5 Questions With R. Bruce Wallace III, MD

How did you become so devoted to studying and correcting presbyopia?
Presbyopia is the most frequently acquired ocular disorder, affecting millions of people worldwide. As baby boomers age, a growing number of patients will look to their ophthalmologists for solutions to this troublesome disability. My interest in lenticular surgical correction for presbyopia began 15 years ago, when I became a clinical investigator for the 3M (St. Paul, MN) diffractive multifocal IOL. My colleagues and I found that, if we selected patients properly, were accurate with our IOL calculations, and eliminated most of their corneal astigmatism, we would satisfy our patients. However, if one or more of these criteria were not met, we could expect to see a few unhappy patients. Since then, we have had the opportunity to investigate four other multifocal IOLs, one of which received FDA approval in 1997, the Array IOL (Advanced Medical Optics, Santa Ana, CA). We continue to look for ways to enhance refractive results with lens surgery in order to maximize outcomes with all lenses, including multifocal IOLs.

How will emerging technologies improve upon the treatment of presbyopia?
New IOL technologies designed to aid in presbyopia reversal are ordinarily either fixed, multifocal optics or accommodating designs. Clinical trials are underway to determine whether newer IOLs will offer advantages over currently available lenses. It is hard to predict at this time which of these IOLs will have the greatest impact. Along with IOL innovation, it is gratifying to see that improvements are being made in phacoemulsification technology, biometry, and astigmatism reduction in order to maximize the future benefits of lens replacement.

What has been your most challenging case?
I have been blessed with a great team of professionals that works closely together, and our clinical results reflect this fact. But, like any surgeon who has been practicing for 25 years, I've had my share of challenging cases. One of these involved my father's cousin. I had followed him for more than 10 years before scheduling his only eye for cataract surgery. His surgical procedure turned out to resemble one of those cases presented in the ?What-Would-You-Do-Now? courses at the AAO meeting. Because he was an avid golfer, fisherman, and traveler, I couldn't help thinking during his surgery what sort of an impact a bad result would have on his ability to continue enjoying life. Fortunately, after a few weeks of hand-holding and hand-wringing, his vision improved, and he was able to resume his active lifestyle.

How have your teaching experiences shaped your career?
Teaching has given me the opportunity to learn a great deal from many bright surgeons. Ophthalmologists tend to be intelligent, motivated, and curious. Many of the new ideas and novel approaches to challenges I have incorporated in my practice came from colleagues in attendance at meetings where I have participated as a faculty member. As long as we are able to pool our intellectual resources, our profession will continue to improve in its ability to help patients.

What is your advice to colleagues who are thinking about establishing an ASC?
Surgeons interested in developing their own ASC need to consider just how much time and energy they are willing to devote to what can be a drawn-out, complex, and demanding project. If they see the potential for satisfactory surgical volume; desire a hands-on approach to ASC design, development, and management; and expect an ASC to offer at least some protection from the significant reduction in their Medicare reimbursement, then they should consider developing an ASC.