Mark Packer, MD: Sitting on the DOCK of the bay

Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Mark Packer, MD, FACS, CPI. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica. By Mark Packer, MD, FACS, CPI The DOCK, of course, is the Demonstration of Ophthalmic Cognitive Knowledge-the final step for me in completing my second round of Maintenance of Certification requirements for the American Board of Ophthalmology (ABO). Just as Otis Redding found sitting by the bay a time for reflection on past accomplishments and future prospects (“I left my home in Georgia / Headed for the Frisco Bay / Cuz I’ve had nothing to live for / And look like nothing’s gonna come my way”),[1] I, too, found that taking this exam initiated a period of contemplation regarding where I’ve been and where I’m going. One reason for this effect is that reading clinical vignettes during the exam took me back to patient encounters from my residency years at Boston University and my early years of practice in Eastern North Carolina, long before I focused on refractive cataract surgery in Eugene, OR. I recalled the midnight traumas at Boston City Hospital, neurological cases from the consult service, and various pediatric emergencies. Taking the exam also caused me to reflect on my service from 2003 to 2006 as a member of American Academy of Ophthalmology’s Ophthalmic Knowledge Base Panel for Cataract and Anterior Segment (which later became known as the Practicing Ophthalmologists’ Curriculum Panel). We were charged with developing a textbook in outline form that would become the basis for examination questions to be developed by the ABO. In fact, I recognized one of my own clinical images on the DOCK! I remembered sitting with colleagues and judging what information about cataract surgery every board-certified ophthalmologist should know. Ten years ago, of course, David Chang’s initial paper on Intraoperative Floppy Iris Syndrome had just been published![2] While that was a huge “Ah ha!” moment for those of us who had been struggling with the mystery of occasional iris prolapse, we also asked if it was really fair to test surgeons on what was then a brand new understanding of pathogenesis. Finally, there is an unavoidable sense of life passing when one has to perform a particular task just once every 10 years. If I do pass the exam (and it takes 8 to 12 weeks to find out), I will not only have very likely taken the last multiple-choice test of my life, but I will also have achieved ABO certification for a total of 30 years. That sounds a lot like a full career. Today, my professional world is all about innovation and bringing beneficial new technologies to patients through clinical research and FDA approval. My days (and, often, nights) are consumed with clinical decisions and regulatory issues in areas ranging from the reversal of presbyopia to minimally invasive glaucoma surgery, from the integration of diagnostic imaging and femtosecond cataract lasers to phakic refractive lenses, from novel capsulotomy construction to genetic medicine, to name just some of the incredibly exciting projects with which I am privileged to be involved. It will be a little while before questions about some of these technologies make their debut on the DOCK exam! Nevertheless, I am reminded every day of the importance of understanding the basic, time-tested principles of ophthalmology. While the recognition of unmet needs in ophthalmic practice creates the inspiration for innovation, the success of innovative drugs and devices depends on safety and effectiveness, outcomes which are governed by the details of ocular anatomy and physiology. When presented with a new idea, truly understanding basic principles gives a person an intuitive grasp of its potential to improve outcomes. However, true understanding can only emerge from the combination of cognitive knowledge and practical experience. If that true understanding indicates a high potential for success, investment and research are warranted to demonstrate the benefits and evaluate the risks. So, for now, I am going to continue to sit on the DOCK and await my results. Looking back, I see that my journey in ophthalmology has been both a “long, strange trip”[3] and a great adventure. Looking forward, I see amazing advances yet to come, and I realize that, appropriately, the key to creating that amazing future is having vision. [1]http://www.azlyrics.com/lyrics/otisredding/sittinonthedockofthebay.html (Accessed Sept. 24, 2015) [2] Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg. 2005 Apr;31(4):664-73. [3]http://www.lyricsfreak.com/g/grateful+dead/truckin_20062376.html (Accessed Sept. 24, 2015)