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Up Front | Feb 2005

5 Questions With George O. Waring III, MD

How have practicing and teaching in so many different countries shaped your view of refractive surgery?

I have taught ophthalmology in more than 58 countries and have lived in Brazil, France, and Saudi Arabia as part of my clinical experience. There are two important aspects of international work. First is the realization that ophthalmology is an international enterprise, with original contributions from so many diligent ophthalmologists in scores of countries. The subspecialty of refractive surgery is likewise composed of very talented professionals who expand this subspecialty with their clinical and technological expertise. The second component of international practice is service. When I work abroad, I always gain great satisfaction from not only being able to treat patients, but also training international doctors. I always learn something from those physicians.

What are your thoughts on the US' regulatory process?

The medical regulatory process in the US is the most stringent in the world. The advantage of such strict regulation is that the US does not get very many Mark1 and Mark2 devices or drugs, because they all undergo many improvements before making their way through the FDA. One classic example is that US ophthalmologists did not perform small-diameter excimer laser ablations in high myopes as physicians in other parts of the world did in the late 1990s. On the other hand, US practitioners' access to new technologies is often delayed, because the FDA's many requirements and long approval time cost companies enormous amounts of money.

As Editor-in-Chief of the Journal of Refractive Surgery, how will medical publishing supply MDs with information in the future?

The core of reliable medical information is the peer-reviewed journal, and the crux of that method of information is the prospective, randomized clinical trial. Whether in electronic or print format, the peer-reviewed journal will remain the gold standard for information that is used to guide clinical practice in refractive surgery. The difficulty is that, for various reasons, most physicians do not take the time to read the peer-reviewed articles and instead rely on trade newspapers and magazines, which contain more colloquial information. One challenge is to improve the effectiveness of communicating the results of complex, multifaceted clinical trials to the busy practitioner.1

What is the background regarding the recent publication of your 10-year-old LASIK data by the National Institute for Clinical Excellence?

The National Health Service (NHS) of the British government recently released a guidance document assessing excimer laser surgery in general and LASIK in particular in the UK. It concluded that LASIK was too dangerous to support and recommend. They based their conclusions on the Cochran Report and peer-reviewed published data, including one study of clinical data that I directed in 1995. It is unconscionable for the NHS and the NICE to present 10-year-old data as the standard of care for assessing current technology. However, LASIK practitioners share part of the blame, because we are not publishing our results. (For more, visit www.usaeyes.org/articles/british_lasik.htm.)

How did you become a Fellow of the Explorer's Club and a Dive Master in the Professional Association of Dive Instructors?

I have a passion for the outdoors. I believe that being in nature keeps my perspective on life humble and appropriately small. I have kayaked the Grand Canyon, the Zambezi River in Zimbabwe, and rivers near Mt. Everest. I have scuba dived in five continents and have been diving with great white sharks. I also go bare-boat sailing every year. Sailing one's own boat out in the middle of the water is not only challenging, but always lets one appreciate the power of nature. I also enjoy heliskiing in British Columbia, where I have skied over 1 million vertical feet. My most rewarding outdoor experience occurred in 1998, when I went with my son, George Waring IV, to the Nepali Himalaya on a mountain-climbing expedition led by ophthalmologist Geoff Tabin. We accomplished the first ever ascent of the mountain Kang Yaja at 20,000 feet. That was a moment of truth.2,3

1. Waring G. On what information do ophthalmologists base their clinical practice? J Refract Surg. 2004;20:414-417.
2. American Alpine Journal. 1996;38:274-278.
3. Rock and Ice. March/April 1996.
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