Message from the Chair

Like all of you, this past tax season I gathered my receipts, calculated my capital gains, and resigned myself to Ben Franklin’s astute and timeless 1789 observation, “…[I]n this world nothing can be said to be certain, except death and taxes.”

At the risk of offending one of our Founding Fathers, to this short list of life’s inevitabilities, I’d suggest we add “Change.” Look around you. Blockbuster to Netflix, empty nest to a boomerang young adult in your basement, Jay to Jimmy on late night TV—if you can’t embrace change, you can’t embrace life.

Change is also in the air here at OMIC. What a delight to be stepping into the shoes of my oculoplastic’s colleague and mentor, John Shore, as I assume Chair of the Board for the next two years. Dr. Shore has handed me the reins of a company enjoying unparalleled success in the medical malpractice marketplace. Of all U.S. ophthalmologists who can choose their malpractice carrier, nearly half choose OMIC. How have we become the undisputed leader in ophthalmic risk management and claims adjudication? Teamwork and the deep bench comprised of our San Francisco-based staff of 45 loyal staff captained by President and Chief Executive Officer Tim Padovese; the dedicated and insightful ophthalmologist board and committee members, past and present; collaborative engagement of our sponsor, the American Academy of Ophthalmology; and most importantly the faith, feedback, and trust of you, our insured physician owners.

I became an OMIC insured 16 years ago, when fresh out of fellowship and without getting competitive quotes or considering other companies, I staked my professional liability with OMIC based on no more than brand recognition and the endorsement of the American Academy of Ophthalmology. This could have been a potentially poor business decision (I mean, who doesn’t bid out one of the largest expenses for a doctor just starting out in practice?). But it ended up being one of the greatest professional choices I ever made.

While these are exceptional times for our company, I recall the growing pains we had during my first few Board meetings in the early 2000s. It was a tense time for medical liability insurers; many exited what had become an increasingly unprofitable marketplace while others simply became insolvent. Displaced ophthalmologists looking for a safe haven found one with OMIC. We were a smaller company then and absorbing these displaced doctors put considerable pressure on our performance measures. Our seasoned executives, financial advisors, and physician board members made calculated and at times difficult decisions that allowed us not only to grow our insured count but maintain and improve our fiscal health as well. A.M. Best rewarded OMIC’s sound decision-making by upgrading our financial stability rating to “A” (Excellent) in 2007, a rating we have maintained every year since then.

Ophthalmologists who placed their professional liability faith in OMIC are being rewarded for their loyalty. In 2014, OMIC is providing a 25% dividend for all active policyholders. Upon application of this dividend, OMIC will have returned more than $30 million to policyholders over the past five years. While you can always count on OMIC’s prudent corporate governance, there will undoubtedly come a time in this inherently cyclical business when we will again face headwinds. As your new Chair, I promise you that with OMIC, you are in no better hands to weather whatever change or challenge lies ahead. Now, if only OMIC could help decipher the U.S. tax code.

Tamara R. Fountain, MD, Chair of the Board 

Protected: “How to Survive Malpractice Litigation: Lessons Learned”

Conjuctivochalasis Repair

Informed Consent for Repair of Conjunctivochalasis

What is Conjunctivochalasis?

The conjunctiva is the tissue that forms the clear outer coating overlying the white sclera of the eye.  Conjunctivochalasis is a condition that causes the conjunctival tissue to become loose and wrinkled with the sagging tissue laying on the lower eye lid.  The excess conjunctival tissue prevents the normal flow of tears from the tear gland to the tear drainage ducts, thus causing tearing, redness, and irritation of the eye.  Although the symptoms of conjunctivochalasis may sound like dry eyes, these eyes typically do not respond to a variety of treatments that usually help dry eye syndrome.  Scientists believe that the connective tissue that sits underneath the conjunctiva starts to degenerate so the conjunctiva is not tightly attached to the underlying sclera, thereby letting the tissue become loose and wrinkled.

What are the symptoms of conjunctivochalasis?

Conjunctivochalasis usually causes eye irritation and redness.   Tearing is also very common because the sagging tissue blocks the normal flow of tears.  Blinking makes the eyes feel worse, just the opposite of what occurs in dry eye syndrome. Activities that involve looking downward with your eyes, such as reading and knitting, may make them feel worse.

Are there medical treatments for conjunctivochalasis?

Since the symptoms of dry eye syndrome are so similar to those of conjunctivochalasis, it may be difficult to distinguish the two conditions.   It may be worthwhile to try dry eye treatments such as frequent lubrication with artificial tears and ointments, topical cyclopsporin eye drops (e.g. Restasis), steroid eye drops, and even punctal plugs, to determine if they help.  Typically, the patient with conjunctivochalasis will get not relief with these treatments.

What surgical treatments are helpful for conjunctivochalasis?

There are many possible surgical procedures to treat conjunctivochalasis, all of which involve excising the excess tissue, tightening the loose tissue, or replacing the abnormal conjunctival tissue.   Conjunctival cautery can be used to create superficial scarring and tightening of the tissue.  The abnormal tissue may be excised and new tissue allowed to grow back over the excision site.  Alternatively, the abnormal tissue may be excised followed by placement of an amniotic membrane graft over the excision site. 

What is Ocular Surface Reconstruction?

Ocular surface reconstruction involves excision of a strip of the abnormal conjunctival tissue (usually the portion that covers the inferior half of the eyeball) and placement of an amniotic membrane graft to cover the site of excised tissue.  The amniotic membrane can be secured in place with sutures, tissue glue, or a combination of the two.    Amniotic membrane is tissue that forms the inner lining of the placenta, and it has many regenerative properties.   This membrane has anti-inflammatory properties, and promotes healing of the ocular surface.

Ocular surface reconstruction with amniotic membrane is usually performed in an outpatient setting, under local or topical anesthesia.  One or both eyes may be treated at the same time.  Your eye may be patched for the first night.

What are the risks of ocular surface reconstruction?

Ocular surface reconstruction is a superficial operation on the white sclera of the eye, but there are still some risks to the procedure which include: hemorrhage, infection, scarring on the surface, loss of the amniotic membrane tissue, double vision, droopy upper lid, recurrence of the conjunctivochalasis, failure of the procedure to help, the need for multiple additional procedures, loss of vision, and very rarely loss of the eye.

If an injection is administered for anesthesia, additional risks include a hemorrhage behind the eye ball, ecchymoses (bleeding under the eyelid skin), irregular heartbeat, inadvertent injection of the anesthetic into a blood vessel, and perforation of the eye ball with the needle.

The eye may be irritated, red, and uncomfortable for the first 48 hours, but usually feels better after that initial period.   You will need to be followed closely by your ophthalmologist until the ocular surface has healed, which may take 2-3 weeks.  Ultimately, the redness, tearing, and irritation should resolve.

If you do not have this surgery, your symptoms of redness, irritation and tearing will persist and may worsen.  Rarely will this condition cause any significant loss of vision.  In general, treatment of conjunctivochalasis is elective, meaning a patient does not have to undergo any surgical procedure if they can live with the associated symptoms.

This procedure will not correct other causes of ocular irritation or tearing such as dry eye syndrome, blepharitis, blocked nasolacrimal ducts, or lagophthalmos (inability to fully close the eyelids when blinking or sleeping).

Summary

Conjunctivochalasis is a common condition that is frequently overlooked.  It typically does not respond to topical medications, and the definitive treatment is usually a surgical procedure.  Ocular surface reconstruction with amniotic membrane graft is one popular and successful form of treatment. 

I understand the risks, benefits, and alternatives of ocular surface reconstruction with amniotic membrane graft.  My surgeon has adequately answered all of my questions to my satisfaction.  I realize that all of the possible risks of the procedure may not be known, nor were they all listed in this consent form. 

I agree to proceed with this procedure on my right /  left/   both/  eye(s).  (circle one)

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Patient’s signature                                                   date

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Print patient’s name

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Witness’ signature                                                   date

Cataract Consent Form – FL Specific

Please click on the following link to view and download this consent form.  Cataract Surgery Consent – FL Specific