latest issueLatest Issue

Notes from an American in Paris

Maryalicia Post shares some hard-earned tips for visitors to the 37th Congress of the ESCRS

Maryalicia Post

Posted: Thursday, March 7, 2019

Photo by John TownerWhat do Gene Kelly and I have in common? Singing? Dancing? No, and not a cheeky grin either. He and I were each An American in Paris. In his case it was for two hours in the famous film; in mine it was for six years in real life. In that time I made a few observations that might be helpful to anyone planning a visit. I realise they are only my conclusions seen through the lens of my personal experience, but if they’re of any use to you – you’re welcome.

1) The French are ‘serious’… by which I don’t mean they are reluctant to laugh. I mean shop attendants, waiters, bus conductors et al seem to have a more professional approach to their job than you might find elsewhere and expect to be treated with due courtesy. On going into any shop greet the staff with ‘bonjour’. (If there are other customers include them with a smile). In a bakery, for example, do not rush in and snap ‘one croissant’. Start with Bonjour and end with Merci.

2) You can’t go wrong if you wait to be shown where to sit, even in an informal cafe. If in any doubt, just stand and look bewildered; someone will point you to a seat, and you’re off to a good start.

3) Don’t feel rebuffed if sales attendants ignore you. In most cases the custom is for them to be available when/if you want help and to stay away until addressed. And, nothing personal, but a French waiter is not automatically your new friend. A smile may not be on the menu.

4) Expect your appearance to be checked out by both men and women in public places like the Metro. Parisians go to some trouble to look their best and assume you do too; being invisible is not the goal.

5) In general, don’t go looking for examples of ‘how rude the French are’. Don’t construe a runny omelette, bloody lamb or smelly cheese as indifference. Au contraire. It’s the way ‘they’ like it and they assume any reasonable person would as well. Make a polite request for a change if necessary.

6) Use whatever French you have. I got used to asking a question in French which would be answered patiently in English, leading to my next question in French, also answered in English… a kind of bilingual duet. When the answer comes in French, buy yourself a drink.

7) If you can’t walk to your destination even in your most comfortable shoes (which you should bring for this very purpose), take the Metro. The best reason for taking the Metro is to avoid taking a taxi. Here’s a useful Metro guide.

8) Are there really rude people in Paris? Oh yes, and they all drive. If you take a taxi you may well find yourself up close and personal with a very rude person indeed. He or she may pretend not to know where you want to go – I always write out the destination and show it in advance – or will bury you under an avalanche of explanations in French as to why he or she is approaching the city via Versailles. Meanwhile, the meter runs on. I pre-book a car to meet me at the airport as this scam seems endemic at CDG. However, if you must, well, c’est la vie. Here’s a good guide to taking a taxi in Paris.

Bon voyage and merci.

I knew that!

Enhance your trip to Athens with some timely background reading

Maryalicia Post

Posted: Thursday, February 7, 2019

The past is present in Athens. Perhaps it’s because the Parthenon looks down like a benevolent schoolmaster, prompting questions – who, where, when?? If your Greek history is now only a faint memory, why not brush up before you get there for the 23rd Winter Meeting of the ESCRS? A good place to start is with Edith Hall’s book Introducing the Ancient Greeks.

It’s Professor Hall’s theory that the Greeks exhibited 10 specific character traits that supported the miracle that was Greece. The character traits were: an appreciation of the sea, being wary of authority, highly individualistic, of an inquiring mind, receptive to new ideas, witty, competitive, prepared to pursue excellence, elaborately articulate and addicted to pleasure of all kinds. The book is organised into 10 chapters, each pairing one of these traits with the country’s unfolding history from 1600 BC to 400 AD. Interesting and informative, the paperback earns its place in your carry-on luggage or can be downloaded to your Kindle app.

If a visit to Asklepios is on your Greek agenda, or even if it’s not, consider Asklepios, Medicine, and the Politics of Healing in Fifth-Century Greece: Between Craft and Cult. It’s a hardback, so both weighty and expensive, but it’s an engrossing examination and comparison of the practices at Asklepios and those of Hippocratic medicine of the same period. The author, Professor Bronwen Wickkiser, is a specialist in ancient Greek history and culture, especially the intersection between religion and medicine. In a subsequent book, The Thymele at Epidaurosshe looks at performance, architecture and acoustics in a Greek healing sanctuary as they relate to music therapy .

If you’re a bit shaky on Greek mythology, now’s the time to remind yourself who was Pandora’s brother-in-law and how long Odysseus was away travelling. There’s a bit of a vogue for retelling the stories in breezy modern dialogue; one example of this approach is Stephen Fry’s book Mythosanother is Robin Waterford’s The Greek Myths: Stories of the Greek Gods and Heroes Vividly Retold. Traditionalists might prefer the classic version by Robert Graves: The Greek Myths: The Complete and Definitive Edition (Penguin, 2017). Available both in paperback and on Kindle.

And if you’d rather catch up ‘on screen’, try The Greeks: Crucible of Civilization.

Narrated by Liam Neeson and with beautiful photography of ancient sites, the 180-minute long documentary was produced by PBS.

The 23rd Winter Meeting of the ESCRS will take place in Athens on February 15-17.

Driving and the elderly

What is the ophthalmologist's role in certifying older patients for driving?

Aidan Hanratty

Posted: Friday, January 25, 2019

The full details are unclear, but on January 17, 2019, Prince Philip, Duke of Edinburgh was involved in a road traffic accident near Queen Elizabeth II’s private home, the Sandringham estate in Norfolk, England.

According to a report from the BBC, the 97-year-old lost control of the Land Rover Range Rover he was driving and made contact with another car carrying two women and a baby. The driver of the other car was unscathed, as was the child, but the adult passenger broke her wrist in the accident. A bystander reported hearing that the Duke told police he had been dazzled by the sun.

While most of the headlines focused on the fact of Prince Philip’s position and the well-being of the injured woman, the incident also opened up a conversation about driving and the elderly.

What is the protocol for older drivers? While specifics vary in different jurisdictions, roughly similar rules abound. In both the United Kingdom and Ireland, drivers older than 70 are required to renew their licence every one-to-three years. In the UK, drivers must meet minimum eyesight requirements, which are as follows:

You must be able to read (with glasses or contact lenses, if necessary) a car number plate made after 1 September 2001 from 20 metres.

You must also meet the minimum eyesight standard for driving by having a visual acuity of at least decimal 0.5 (6/12) measured on the Snellen scale (with glasses or contact lenses, if necessary) using both eyes together or, if you have sight in one eye only, in that eye.

In Ireland, however, drivers older than 70 require a certification of fitness to drive by their doctor.

“This includes a cardiac and neurological and cognitive assessment as well as vision and hearing,” says Dr Tony Cox, Medical Director of the Irish College of General Practitioners. “Assessment of their mobility and independence is also undertaken. It’s a thorough enough assessment.”

A doctor can certify for one or three years, and can add restrictions to person’s range and time of driving.

Arthur Cummings MD describes this assessment: “It needs to be mentioned whether you first of all pass the required 6/12 with spectacles and if you don’t wear spectacles, whether you pass the 6/12 without spectacles. The license then states whether you need to wear spectacles or not.”

Mr Cummings, Consultant Ophthalmic Surgeon and Medical Director of the Wellington Eye Clinic and Head of the Department of Ophthalmology Beacon Hospital, Dublin, continues: “The second requirement is doing a binocular visual field test to ensure that the visual field is wide enough and the current requirement is 150°.”

Speaking to EuroTimes in 2014, Louis Kartsonis MD, a general ophthalmologist in San Diego, California, US, described a scenario where a patient presented with high visual acuity but her family informed him that she was displaying early signs of Alzheimer’s.

“You have two ways to go with a case like this,” said Dr Kartsonis. “One, you could say my job as an ophthalmologist is vision care, and my responsibility stops with evaluating the status of vision. But we have to recognise a larger picture, particularly in a case where driving accidents have already occurred.”

In California, a doctor can file a report with the Department of Motor Vehicles questioning the patient’s fitness to drive. The patient then receives a letter informing them that their licence has been suspended and requesting they perform a hearing, vision, written and driving tests.

Concerned doctors – GPs or ophthalmologists – can take simple steps to test patients’ cognitive functions. These include trail making, where the patient is asked to draw lines connecting circled letters and numbers in different sequences, and the clock drawing test.

In this test the patient is asked to draw a clock face, drawing in the 12 hours and then drawing in the hands to a specific time. If the patient is unable to complete the task it is a clear sign of cognitive impairment.

While these are rudimentary tests and should not be used in isolation, they may help to point in the direction of a diagnosis.

Ultimately, the directions are clear. However, the remaining unknown is the quality of the relationship between the patient and GP, which can be built up over many years and can be shattered in moments.

With patients referred to him by GPs, the issue can go one of two ways, says Mr Cummings: “Many times the issue is due to a cataract and we can resolve it with surgery and sometimes unfortunately it is due to something like advanced glaucoma, or age-related macular degeneration and then the news is less good.”

It may also fall to the patient’s family to step in. The ability to drive can be someone’s lifeline, a symbol and manifestation of their independence. This will not be given up lightly. Patient safety, however, and that of other road users, is paramount.

Old meets new at 23rd ESCRS Winter Meeting

We take a look back at medical approaches to cataract in Ancient Greece

Aidan Hanratty

Posted: Friday, December 21, 2018

The 23rd ESCRS Winter Meeting will take place in Athens in February, 2019. This will be the fourth Winter Meeting in the city, once the centre of the ancient western world. There will be many topics up for discussion including ocular surface disease, complications in corneal graft surgery, advances in glaucoma as well as didactic courses and practical workshops.

The Hellenic Society of Intraocular Implant and Refractive Surgery will also host a symposium entitled “Advanced technology – better results?” This is an interesting question, especially in the context of the history of medicine in Greece.

The term “glaukos” was a non-specific descriptor meaning blue, green or light grey, and its use in medical terms came from the colour produced in angle-closure glaucoma. The goddess Athena was referred to throughout Homer’s Iliad as “Glaukopis Athena” for her bright or “flashing” eyes. Speaking more generally, the word “ophthalmos” was the Greek for eye, and combined with “logos” meaning word or study, it forms ophthalmology.

Writing about “The Cataract Operation In Ancient Greece” in Histoire des sciences médicales in 1982, Jean Lascaratos and Spyros Marketos describe the understanding of and methods to treat cataract in Ancient Greece.

Hippocrates, known as the father of western medicine, mentions the term “glaucosis”, they write, but it is believed that he was in fact referring to what we now call cataract. Galen, who came several hundred years later in the 2nd Century AD, believed that hypochyma (as cataract was then called) was a coagulation of the aqueous humour, while glaucoma was the transformation of humours existing in the eye to a sea-green colour.

Galen wrote that a treatment for cataract was discovered by accident: “That is, a goat suffering from hypochyma saw again when it fell upon a thorn that pierced its eye.”

His standard was as follows: “We pierce the cornea with a needle on the periphery until it has entered the anterior chamber. Then we pierce the hypochyma, which we push aside.” Another method described by Galen was called depression, which consisted of moving the cataract away from its original position. He also writes that some doctors tried to remove the cataract by opening the cornea, yet this was a rare, risky approach.

To think it would be some 1,600 years before Jacques Daviel successfully extracted cataracts, and another 100 after that before the advent of phacoemulsification, the Ancient Greeks deserve a lot of credit for their efforts. What they might make of the advances made today, and on show at the 23rd ESCRS Winter Meeting, we will never know.

I didn’t sign up for this!

When it comes to your own practice, ‘leadership’ comes with the job

Maryalicia Post

Posted: Thursday, November 15, 2018

Photo by rawpixel on Unsplash

There are many reasons for choosing a career in ophthalmology; for most it’s probably the blend of medicine and surgery, the appeal of the technical environment and the satisfaction of healing and helping. An interest in leading a business practice isn’t normally high on the list. Yet in real life it turns out that ‘leadership’ comes with the job. And the first task is knowing where you’re going.

Here’s how one business guru puts it: “All successful physician practices have a clear vision of their reason for existence… This can be referred to as the corporate culture or the core values of the company that clearly defines the values and preferred expectations of behaviour.”

LinkedIn recently sent out an article on ‘building a great company culture’. The piece is written by Claude S Silver, Chief Heart Officer at VaynerMedia. A ‘heart officer’ is not someone who deals with cardiac arrest in the office setting – In this case it turns out to be someone heading up what used to be called ‘Human Resources’. It’s Claude’s job to show love and empathy to the employees while monitoring their performance, thus motivating them to do their best for the team of which they are a part.

Without going so far as to employ a Heart Officer, if you’re ready to consider sharpening up your office practice, an internet search turns up an article that outlines the ‘10 hallmarks of leadership in an ophthalmologists practice’. Realistically enough, it begins by flagging up the need to find the time: “At least eight additional hours per week on top of your core job as an ophthalmologist.” And just as realistically the author points out that: “ophthalmic microsurgery is the domain of slow, cautious, 100% perfection. Ophthalmic leadership is the domain of well-intended, timely approximations of 80% perfection. Or less. … get on with it.”

The article ends with this cautionary note: “Most patients can choose from whom they receive care. Even if they love the ophthalmologist, they might go elsewhere if the office is poorly run. As a physician, you’re more than just the doctor. You must also be an effective organiser and facilitator of a large group of staff.”

Whether you have a “large group of staff” or simply one or two overworked employees, a checklist of who does what in an ideal world – an outline of the ‘five key roles in the ophthalmic practice‘ – is a useful checklist.

Hello Dolly

Initiatives that help doctors speak to patients on a human level can only help both sides of the interaction

Maryalicia Post

Posted: Tuesday, November 6, 2018

I read not long ago of an initiative that introduces doctors to ‘normal’ older people. One of these older people, a retired family therapist, mentioned a gastroenterologist who dismissed her complaints of fatigue by saying: “At your age, you can’t expect to have much energy.” Then, in her 70s, she switched doctors and learned she had a low-grade infection.

It happens.  Not long after my husband died, I’d called in to an ophthalmologist’s clinic.  For some months I’d been aware my eyes were red and didn’t feel ‘right’. Now I had time to investigate. The consultant performed his exam. “Tell your boyfriend it’s just age,” he said. That, and the bill, was the extent of the consultation.

Heavy-handed humour? Joke gone wrong? I felt affronted, an old-fashioned word for an old-fashioned reaction.  When I ran out of moisturiser, my eyes cleared up. I’d been allergic to it as I discovered, no thanks to that ophthalmologist.  I never did forget the insensitivity of his remark – or return to that clinic.

I was reminded of that when I read about mannequins being used in medical training.

These dolls bleed, twitch and have seizures just like real people. As no one wants to be the first patient a trainee doctor intubates, for example, it’s wonderful these dolls exist.  But on the other hand, it’s already all too easy for today’s harassed doctors to regard their patients as mannequins, or at least to forget they have feelings.

Happily, empathy skills are increasingly part of medical training, both for the patient’s benefit and the doctor’s. At the University of Houston, Texas, end-of-life conversations are already being practised on mannequins.

But what about the more common situations, like routine operations? One of the most empathetic things a doctor can do is find time to stop by the bedside to ask how the patient is feeling, answer questions, assure him or her that all went well.  So far, that can’t be practised on a mannequin, but if it were I’ll bet even a stand-in human would respond with lower blood pressure and a thumbs up.

Give me a break! (Oh no, wait, I have one)

'Femuring' is a well-known experience in the skydiving community

Maryalicia Post

Posted: Friday, October 12, 2018

As you may or may not know, snapping the thigh bone is such a common injury in skydiving that they invented the verb ‘to femur’. I didn’t know that but it was a comfort when I femured myself two months ago.

Actually, I hadn’t been skydiving, but it cheered me to think I might have been. In fact I’d been creeping downstairs in the dark in a trailing kimono when I tripped myself up and flew off the stairs to the floor.

I’ve learned a lot since then really. What it feels like to wait on queue in hospital on an ambulance stretcher (it’s hard to keep up a conversation with an ambulance driver for three hours as he waits to retrieve his property from under you), how it feels to talk to a surgeon in dawn’s early light (amusing – but that was probably due to the drugs – mine not his). And that in hospital (the one I was in anyway) it is now standard to ask for agreement before laying a hand on you..

Nurse: I’m going to take your blood pressure. Is that alright? Me: Good idea.
Nurse: I’m going to take a blood sample. Is that alright? Me: If you must.
Doctor: I am going to repair your femur, is that ok? I’ll be using a titanium pin, a metal plate and six screws. Me: Absolutely! I have no other plans for today.
Someone: We’re going to give you a spinal (something… words indistinct). Me: Be my guest.

From then on silence interrupted only by the sound of hammering seeming to come from under the table. I wanted to tell them what my father taught me when I was young: never hammer a screw.

Afterwards I discovered that the words ‘physio’ and ‘rehab’ were often said in the tone of voice once reserved by us Catholics for ‘get confession’ and ‘go on a retreat’… the tone of the first implies ‘it won’t be pleasant but you have no choice’, and the second ‘relax and get holy at the same time’.

I said no to both. I could ‘walk through the pain’ (as skydivers say in their online femur forum) – with a little help from a blue tablet (hospital) and paracetamol (home). And I did.

My femuring is almost a memory now.

But I’m careful on the stairs.

Is there life after ophthalmology?

Research shows that one-in-four retirees in Britain goes back to work either for the income or the social aspects

Maryalicia Post

Posted: Thursday, October 11, 2018

Maryalicia Post

Is there life after ophthalmology?

If you’re an opthalmologist nearing retirement age, you might be asking yourself that question. Chances are the answer’s yes… probably many good years lie ahead.  You may be looking forward to the leisure.

Or perhaps not so much. According to a 2017 study in the journal  of Ageing and Society, one-in-four retirees in Britain goes back to work either for the income or the social aspects.

I’m not an ophthalmologist.. but I did retire once. It didn’t ‘take’.

My second career, as a travel writer, is already longer than my first as a medical editor.  I’ve been a travel writer since 1992. In 2001, I began writing for EuroTimes, still my favourite readership.

The first assignment was Amsterdam. I remember reporting on a trip through the Netherland bogs in a rowboat; in the early days, I reported for ESCRS on places as diverse as the arctic circle and Zanzibar. Currently the focus is on congress destinations, including Vienna, which will host the 36th Congress of the ESCRS in September.

Most of of the articles are at Other pieces have appeared in the Irish Independent, Irish TimesIrish Examiner as well as Abroad Magazine and France. Two of my articles were included in anthologies: Travel Guide France and Travel Guide Ireland.

I embarked on my second career when my husband died of lung cancer. I’d long been involved in anti-smoking campaigns and was editor of a respiratory news letter. Suddenly I didn’t want to read or write anything more about the subject.  I was nearing retirement age anyway. So I quit.

But I missed work. I missed having a project. On the plus side, I could come and go as I pleased, be away for long periods, take risks with no one home worrying about me. I had  contacts with newspaper and magazine editors. I’d travelled a lot in my first career and being a single woman in out-of-the-way destinations didn’t bother me either.

Only a month after my husband’s death, I set off on my first travel writing assignment. A friend chided me for running away from grief. I knew that was not the whole story. Starting a second career felt as if I were ‘running towards’ something rather than running away – running towards new experiences, new friends, a new life.

The ‘second career’ has been a success. Will there be a third?  I hope to be travel writing for a while yet.

But I could write a book (couldn’t we all?)  I did write a book, After You, to track the year after my husband’s death in poetry.  Recently I discovered tanka, the Japanese five-line poem and that led on to the cherita a six-line poetry format. I’m writing in both forms now.

When the wings come off my plane – metaphorically speaking – poetry may be what holds me up.

You never know what’s next…

When travel stress comes with the job

Travel-related stress – no one wants it, everyone faces it

Maryalicia Post

Posted: Monday, September 3, 2018

Not so long ago if you told people you did a bit of travelling for work (as I do, and as many ophthalmologists do) they’d say how lucky you were. No longer. What’s changed? Travel-related stress. No one wants it, everyone faces it.

In 2016, undertook a survey to quantify the causes of travel stress, questioning more than 4,555 respondents who travelled at least four times a year. Of them, 93% suffered from stress at some point in their journey. The top three worries: missing a flight (32% of respondents), language barrier on arrival (26%) and the possibility that luggage would be lost (22%).

Oddly, my own biggest worry was way down the list – losing my passport, a concern only 18% of my fellow passengers share. Nonetheless, I’ve had mine stolen in a New York airport and again on La Rambla in Barcelona. In my opinion, no experience comes close in terms of inconvenience and, yes, stress. Now I carry a photo copy of the passport and a spare credit card separately and hang the originals around my neck the way pilgrims to Santiago once carried a scallop shell.

I don’t worry about the language barrier; there’s an app for that. I use Google Translate. There are others – for an overview:

But cancelled flights do come in second for me, ever since the frantic scramble for a seat on an onward flight after a cancellation in Catania, Sicily. I had a top-level frequent flyer card on the air-line in question, and discovered loyalty pays! I also had a membership card giving me access to a lounge where the receptionist mercifully sorted my ticket.

My own third concern – an accident abroad – didn’t figure in the survey. But when I woke up in a Boston hospital a day after being concussed by a falling roof tile (I didn’t see that coming!), I couldn’t remember where I was staying, or where my belongings were. Now I carry a card from the hotel I’ve checked into – ‘just in case’.

There’s not much you can do about the stress of lost luggage, aside from carrying essentials in your hand luggage. However, stuck without my bags in Lyon, Air France provided me with an overnight amenity kit containing a toothbrush, an oversized tee shirt, two aspirin and a condom. Now that’s one worry off my mind.

Get growing!

Maryalicia Post says greens really are good for ophthalmologists

Maryalicia Post

Posted: Tuesday, August 14, 2018

‘Earth heading for 25-hour day.’

The headline gave me a flutter of anticipation. We all know that ‘work expands to fill the time allotted to it’ and now at last the shoe might be on the other foot – time expanding to accommodate the pressure of work. But no. The article goes on to explain the extra hour is due to the slower rotation of the earth around the sun and won’t be ours to spend for 200 million years.

So that means the over-stretched among us – and that’s most ophthalmologists – will continue to fit 25 hours of work into a 24-hour day and look for other ways to reduce the stress, anxiety and depression that come with the lifestyle. A meta review of studies at suggests a novel approach… ‘nature therapy’… aka light gardening.

Fortunately for the city dweller, you don’t even need a garden. The main benefit comes from the interaction with nature itself; just one plant can make the difference in raising mood and reducing stress levels And not only do mood and creativity get a boost, other studies confirm that tending your aspidistra may lead to less sickness and improved attentiveness too.

An entertaining way to get started is to download the interactive Plant Life Balance app devised by RMIT and Melbourne University. Take a picture of your space with your mobile phone, choose the visual effect you’d be happy with, then follow instructions to add the appropriate potted plants. The app calculates the therapeutic benefits of your new decor. Free download at iTunes and the Google Play Store.

A residual benefit of growing houseplants is cleaner air. Even NASA weighs in on the ability of plants to remove “volatile organic compounds which lurk around the average office, in carpets and furnishings, solvents and ink”. A NASA publication, How to Grow Fresh Air: 50 Houseplants That Purify Your Home or Office, explains: “Plants emit water vapour that creates a pumping action to pull contaminated air down around a plant’s roots, where it is then converted into food for the plant.”

A TED talk , How to grow fresh air by Indian environmentalist Kamal Meattle, winnows the list down to three commonly available plants that do the job: Areca palm, mother in law’s tongue and the money plant.

Greens really are good for you..