The Insight Blog

Rodgers and Hammerstein in action

As I write this I am listening to the music of Rodgers and Hammerstein and appreciating the timeless talent of the greatest creative partnership American musical theatre has ever seen.

It is exceptionally pleasant to re-visit all those classics of yesteryear: “I’m going to wash that man right of my hair”, “People will say we’re in love”, “I enjoy being a girl”, all those recognisable tunes from Carousel, Oklahoma! The King and I and The Sound of Music … the list goes on and on.

I find myself humming “The corn is as high as an elephant’s eye, an’ it looks like its climbin’ clear up to the sky!” It is impossible not to smile while singing something as optimistic as “Oh what a beautiful morning.”

Prom 49 – a celebration of Rodgers and Hammerstein with the John Wilson Orchestra and Kim Criswell heading the singing bill –  also marked fifty years since the death of Oscar Hammerstein.

The subsequent BBC television broadcast promised (and delivered) nearly two hours of toe-tapping tunes from the best of Broadway. For a group of us London Vision Clinic patients the BBC Proms 2010 programme provided the opportunity to listen again to the concert we had enjoyed live at the Royal Albert Hall the previous week.

Thank you London Vision Clinic for this unforgettable experience.

Dan Reinstein playing the saxophone at the 606 Jazz Club in London

This could be the time to confess something I have not yet dared to admit… here goes: I don’t like jazz.

Or, at least, I didn’t think I liked jazz.

Happily though I do have an open mind and am prepared to be swayed – should the music take me – and I now realise that like bodies, art and almost everything else in life, jazz comes in all shapes and sizes.

For the past five years, each month I have attempted to get myself to the 606 Club in Chelsea to see Dr Dan and his sax in action and each month something has conspired to prevent me … or could it have been a subconscious desire not to get across London (I live in North London) for an evening that I didn’t expect to enjoy?

But this month all that changed – and I changed my mind set too. It was a song called Merci, Merci (or should that be Mercy, Mercy?) that did it.

Looking back I realise that my instinctive rejection of jazz stems from an unfortunate session I was once forced to endure. The less than talented musicians attempted to be in some way avant garde; but to me the resulting sounds were raucous and discordant with each instrument almost fighting with the next in some musical battle the object of which was way over my head. It was like having to sit through a  cacophony of  jumbled, angry notes thrown together in order designed (if there was any plan involved) to leave the listener with a tense, nervous headache.

I totally didn’t get it and, after deciding that nails grating on a blackboard would be preferable, I pledged to give jazz a wide berth in the future. Since that unfortunate experience I rejected all jazz exploring instead other musical genres and ending up with an eclectic compilation in my taste mix.  My “Desert Island Discs” selection would include pop, r and b, opera, country, classics and even a stray big band track … but not a jazz note would have featured..

That was until my recent visit to the 606 Club and listening to the Dan Reinstein Quintet in action. Here I learned the lesson that jazz can be harmonious. The double bass, the drums, piano and trumpet all melded together in a rich, melodious manner. Their solos – while giving the impression of being casually improvised – must have been the result of a lifetime of practice. Each was played with the skill and confidence that only comes from total trust in the other members of the musical “team”; then Dr Dan’s saxophone would pull the musical theme together again, directing the melody back on course. It was slick and smooth.

As a student, Dan Reinstein faced a tricky choice: he could pursue a professional musical career or become an eye doctor. I am sure that we London Vision Clinic patients are happy that he selected the latter. Actually, we have the best of both worlds as we can also enjoy his music at various patients’ gatherings and at his monthly gig at the 606 Club.

Welcome to a special post on the London Vision Clinic blog … no, we are not marking the end of the summer – despite the fact that with all the wind and rain this week London has felt far more like autumn than August.

Nor am I going to write about the ESCRS 2010 (European Society of Cataract and Refractive Surgeons) which this year is convening in Paris -perhaps you remember the articles from last year’s gathering in Barcelona.

No, instead I am going to open a glass of bubbly to mark this momentous moment … this is the 100th article I have written for the London Vision Clinic blog.

The previous ninety-nine posts have covered a varied bag of eye health related topics, the opportunity to meet some of the exceptional people who make up the London Vision Clinic and to delve deeper into the personal experiences of a few patients.

They have included the London Vision Clinic’s continued expansion and the move from Devonshire Place to the new and much larger clinic at 138 Harley Street. Over the last couple of years, I have also moved (four times) and have written these pieces from different desks at many locations looking out at a variety of views as the seasons have changed. I have looked up from my laptop at the skylines of London, Norfolk, Malaga, Barcelona and Beverly Hills for my inspiration.

Since the blog began, new members of staff have joined the elite team and some others have celebrated massive changes in their personal lives – like getting married or becoming parents. Through it all every one has always given 100% professional effort to their career in eye health – devoting themselves to the continued effort of always providing excellent care and as near perfect eye sight as possible for each of their patients.

We patients also know that the care and connection to the clinic continues long after our surgery is over and I am looking forward to meeting you at the next patient event.

So in this special 100th edition of the blog, I would like to raise a glass and drink to the continued and well deserved success of the London Vision Clinic … and to the next 100 blog posts.

Artemis ultrasound scanner

Today, in addition to her successful legal career, Susan Singleton is a busy single mother of five.

Her children range in age from 25 to eleven-year-old twin boys; while professionally she is often called to advise large companies on legal issues and conduct talks and seminars in far flung countries – she was recently working in Iran and Nigeria.

As predicted, after twenty years elapsed since the radial keratotomy procedure, Susan was back in specs … and hating it.

“I put it off as long as I could” she said, “but eventually I had to give in!”

Like everybody of a certain age (except those already enjoying blended vision), Susan was not happy with the inconvenience of reading glasses – in her hectic schedule she also found that they slowed her down and made her feel and look older.

“Everything just takes longer with glasses. Each time I wanted to read a text on my phone, I would have to hunt for my glasses in my bag (she rejected the aging trend of wearing them on a chain around her neck). When I opened the dishwasher they would steam up, they would fall off while I was gardening, and I never seemed to have them with me when it was time to read a night time story to the twins.”

They were also an inconvenience in Susan’s professional life.

As the name suggests, reading glasses become necessary for all reading and close work – so, on they have to go for computer work and digesting legal documents. Susan particularly hated the on and off yo-yo action that accompanied checking notes at conferences, giving group talks and making public speeches.

“Along with having grey hair, using reading glasses is incredibly aging”, she points out.

Happily now we can easily colour our hair and – thanks to blended vision- we can also ditch the readers.

Susan returned to the eye clinic that had successfully treated her twenty years ago; but they could only suggest the intrusive method of lens implantation which did not appeal.

Then she read about blended vision and later heard from a friend who had undergone the procedure at the London Vision Clinic.

However, because Susan’s eyes still bore the scars from the incisions made for the radial keratotomy twenty years ago, the procedure to correct her loss of focus could only be carried out with exceptional skill and highly specialised equipment. This included the Artemis ultrasound scanner (developed as a direct result of research by Dr Dan and a select team of LASIK surgery experts) and specialised shape based, topography guided, treatment.

Susan is thrilled with the result.

“It has made an enormous difference to my life. It makes me feel younger – I can do things more quickly.

“If you break your leg you don’t have to wear plaster and use a crutch for the rest of your life, you have the injury repaired – so why do we think of eyes differently. To continue to use glasses – when there is an alternative – would be like using a crutch for the rest of your life.”

MEL 80 Excimer Laser

In 1990 Susan Singleton had radial keratotomy, in what was then a new eye surgery technique, to correct her myopia. Twenty years later she underwent the latest laser procedure to correct presbyopia or aging eyes.

Twenty years ago eye surgery was newsworthy – nowadays, carried out with the help of highly accurate laser machines, it only attracts the attention of journalists if a celebrity suddenly appears minus glasses or speaks out about ditching his or her contact lenses.

Back then RK was only used to correct short sightedness (myopia) and astigmatism – it was not suitable for long-sighted patients. This was thirteen years before Dr Dan invented the blended vision technique of ridding patients of their reading glasses. The MEL 80 Excimer laser (that Dr Dan helped to develop alongside Carl Zeiss) would not arrive at the London Vision Clinic until 2003.

The radial keratotomy procedure was abandoned a few years after Susan’s operation as it was found that to be unstable resulting, long term, in many patients became hyperopic (far sighted)with astigmatism.

Back in 1990, after reading and researching about RK, Susan made up her mind. She had worn glasses since her sight began to deteriorate at the age of twenty.

“I had never got on with contact lenses”, she told me. “At the time I had three children under five – you know what babies are like, they kept grabbing at my glasses and pulling them off!”

Twenty years ago when Susan Singleton decided to undergo RK at another eye clinic she found herself in a very small minority of the population.

At the time she wrote in her Vogue article that many people dismissed the procedure as “cosmetic surgery”. But, she argued with the skill born of her legal training, the fact that she suffered from poor eye sight was: “comparable with a hip problem requiring a hip replacement operation”.

Unfortunately the attitude of medical insurance companies and the NHS remains unconvinced and unchanged over the years.

The articles Susan wrote about her eye surgery twenty years ago paid for half the cost of the procedure (as well as Vogue magazine another by her was published in the FT Magazine).

As a struggling freelance writer in 2010, I can report with certainty another change over the years – publications are not nearly as generous these days.

London Vision Clinic patient Susan today

Flicking through an old copy of Vogue magazine (April 1991) the make-up and fashion features have not dated as much as you might expect.

Philip Treacy’s haute couture hats are still “ahead of their time” and top model Christy Turlington – although no longer the face of Calvin Klein- remains stunningly gorgeous; while yoga could also today be described as “the modern choice” and most of us are still in love with denim.

However I am in for a surprise when I delve further into the magazine’s health section and find an article entitled “Eyes Righted – Susan Singleton braves the surgeon’s knife”.

Here I read that radial keratotomy – the surgery that Susan had to correct her extremely poor vision – is an “irreversible and relatively new (in 1991) procedure demanding great precision”.

The notes at the end of Susan’s article continue that one eye hospital conducting a trial at the time: “insist that the only real risk is that patients might be dissatisfied if results yield only a partial improvement in their sight, about one-fifth of patients are said to be disappointed following their operation.”

Happily, Susan was not that one in five and her RK operation was a complete success.

Her eyes were corrected one at a time – with six weeks apart. After the first procedure she suffered some pain and her eye was sore and swollen, but: “As the swelling came down, I was aware of an incredible clarity of vision: I could see in a way that I had not done since I was a small child.

After the second operation, Susan wrote, that there were no complications: no headaches, no blurred vision and no problems with glare.

At the time Susan was told that she would enjoy the benefit of good eye sight for approximately twenty years by which time, through the unavoidable problem of aging eyes, she would start to need reading glasses.

Having experienced successful early eye surgery, it was unlikely that this successful solicitor – now a mother of five – would accept the inevitability of presbyopia and the inconvenience of reading glasses.

However, having had the RK procedure (which involves cuts of 90% depth in the peripheral cornea weakening the area and so causing flattening in the centre of the eye to correct myopia), would Susan be a suitable candidate for blended vision?

Mary in reception with the patient feedback device

Here’s a new game that returning London Vision Clinic patients might like to play: it’s called “Spot the Difference”.

Changes have been made in the reception area at 138 Harley Street and it should be pointed out that these are part of an ongoing project to improve the overall appointment and waiting experience for patients. We all know that the London Vision Clinic’s philosophy is never to rest on its laurels*; but to constantly strive to provide an even better service.

Those who would like to play – while still enjoying a cuppa, cool drink and a tasty snack –might look up from their magazine to note that they are not only sitting on new sofas and chairs but also the receptionists’ desk is different. That’s not all…  there is a new glass jar for all those pairs of redundant glasses and something else… what are these tablet-like gadgets that look a bit like an iPad?

In addition to the usual methods of assessing feedback – the patient forum, testimonials and questionnaires – the London Vision Clinic now has two of these handy gadgets both offering the following multiple choice questions:

• How would you rate the complexity/simplicity of your patient journey? (Very simple/Simple/Neutral /Complex/Very complex)
• How would you rate the value you have received for your money?
• How would you rate the quality of the clinic care you have received to date?
• How would you rate the quality of the team you have interacted with so far? (Excellent/Good/Fair/Poor/Very Poor)
• How likely are you to refer a colleague or friend to the London Vision Clinic? (Very likely/Likely/Neutral/Unlikely/Not likely at all)

It is a simple and anonymous way that London Vision Clinic patients can (only if they want to) provide feedback which is regularly assessed.

*The origin of this saying goes back to ancient Rome where athletic excellence was acknowledged by a wreath of laurels – so, to “rest on one’s laurels” literally means to live off one’s reputation or refrain from further effort because of satisfaction with what has already been achieved.

Perhaps this would also be a good time to wish the London Vision Clinic a happy 8th birthday … yes, it all began on August 17th 2002.

Christina, Michelle and the delightful Disney

A female friend of mine describes herself as a “Techno Tart” – for the sake of alliteration let’s call her Trisha.

I feel quaintly old-fashioned after spending time with Trisha and her shiny new iPad. Only interrupted by the sound of emails regularly plopping into the inbox of her iPhone 4, she shows me her holiday photographs in all their hi-tech glory. Not only does she have an enviable bikini body, but she also has the ability to get hold of the latest gadget really quickly … and – even more impressively – to master how they work in record time.  Not for Trisha a patient wait for the teething problems to be ironed out, or for the price to come down. She wants what’s hot right now!

It’s not that I am a Luddite – I am certainly not against technological progress. It’s more that, when it comes to gadgets (not shoes I hasten to add), I become a cautious shopper – someone who weighs up the various applications and advantages before making a commitment. However fancy the page turning features, do I really want to curl up on my sofa reading an on screen iPad book?  Can anything replace the thrill of flicking through fresh paper pages?

At the moment I think that, for me, the answer is no. But never say, never!

Like many technology prudes, (if that’s what we are) I have, however, learned to embrace meaningful shortcuts and helpful time saving inventions that are relevant to my work. I happily remember, during my broadcasting days, the joy of binning the tangled reels of tape along with all the cutting and pasting paraphernalia. It was a terrific breakthrough to discover the new world of digital audio editing at the mere click of a mouse.

I only share this with London Vision Clinic blog readers, because I have been on something of a learning curve and would like to say a big “thank you” to Christina and Michelle for their infinite patience during our recent training session. By sharing their skill and knowledge, I am proud to say that I can now (more or less!) handle the behind the scenes intricacies of this part of the London Vision Clinic website on my own.

Dr Kishore Raj Pradhan from Nepal with his wife and Vimal

Having written about the Three Phases of Truth and how they might relate to the expectations of the Laser Eye Humanitarian Project in Nepal, it occurred to me that the thoughts of the German philosopher, Arthur Schopenhauer, could also be applied to most medical developments and scientific inventions – including the pioneering work carried out by the London Vision Clinic.

- First they are ridiculed.

- Second they are fiercely and violently opposed.

- Third they become self-evident.

The next layer of the theory is as follows:

When a new way is suggested, people often criticize it as strange, outlandish, or even at odds with how the laws of the universe. It is lambasted and laughed at.

Then when momentum begins to build for change, ridicule gives way to concerted opposition. The forces that benefit from the current situation feel affronted. They defend the status quo with whatever means necessary.

Finally this momentum builds into an undeniable force – it creates an incentive for the power-holders to move from their adamant position. Now the impossible is not only possible, it becomes the new standard. It becomes self-evident.

So now we have a glimpse of the future… as well as the past.

It might be easier for some others to accept change and view developments with the benefit of hindsight; but those of us connected to the London Vision Clinic are always going to be several steps ahead.

According to the German philosopher Arthur Schopenhauer (and Professor Dan Reinstein founder of the London Vision Clinic) truth passes through three phases:

-First it is ridiculed.

-Second it is fiercely and violently opposed.

-Third it becomes self-evident.

Dr Dan was in a somewhat philosophical frame of mind when he spontaneously climbed on to a chair to speak to the London Vision Clinic guests at the summer barbeque.

He brought us up to speed with the progress of the London Vision Clinic Foundation in Nepal which promises to invent “Humanitarian Laser Eye Surgery” helping ‘those who are too poor to see, can’t see to work, and can’t see to survive’.

This work is in partnership with the Tilganga Eye Institute in Kathmandu which is already inundated with patients who live in abject poverty. Glasses would only offer a temporary solution and the soon to be launched London Vision Clinic Foundation expects instead to offer the best laser eye surgery care with the latest equipment from doctors trained at the London Vision Clinic. Dr Kishore Raj Pradhan and a technician from the Nepalese eye hospital are currently studying at the London Vision Clinic so that they can transfer their newfound specialist skills to their home country.

This is all unchartered territory and whether or not its progress will follow the pattern laid out by the 19th century philosopher and quoted by Dr Dan at the summer barbeque remains to be seen.

It was however a different doctor -Dr. Martin Luther King, Jr- who pointed out that change doesn’t take place magically… “Duration is not enough: the mere passage of time does not create change. It requires ordinary people envisioning, acting and constructing the future”.