What are some of the areas you're presently researching? The major emphasis of the current clinical research my colleagues and I are working on involves power modulations in phacoemulsification, decreasing the invasiveness of cataract surgery, and increasing the rapidity of visual rehabilitation, all under the umbrella of cold phaco. We're also beginning work shortly on -1.0-mm cataract extraction techniques. We're actively engaged in the CrystaLensTM accommodative IOL (C&C Vision, Aliso Viejo, CA), and we are performing increasing numbers of refractive lens exchanges to address presbyopia. We've recently begun a study of the implantable miniature telescope for treating macular degeneration, as well as a study on Pharmacia's wavefront technology, the Z1000 IOL (Pharmacia Corporation, Peapack, NJ).
What do you feel are the most promising developments in ophthalmics right now? I think that down the road, refractive lens exchange will be the dominant refractive surgical procedure. Surgeons will be removing the lens through a very small incision and implanting an IOL that will address every component of a patient's refractive error, including presbyopia. I think wavefront technology is exciting, but in corneal surgery it is probably going to be useful for only a small number of patients with irregular astigmatism; I don't know what role it will play in the average person's surgery.
What was your most memorable experience while in surgery? I was performing cataract surgery on a one-eyed patient, at a time when we used to perform a retrobulbar before we started surgery. I had the feeling that I ‘d perforated the patient's eye with the injection. I kept the needle where it was, and asked the nurse to put an indirect ophthalmascope on me and hand me a condensing lens. I could see the needle going into the eye through the vitreous cavity and then out of the eye, indicating a double perforation, which sets the stage for a horrible retinal detachment. I asked the assistant to take a retinal cryoprobe and freeze the edge of the needle close to the hub. This transmitted cold along the metal shaft of the needle, which created a cryopexy scar at both the entrance perforation and the exit perforation. Next, I performed the cataract extraction. The patient had two scars in the retina, at the entrance and exit wounds. Happily, the holes were not dangerously close to the macula, and he never had a day's worth of trouble. That case happened nearly 30 years ago, and I've seen the patient continuously every year.
As a surgeon, do you have any heroes or role models? I suppose my biggest heroes in ophthalmology are Charles Kelman, MD, who innovated phacoemulsification, and Drs. Richard Kratz, Robert Sinskey, James Little, and Jared Emery, who were early converts to phaco. The insights and teachings of these men enhanced the lives of millions of people throughout the world, and in addition, fostered satisfying careers for many of us who followed.
Tell us about riding Harley-Davidsons. All my life I've been attracted to motorcycles—I love it. I have five of them now, and two on order. I love everything about riding; it's a great stress reliever because you have to concentrate on all of the conditions while you are driving in order to avoid an accident. It's a thrill I can't explain, I can only tell you that I never feel as alive as when I'm on a motorcycle. I also I like the fact that in addition to being Dr. Fine, I have the image of being a motorcyclist.
