dr. Robert Jamieson, for taking the time in the early
‘80s to discuss “co-management” and helping me set the bar for standards and ethics in
practicing medicine. I also thank my dad for expecting me to become the type of physician he
would go to.
My sense is that retirement will continue to afford me the luxury to learn and expand my horizons,
to meet interesting people, and to help others in a meaningful way. It will also let me spend more
time with Margo, my kids and grandchildren.
I have enjoyed our partnership.
Michael W. Field, MD
10330 Meridian Ave. N.
Suite 370
Seattle, WA 98133
CONTINUING EDUCATION
NOVEMBER 7 | THURSDAY
13TH Annual Optometric Medicine
Review & Surgical Update
Chateau Ste. Michelle Winery
3 p.m.
NOVEMBER 12 | TUESDAY
13TH Annual Optometric Medicine
Review & Surgical Update
Chateau Ste. Michelle Winery
3 p.m.
DECEMBER 4 | WEDNESDAY
Interesting Cases
Justin Wright, OD; Britta Hansen, OD;
Brett Bence, OD
Bellingham Clinic
Congratulations, Dr. Kuzin
Aaron Kuzin, MD, will receive the first Paul M. Sims
Education Fund Award as a panelist at the American
Academy of Optometry annual meeting in October in
Seattle.
Dr. Paul M. Sims, OD, was an optometrist and an
Academy Fellow for 60 years. His son, Dr. John W. Sims,
OD, established the endowment in May 2013 in his
memory.
Dr. Kuzin will speak on “Point-Counterpoint: Evidence-Based Decisions in
Glaucoma Management,” for the glaucoma Special Interest Group symposium
on October 25th.
6 p.m.
“I think it’s a great opportunity to speak to this group. It’s a good topic
because now there are so many new ways to treat glaucoma, it’s become a
personalized approach,” said Dr. Kuzin.
DECEMBER 9 | MONDAY
Topic to be determined
Dr. Kuzin will serve on the panel with Drs. Richard Madonna, Kathy YangWilliams and Michael Sullivan-Mee.
Matthew Neimeyer, MD
Sequim Clinic
6 p.m.
DECEMBER 10 | TUESDAY
Interesting Cases
Justin Wright, OD; Britta Hansen, OD;
Brett Bence, OD
Smokey Point Clinic
6 p.m.
Welcome Dr. Wright
Justin Wright, OD, joined our team in July. He currently
provides medical eye care in both the Mount Vernon and
Bellingham offices. Over the next few months, Dr. Bence will
transition to Seattle to coordinate our optometry programs
and referral center co-management administration.
Dr. Wright and his wife have three sons and one daughter. In
his spare time he enjoys dating his wife, playing with his kids,
skiing, drawing, and both performing and listening to music.