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Up Front | Oct 2004

5 Questions With Richard J. Mackool, MD

Dr. Mackool discusses his philosophical approach to ophthalmology and the accomplishments that he expects from generations to come.

Why did you choose the field of ophthalmology?
As a third-year medical student, I recognized that the role of an ophthalmologist was critically important, because most people regard their sight as their most valuable sense. I decided to find out if ophthalmology was for me. I had a 5-month elective period, and I opted to spend it entirely in ophthalmology. My first view of the eye through a slit lamp took my breath away, and within a short time I was in love. Within 2 months, the residents at Boston University had enough confidence in me to leave me in charge of the clinic on days when they were operating. I never looked back.

What do you believe is the biggest remaining challenge in safe nuclear removal?
In eyes with normal anatomy, we are already there. The nucleus should be removed uneventfully in nearly 100% of these eyes using current technology in true closed-eye fashion (ie, with no incisional leakage alongside the phaco needle). The biggest challenge is in an eye with a weak/deficient lens zonule. Endocapsular rings really do not solve this problem, at least not in severe cases. Also, the use of iris retractors is too often insufficient; they are too weak and poorly designed for the task. I designed the Cataract Support System (Alcon Laboratories, Inc.), and it really works. In my opinion, more surgeons need to use this system for such cases.

What is unique about the way that you run your facility in Astoria, New York?
In forming the first ASC in New York (we opened in 1983), my staff and I encountered a good deal of adversity, and I think it is fair to say that we blazed some interesting trails. The experience has made us “tournament tough,” but we realize that becoming overconfident is a sure way to wind up on our rear ends. If there is anything unique about my staff and me, I believe that it is a combination of our experience and this philosophy. We know that we can get the job done, but we also know that anyone can fail if he neglects to pay attention to the details that got him there. As an example, we pay close attention to what our patients tell us about our services. We do not care how cranky they are; if they criticize us, we listen very carefully and take action. We have no hesitancy in penalizing or terminating marginal employees. On the other hand, we realize that we have to reward the excellent ones or they will not be with us very long. We may not run the leanest organization (our profit margin is not great), but I do not think we mess up very often, either.

How do you spend your free time? Do you have any interesting hobbies?
I love to golf, and my game can vary from awfully good to awful. Happily, my surgical results are more consistent. Recently, I became a Wetlands Commissioner in my hometown of Greenwich, Connecticut. The seven members of this commission are called upon to make some very serious decisions concerning the preservation of our wetlands and waterways, and we are committed to protecting our resources without unduly penalizing residents and businesses. It is actually a pretty challenging balancing act that requires careful consideration of many issues. My favorite hobby, however, is watching my youngest child, Serena, who is 13 years old, perform at her avocation, which is classical ballet. This kid is amazing! She sets her proud father's heart racing with moves that have to be seen to be believed. She has already performed on six occasions with the American Ballet Theater at the Met in Lincoln Center. With age, it definitely becomes more fulfilling to watch your children accomplish things than to gain accolades for yourself.

What do you hope to accomplish professionally in the near future?
Anything that I can do to make surgery easier and more successful for my colleagues excites me. I love watching the approximately 30 ophthalmologists who operate at my ASC improve. I like to think that the atmosphere and environment that we create for them is aiding them in their growth as successful surgeons, and I believe this to be true. After performing about 40,000 procedures myself, I get a bigger kick out of tracking the improvement in their skills than I do out of my own accomplishments, similar to my sentiments about watching my own children grow and improve.

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