Patients Report: Some of the Best Things in Life Are Seen - page 6

published by

A BoozmanHof Quarterly MagazineWinter 2011

Eye Care Evolves - page 4

Eyedea

Cassie’s Thoughts on Cataract Surgery - page 9

(others are still tasted)

Doctors

C. William Hof, M.D.Randall E. Cole, M.D., F.A.C.S.

Randall O. Bell, O.D.Darren L. Brodie, O.D.

Leah B. Cate, O.D.Jim S. Myers, O.D.

C. Scott Woodward, O.D.

Website

www.boozmanhof.com

Eyedea published by

Editor and PublisherMatt Young

Copy EditorHannah Nguyen

DesignerWinson Chua

Cover Image: Jack and his Guinness

Copyright © 2011 Painter: Dennis Young

www.dennisyoungarts.com

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Good News: Even More Vision Correctable by Refractive Cataract Surgery

S ometimes people think they have problems with “a stigmatism”

when actually the condition is called “astigmatism.”

That seems to be the way things go with astigmatism: it has always been a misunderstood vision problem, and even treatments until recently have left something to be desired.

Until now. Recent toric intralocular

lens (IOL) options have become available that have almost doubled the amount of astigmatism we can treat with lenses at the time of cataract surgery—to currently about 95% of people who have astigmatism.

It is simply a wonderful piece of news that has happened in our world of refractive cataract surgery, and we’re enthusiastic to spread the word and treat more patients that need this kind of lens help.

We’re also excited to welcome Daniel Sines, M.D., aboard BoozmanHof, as his

talents as an occuloplastic surgeon are surely needed in our Northwest Arkansas region. Further, we’re delighted to introduce Cassie Schroeder, our refractive specialist.

In this issue of Eyedea, we explore vision in a new light—from patient

experiences after both LASEK and cataract surgery. Their tales remind us all about what it means to have the gift of sight, and we thank them immensely for sharing their vivid experiences. Thank you Sheila, Jim and Emily.

We also explore thoughts on advanced surface ablation and even leadership—from the point of view of those working at our ambulatory surgery center (ASC).

In this Issue...

06 10 11

Cataract surgery is cheap

compared to a car

Patients praise new vision Leadership values from a

leading medical center

What’s better than laser

eye surgery?

Our esteemed medical coder, Janis Geary, once again demystifies that increasingly complex world.

And we’re excited to feature our friends at Parenti-Morris Eyecare as part of our valued network of stellar eye care providers in Northwest Arkansas.

As always, we like to update you on cool stuff in terms of technology we’re working with and thinking about. And Dr. Jim Myers shares his thoughts on complex contact lens fittings.

We hope you find this issue of Eyedea valuable, as we believe—from refractive cataract surgery to LASEK to all other eye care services—that you deserve the very best.

Sincerely,

Randall E. Cole, M.D.President, BoozmanHof Eye ClinicMedical Director, BoozmanHof Eye Surgery and Laser Center

To Our Readers

02 n Eyedea

1105

Eyedea n 03

One of the few good things about being old is that you have lived long

enough to see many great technological advances in our profession.

Some of these are in the area of contact lenses. When I was in training back in the early 1970s, the primary contact lens that we fit was an old hard PMMA lens.

It was non-gas permeable and it was common to see severe corneal edema and emergency room visits secondary to hypoxia.

Advances in Contact Lens Technology O.D. Corner

New Doc Tackles Tough Cases

Doctors’ offices all too often are full of bad news. “A lot of times in the medical field,

you give patients the bad news and there’s nothing you can do about it, but in ophthalmology, you can,” said Daniel Sines, M.D., the new fellowship-trained occuloplastic surgeon at BoozmanHof. “One of the things that I enjoy is helping people with skin cancer on their eyelids.”

When patients come to Dr. Sines, he helps reconstruct both a good, functioning eyelid and a cosmetically pleasing one as well.

“These are usually scary times for patients,” Dr. Sines said. “They don’t understand what’s going on. You need to spend extra time with these patients. People are very concerned about this area because it’s on their face.”

During my training, Bausch & Lomb (Rochester, New York) launched the original soft contact lens with 3 base curves: F (flat), N (normal), and S (steep). It was soon understood that even the flattest base curves were not flat enough and the original B, F and J series were introduced.

In the late 1970s, I began to fit the first stable hard gas permeable lens on the market, which was put out by Polycon.

This was a huge advance in contact lenses, reducing most of the overwear and hypoxia problems. At that point, even though the soft lenses were improving, the stability of a toric lens left a lot to be desired and we used to call them “snowflake lenses” because no two were alike. The reproducibility was horrible.

Along with the first generation of refractive surgery—radial keratotomy—

Dr. Daniel Sines (left) with his wife and child. (Right) A favorite pastime: fishing.

By Jim Myers, O.D.

there came huge advances in the quality of corneal topography, which greatly helped us in contact lens fitting, especially with the complex fits, such as keratoconus, pellucid marginal degeneration, corneal trauma and post-surgical complications from primitive refractive surgery.

Today, with the new generation of silicone hydrogen polymers, reverse geometry design, and third generation hybrids such as the SynergEyes (Carlsbad, Calif.) lenses including KC and ClearKone, we have much better options for fitting difficult corneas.

However, I do sometimes fall back on some of the older fitting methods, such as Rose K2 designs or even sometime piggyback fits.

Overall, it’s great to live in a day when you do have an option for fitting these complex patients.

Providing exceptional care first, and foremost, is on Dr. Sines’ priority list.

“You want it to look as nice and normal as possible,” Dr. Sines said. “We can do things to make scars as minimally noticeable as possible or hide them entirely.”

It’s common for Dr. Sines to work on eyelid malposition, bow lift, and more complex problems involving the eye socket.

“That’s something most ophthalmologists don’t do,” Dr. Sines said. “I treat tumors behind the eye and in the eye. I also treat orbital fractures from trauma.”

That makes Dr. Sines a great addition to the BoozmanHof surgical family.

“You’re looking at a couple hours by car to get to anyone else that does what I do,” Dr. Sines said.

Considering how bustling Northwest Arkansas has become, it’s a good thing indeed that Dr. Sines has the unique eye care expertise that he does, and has found a home in Rogers.

04 n Eyedea

RefractiveEvolution

A s it turns out, the spirit of refractive surgery was within BoozmanHof before the clinic

even existed. Charles Casebeer, M.D., was an

early, pioneering advocate of radial keratotomy (RK).

“He put together a system of RK that improved predictability,” Dr. Cole said. “And it was Charles Casebeer’s uncle that [BoozmanHof co-founder] Fay Boozman actually acquired his original practice from.”

It’s a little piece of BoozmanHof trivia perhaps—almost inconsequential on its own—but it’s an early marker of the direction the clinic has been taking ever since: one of paramount importance in refractive surgery.

C. William Hof, M.D., co-founder of BoozmanHof, also trained in RK in Russia with ophthalmology giant Svyatoslav N. Fyodorov, M.D. Randall Cole, M.D., medical director, BoozmanHof Eye Surgery and Laser Center,meanwhile, met Dr. Fyodorov in Florida, where Dr. Cole learned RK fundamentals.

“In 1985, we were the first practice in Northwest Arkansas to do RK,” Dr. Cole said. “I had RK in my own eyes in 1991. I still see 20/20 uncorrected for distance.”

RK sounds like such an

antiquated procedure these days, as lasers have taken over the marketplace. But BoozmanHof’s experience in the procedure testifies to their early knowledge in the field.

“The problem was with RK, it was dependant on the surgeon,” Dr. Cole said. “It required the surgeon to have good hands and technique to get good results. That affected predictability, although we got very good results with RK in our practice with several

thousand procedures.” In the 1990s, BoozmanHof

participated in the evolution of refractive surgery.

“We went from using the Automated Corneal Shaper [Chiron Inc., Irvine, Calif.] with the Hansatome [Bausch & Lomb, Rochester, N.Y.] to progressing to advanced surface ablation (ASA),” Dr. Cole said.

He explained that although LASIK is a great procedure, there is a small subset of patients with suboptimal results.

“But if you’re doing something elective in the realm of refractive surgery, you have to get in the mindset of no problems,” Dr. Cole said.

That is essentially what has happened with the transition to ASA, Dr. Cole said.

“By avoiding the flap, you avoid 90% of the problems or complications from LASIK,” Dr. Cole said. “It’s a small percentage, but a small percentage of people in a large number of procedures each year creates a significant population.”

Dr. Cole explained that ASA yields patients the best vision with fewest complications,

lowest enhancement rate and no flap-related problems.

“You don’t transect the cornea, you avoid cutting the nerves, and there’s no dry eye,” Dr. Cole added. “You don’t get diffuse lamellar keratitis (DLK), toxic photosensitivity syndrome, or late flap complications.”

The only downside to ASA is the slightly slower visual recovery time.

“On day one with ASA, walking out of the laser room—boom—patients can see,” Dr. Cole said. “As the cornea resurfaces, vision drops off, so at one week postoperatively, vision might be 20/40. At two weeks, vision returns to 20/20. And ultimately, results are the best with fewer higher order aberrations. LASIK flaps induce aberrations, as you would guess.”

LASIK flaps also can respond in scary ways to trauma.

“Yesterday, the craziest thing happened,” Dr. Cole said. “I saw a patient that had LASIK in Boston five to six years ago. He came in and said, ‘A kitty cat scratched my eye two weeks ago. I haven’t seen right since then.’”

The patient had blurred, double vision as a result of a lacerated LASIK flap. Epithelial ingrowth occurred through the scratch down into the interface beneath the LASIK flap.

“His eye won’t ever be the same,” Dr. Cole said. “Instead of being a simple abrasion of the cornea, 5 years after a LASIK procedure, you have epithelial ingrowth under a flap. He will probably end up having a corneal transplant.”

An eye that underwent RK (left). An eye that underwent LASEK (right)

Dr. Randall Cole (left) and Dr. C. William Hof (right) with a building contractor in an earlier era at BoozmanHof

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Eyedea n 05

In the 1980s, while Randall E. Cole,

M.D., was performing cataract

surgery in central Florida, he was

impressed by the cheaper business

model in play.

Hospitals were charging a

$5,000-per-eye facility fee at the time.

But at his practice, run by James

Gills, M.D., cataract surgery was

performed outside the hospital quicker,

more easily and with less expense:

a $2,300 per eye surgeon/facility fee.

So the combined payment at Dr. Gills’

practice was half of what the hospitals

were charging for the facility payment

alone.

“Today a procedure which is

much more advanced and much more

predictable has gone to where the

surgeon fee paid by Medicare is under

$700 and the facility fee is about $950

per eye,” Dr. Cole said. “In 20 years,

notwithstanding inflation, I can’t think

of anything else where prices have

become so much less in terms of

things getting better and better. ”

Cars, houses, appliances…

prices have indeed gone up for most

consumer items, while cataract surgery

has become an incredible value. And

it’s incredibly life-enhancing.

“It is the most life-changing

procedure and device patients will

encounter,” Dr. Cole said. “Nothing

else comes close. “

That’s because after the procedure,

a 70-year-old can quite possibly see

better than ever before in life. We’re

talking about sight—one of life’s most

precious gifts.

“At age 70, there’s not anything

mentally or physically that people can

do that compares to what they can do

at their apex,” Dr. Cole said. “But what

we do with modern cataract surgery

gets people to a level that they can see

or function visually that exceeds what

they have ever experienced in their life

at any point at any age. And it’s less

expensive than 20 years ago.”

Hence, Dr. Cole calls modern

cataract surgery one of the best values

not just in medicine, but in any industry

today, and he’s not alone.

“Compare cataract surgery to

another common ‘purchase,’ a Ford

Taurus,” Edward J. Holland, M.D.,

president the American Society of

Cataract and Refractive Surgery, wrote

in an August press release. “[It’s]

hardly a luxury car, but a necessity

for the activities of normal living in

the U.S. In 1990 the cost of the car

was $12,600, and the cost of cataract

surgery was $1,500. In 2005, the

average cost of the car was $20,830,

a constant dollar increase of 9% while

the fee for cataract surgery was cut 71

percent to $684.”

That’s quite some value for what

Dr. Holland calls “one of the miracles

of modern medicine.”

Source: Edward J. Holland, M.D., president, American Society of Cataract and Refractive Surgery

Dollars & Sense

The Declining Cost of Cataract Surgery By Matt Young

Eyedea editor

1990

2005

Ford TaurusCataract surgery

Ford TaurusCataract surgery

$12,600

$1,500

$20,830

$684

06 n Eyedea

It’s easy to take sight for granted.

For instance, did you know that

your eyes process 36,000 bits of

information per hour? They also blink

more than 10,000 times per day and

contribute toward 85% of your total

knowledge.

We often overlook how precious

our eyes are, and that’s ok. The best of

sight functions seemingly flawlessly.

But those who have had surgery to

restore vision or improve upon it know

what many of us don’t: how amazing

vision truly is, and how far sometimes

one needs to go to get it.

Up until his LASEK procedure,

46-year-old Siloam Springs resident

Jim Berger relied on optical correction

nearly his whole life. He was in glasses

in the 3rd grade, contacts in high

school, and reading glasses in adult life.

“The only way my nerdy mind

could handle that [reading glasses]

development was I picked a pair that

looked just like the ones William

Shatner wore in Star Trek II when the

aging Kirk character had to admit he

was getting old,” Mr. Berger recalled.

Because of Mr. Berger’s thick

prescription, he learned he was not

a candidate for LASIK, a laser vision

correction procedure.

“Then one year my optometrist

said something different and I was

Cover Story

In Their Own Words: Patients Praise New VisionBy Matt Young, Eyedea editor

stunned,” Mr. Berger said. “He said

recent developments in procedures

held the potential that even with my

poor vision I might be a candidate for

corrective surgery. He encouraged me

to check things out and recommended

BoozmanHof to me. Sure enough they

ended up telling me I was just barely in

the eligible range for LASEK. I learned

how it was more specialized and more

specific to my needs than LASIK. And I

remember having to explain ‘IK’ versus

‘EK’ to my family and friends as I told

them I was considering it.”

In 2004, Mr. Berger planned to

have the surgery done at the end of the

year to use the Christmas to New Year’s

break to recover.

“We worked to set aside the

money and the excitement grew,” Mr.

Berger said. “I switched from contacts

to nothing but glasses in preparation.

But in the last months leading up to

the procedure I got cold feet. I canceled

my agreement and spent New Year’s

wondering what it would have been

like.”

But Mr. Berger kept hearing good

things about LASEK, an epithelial laser

technique less invasive than LASIK.

“With a clearer understanding of

what lay ahead I again made end of the

year plans,” Mr. Berger said. “But this

time I kept them!”

“ The only way my nerdy mind could handle that [reading glasses] development was I picked a pair that looked just like the ones William Shatner wore in Star Trek II when the aging Kirk character had to admit he was getting old…”– Jim Berger

Eyedea n 07

In December 2006, Jim Berger

and his family traveled to Little Rock

for a Trans-Siberian Orchestra concert,

which he described as a “fusion of hard

rock and Christmas music.”

It was a year after Mr. Berger’s

LASEK procedure at BoozmanHof to

restore glasses-free vision.

“The arena show boasts an

amazing light and pyrotechnics

display,” Mr. Berger wrote in a

letter to Randall E. Cole, M.D., and

BoozmanHof. “As I sat watching

every laser beam and explosion with

incredible clarity, I honestly said

a prayer of thanks for you and my

procedure.”

Going on six years after LASEK,

Mr. Berger still enjoys unaided sight.

“All year long, but especially

during the fall, I enjoy sunrise and

sunset both,” Mr. Berger said.

“Whether out walking for my health in

the morning or driving home from an

occasional late ending to the work day,

I like to look at the trees—those fleeting

moments when they are intricate

black outlines backlit by the orange

and pink and golden sunlight. They

look like some amazing artists pencil

drawings. And I can see every detail to

my delight. If I remember right, I was

probably the poorest vision numbers

Dr. Cole had ever worked on to that

In Their Own Words: Patients Praise New Vision

point. I’m so thankful that he did. I still

tell folks it was one of the best health

choices I ever made.”

Sheila Gallagher experienced a

similar world opening up before her

eyes after cataract surgery.

Ms. Gallagher, now 72, wore

glasses since her early 30s when she

was reading a lot as a graduate student

at Notre Dame.

“My eyes got pretty well used,”

she quipped.

Earlier this year, she had cataract

surgery at BoozmanHof in one eye, and

had it in the other eye some time later.

She explained what it was like to have

her vision back in the first eye.

“The first thing I noticed was if

I looked at the sky with my recently

operated eye, the sky was blue and

the trees against it were green,” Ms.

Gallagher said. “If I looked with the eye

that had yet to be done, everything was

sepia tone. I already immediately after

the first eye noticed a level of detail,

brightness in my vision, and perception

of colors that I really did not know I had

lost. When you realize that you had lost

something and now it’s back, it literally

is eye-opening.”

Ms. Gallagher penned a letter of

thanks to BoozmanHof afterwards.

“You and your clinic staff make

excellent care into a routine without

“ The first thing I noticed was if I looked at the sky with my recently operated eye, the sky was blue and the trees against it were green… If I looked with the eye that had yet to be done, everything was sepia tone. ”– Sheila Gallagher

Sheila Gallagher with Dr. Randall Cole

Continued on page 8 >>

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08 n Eyedea

D r. Pete Parenti, O.D., has been practicing in Benton county longer than any other eye

care professional.“I’m a few months older than

Bill Hof,” Dr. Parenti chuckled, knowing full well that’s a jab in good jest.

Over the years, Parenti-Morris Eyecare has had an outstanding relationship with BoozmanHof for several reasons.

“They’ve done a really magnificent job working with optometry,” Dr. Parenti said. “I have always had a high degree of comfort in contacting them about patients. I’ve sent my own family members there for surgery that I

Working Together to Advance NW Arkansas Eye Carecouldn’t handle in my own clinic. They’ve also solved some problems as far as my eyes.”

Dr. Chris Morris, O.D., also in practice with Dr. Parenti, said he needed someone he could trust in handle specialty care.

“As optometrists, we need surgical care to be a team concept,” Dr. Morris said. “There’s care I am not going to physically provide, but I am well educated in terms of what to recommend and then we can follow-up so that our relationship with the patient continues. That’s what they

guys at BoozmanHof are committed to.”

Dr. Alex Bell, O.D., has a particularly special relationship with BoozmanHof.

“My father is an optometrist there: Randy Bell,” Dr. Alex Bell said. “So my relationship with those docs has gone

back for a long time, as I pretty much grew up around all the docs there. They produce an excellent situation as far as partnering and patient care.”

Added Dr. Parenti in good humor: “The second best Dr. Bell works at BoozmanHof.”

treating a patient as just one more

pair of eyes,” she wrote. “That can’t

be easy, considering the hundreds of

people you see in a week. You know

the bumper sticker that says, ‘Commit

a random act of kindness’? ‘Random’

doesn’t work in health care. Instead,

you deliver an ‘organized act of

kindness’ in your service to patients. I

will think of you all warmly, even after

that last eye drop goes in.”

In fact, 73-year-old Emily Crofut

traveled with family after her original

cataract procedure in Texas to Rogers,

Ark. just to have some additional

cloudiness in vision removed.

Ms. Crofut formerly lived in

Arkansas where she had been receiving

eye care services from BoozmanHof.

After her suboptimal result after

cataract surgery in Texas, she travelled

all the way back to BoozmanHof for

care she could trust to restore her

vision.

“Dr. Cole had just come back from

vacation,” Ms. Crofut recalled. “They

called him. He worked me in and did it

for me so I could go back to Texas.”

In a subsequent letter to

BoozmanHof, Ms. Crofut wrote how

appreciative she was of the jovial staff.

“When I’m up tight and nervous

about what I have to go through and

those taking care of me are happy

and relaxed, I find myself laughing

too!” Ms. Crofut wrote. “It’s hard to be

fearful when you’re laughing! P.S., the

bonus is I can see a whole lot better.”

“ When I’m up tight and nervous about what I have to go through and those taking care of me are happy and relaxed, I find myself laughing too!… It’s hard to be fearful when you’re laughing! ”– Emily Crofut

“ Dr. Cole had just come back from vacation. They called him. He worked me in and did [a vision procedure] for me so I could go back to Texas. ”– Emily Crofut

>> Continued from page 7

(From left to right) Dr. Alex Bell, Dr. Pete Parenti, and Dr. Chris Morris

Eyedea n 09

When a lot of medical coders think of dry eye, they think of Sicca. But “Sicca” is not always the

best code to use. A lot of times there are other things associated with dry eye, like punctate keratitis.

In fact, the most common diagnosis code associated with dry eye is 375.15 (Tear film insufficiency, unspecified).

Another common diagnosis code associated with dry eye is 370.33 (Kera-toconjunctivitis sicca, not specified as Sjogren’s).

A final common diagnosis code is 370.21 (Superficial keratitis without conjunctivitis; punctate keratitis).

Caution: If a patient presents with punctate keratitis, you need to determine the cause.

• If dry eye syndrome is the cause use code 375.15

• If dry eye syndrome is NOT the cause use code 370.21

In other news, Medicare will not cover a therapeutic contact lens (92310); it is included in the eye exam.

A lot of times, patients come in and have a corneal ulcer. Sometimes they purchase expensive contact lenses, but these are not covered. Instead, bill for the eye exam and include the contacts bundled into the visit.

Use procedure code 65435 for Rust ring Removal (Removal of corneal epi-thelium; with or without chemocauter-ization [abrasion,curettage]). There are so many different foreign body removal codes, but this code most accurately describes this type of removal.

New Glaucoma codes added to the CMS Web site effective October 1, 2011.365.01 was REVISED to the following: Borderline Glaucoma; open angle with borderline findings, low risk.

NEW CODES include:365.05 – Borderline glaucoma;

open angle with borderline findings, high risk

365.06 – Primary angle closure without glaucoma damage

365.70 – Glaucoma stage, unspecified365.71 – Mild stage glaucoma365.72 – Moderate stage glaucoma365.73 – Severe stage glaucoma365.74 – Indeterminate stage

glaucoma.

For the final full set of ICD-9 code changes visit the CMS Web site. Since the new codes took effect on October 1,2011, CMS only adds new ICD-9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.

Physicians should start documenting clearer diagnosis now to prepare for ICD-10 coding.

For example, coders and billers will have a difficult time determining the most accurate ICD-10 code when a physician writes OAG (Open Angle Glaucoma) with no additional detail.

Hopefully, the coding tidbits are helpful enough to keep in your office for quick reference.

Don’t forget, if you have further questions related to this or any other medical coding issues, call me at 479-246-1700, or email me at jgeary@boozmanhof.com.

Janis Geary, ACS-OH, is the BoozmanHof business office director.

By the time someone is 70, they’re

clearly at a visual disadvantage,

and cataract surgery can make all the

difference.

“A lot of people don’t realize

what they are missing in life until

they have cataract surgery and

correct the cataract, astigmatism, and

visual acuity problems,” said Cassie

Schroeder, BoozmanHof’s refractive

surgery scheduler and patient

consultant.

So even before surgery, Ms.

Schroeder feels it is paramount for

patients to choose the right lens

option, and she helps them with that.

“I love that I get to talk to patients

about the different lens options they

have to choose from to help make

cataract surgery benefit them the

most,” Ms. Schroeder said. “I enjoy

seeing patients that have had the

ReStor lens [Alcon, Fort Worth, Texas]

or toric lens and are so excited to tell

me that they can see

nearly everything

without glasses.”

Ms. Schroeder

also has witnessed

visual transformation

on other levels.

“When I was a technician for

[BoozmanHof’s] Dr. Woodward, I

really enjoyed watching children that

were unable to read the visual acuity

chart before glasses transform into

confident and assertive children with

their glasses,” Ms. Schroeder said.

“This is a very rewarding job on every

level.”

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Did you Know?

Ask JanisVeteran medical coder provides answers to your ophthalmology management questions

10 n Eyedea

Surgery Center Update

Donna Acord was 31 years old with a newborn baby and a kindergartener when she signed

up to be director of BoozmanHof’s new ambulatory surgery center (ASC) in 1996.

“I don’t know how I did it,” said Ms. Acord, now 48.

But she does know what informed her leadership style to help make the ASC an incredibly successful, problem-free place to have surgery.

Books. “I was required in school to write

a nursing philosophy,” she said, and despite being married with children, that’s when her love affair with management books began.

One of her favorites is Nuts! Southwest Airlines’ Crazy Recipe for Business and Personal Success.

Ms. Accord particularly likes how they “set up and led a company,” and that’s understandable by reading the intriguing book description:

Herb Kelleher reinvented air travel when he founded Southwest Airlines, where the planes are painted like killer whales, a typical company maxim is “Hire people with a sense of humor,” and in-flight meals are never served--just sixty million bags of peanuts a year.

Today, Southwest is the safest airline in the world and ranks number one in the industry for service, on-time performance, and lowest employee turnover rate.

“I have read a lot of John Maxwell, The Management Methods of Jesus, Robert Barner… I have a whole bag full of books,” Ms. Acord said. “It is nuts.”

What has she learned after so many cover-to-cover nights?

“From a philosophy standpoint, I believe that successful leadership is dependent on congruent goals,” Ms. Acord said. It sounds pretty deep, and what she means is that goals must be aligned among leaders of organizations. Leaders include owners, managers, physicians and even government board members, she said.

“They can be met in different ways,” Ms. Acord said. “But if goals are not aligned, you will find yourself frustrated.”

Successful leadership also is built upon high quality, self motivated employees—people you work with on the front lines who are willing to take a risk, she said.

“It’s more important that you have solid front line,” Ms. Acord said. “My job is much easier if people that work under me are self-motivated, quality-

Leadership PhilosophiesButtress Surgery Center

BoozmanHof staff at the opening of the ambulatory surgery center (ASC)

Staff at a recent festive sweater party

oriented, type A. It’s hard to find, but you do find that still in a lot of people.”

Asked how she hopes she is viewed as a leader, Ms. Acord is humble, and for a reason.

“Servant leadership would be how I hoped I’m viewed,” Ms. Acord said. “I am not going to ask you to do anything that I’m not willing to do myself. How one performs a task sets the tone for the remainder of the team. If I expect you to do something meticulously, correctly, and perfectly, then I need to emulate that expectation.”

Ms. Acord’s reading habits, thoughtful introspection, and leadership experience have helped make BoozmanHof’s ASC what it is today: a huge success.

“Ophthalmology is the biggest offender [in medicine] for wrong site surgeries,” Ms. Acord said. Since opening, the ASC hasn’t experienced one such problem, she said.

There also has only been one late-onset endophthalmitis in 29,000 cataract surgeries, which is among the best infection rates anywhere. The first ambulatory center of its kind in northwest Arkansas, the ASC also has received national recognition as a Center of Excellence.

And most importantly, more people pass through the ASC each day, and more come out with incredible new vision.

Worst Nightmare Eliminated

In LASIK surgery, flap complications and related

infections are worst-case scenarios. And indeed, they are pretty bad.

In LASEK surgery—which does not involve the creation of a stromal flap, but rather involves more superficial epithelial removal—worst-case scenarios involve the formation of haze and resulting unclear vision.

Now, the advent of mitomycin C (MMC) has reduced the incidence of haze to 0 at BoozmanHof. Essentially, what MMC does is create a level playing field in terms of patient healing response to LASEK, explained Randall E. Cole, M.D., medical director, BoozmanHof Eye Surgery and Laser Center. Although each person’s biological system responds differently to surgery, MMC reduces that variability after LASEK.

“I use it with every LASEK patient,” Dr. Cole said. “It’s a low concentration of mitomycin C for the last 30 seconds of the procedure. There’s no scarring and no haze. And when you look at the corneas—from an aesthetic point of view from the slit lamp—it’s like stealth surgery. You can’t see anything has been done. These corneas are crystal clear.”

Waiting in the Wings: ECP

Imagine a fiber optic probe with a laser at the end of it. It could see something in the body and zap, laser

something away if necessary. The tool already is available in the form of

endoscopic photocoagulation (ECP), which has been used in glaucoma surgery. The aim is to search for anatomical processes creating aqueous and pressure buildup and destroy them.

In fact, it has been around at least 10 years, but C. William Hof, M.D., co-founder, BoozmanHof Eye Clinic, believes it needs to be further refined.

“Of all the surgical procedures for glaucoma, it has the most long-lasting effect,” Dr. Hof said. “But it creates a lot of inflammation inside the eye.”

Dr. Hof is considering re-looking into ECP to see if the technology has advanced further, but at the moment is reserving judgment on this innovative, but still evolving procedure.

Cool Stuff

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Lens Over Laser

What could be better than quick laser eye surgery? For some, a phakic intraocular lens (IOL) could be better.

That’s because laser ablates corneal tissue, and some patients with high dioptric corrections just can’t undergo too much ablation. The laser procedure just won’t work well that way. Enter the Visian ICL (STAAR Surgical Co., Monrovia, Calif.), a lens that is implanted into the eye to correct vision. It’s not an IOL that replaces the natural lens, so it’s not the same device used in cataract surgery. It’s much more minimally invasive than that, according to STAAR Surgical. It can be removed, for instance. And it can be inserted through a tiny 3 mm opening rather than utilizing a 7 to 9.5 mm corneal flap like with LASIK. “It is a good option for people too nearsighted for LASIK,” said Randall E. Cole, M.D., medical director, BoozmanHof Eye Surgery and Laser Center. “You can correct higher amounts of myopia without damaging the cornea like you would with a LASIK flap.”

W hen you send patients to BoozmanHof Eye Clinic, you can be confident that your patients will receive the very best care, with the latest technology, from experienced skilled physicians. We will work closely

with you and your staff to ensure that your patients obtain the best possible results. Once a treatment plan is formulated, our surgical counselors will work with your office in arranging the return to your care.

Since its beginnings as Boozman Eye Clinic in 1977 and later as BoozmanHof, our practice has endeavored to offer the latest innovations in ophthalmic surgery. We offer the precision of wavefront-guided LASEK and a full range of new lens options for cataract patients, including apodized diffractive optics technology (the AcrySof IQ ReStor) and accommodating IOL technologies (Crystalens).

Our fully accredited, Medicare-approved surgery center accommodates every outpatient procedure we perform, including cataract surgery, LASEK, glaucoma and oculoplastic surgery. Staffed with experienced eye care professionals, our facility offers the very best in ophthalmic surgical technology in a comfortable, patient-focused environment.

We look forward to working with you and your staff!

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Procedures include:• AdvancedSurfaceAblation(LASEK)• Astigmatickeratotomy• Avastin/Lucentisintravitrealinjections• Blepharoplasty• Botox/Juvederm• Cataractextractionwithintraocular

lens implantation (lifestyle, toric and aspheric lenses available)

• Ciliarybodydestruction(endoscopiccyclophotocoagulation)

• CornealtransplantsincludingDSEK

• Ectropion/Entropionrepair• Endothelialkeratoplasty• Excisionofpterygiumwithconjunctival

flap• FocalGridLaser• Irisrepair• Laserperipheraliridotomy• Nd:YAGcapsulotomy• Panretinalphotocoagulation(PRP)• Removalofskinlesions

If you have any question or if there is

anything that we can do for you, please

don’t hesitate to give us a call at

800-428-3937 or 479-246-1700, or email us at

info@boozmanhof.com.

Visit our website at www.boozmanhof.comBoozmanHof Eye Surgery and Laser Center offers:• Aninviting,spaciousclinic• Comfortablereceptionandrecovery

areas

• Experiencedsurgeonsandstaff• State-of-the-artoperatingroomand

laser suite

We Value Our

Relationship with YouOur Surgeons

Dr. C. William Hof, M.D. Dr. Randall E. Cole, M.D.

• Repairoflacerationofcorneaorsclera• Repositioningoftheintraocularlens• Scleralreinforcementwithgraft• Strabismussurgery• Temporalarterybiopsy• Trabeculectomy(withMitomycinCor

Ologen)• VisianICL(ImplantableCollamerLens)

implantation• Vitrectomy