NEWS-Line Communications - Physician Assistants
Of the post-cataract patients that Physician Assistant William (Bill) Ausmus treats, ì99% are better [than before surgery], 90% are vastly better, and 70% now need no glasses,î he says.ìCataracts are brownish in the main, so when they are taken out people are seeing a sky that is blue again and whites that have no beige in them.Twenty or more times during the day, youíre seeing a patient and saying, ëthatís just great; youíre doing wonderfully wellí - and youíre often talking to somebody who was ready to give up activities, maybe even give up a profession.î Commenting on his work, he says, ìItís a wonderful job.îAusmus
is a PA at St. Luke Cataract and Laser Institute in Tarpon Springs, Florida
, working under Dr. James P. Gills, who, he
says, ìis one of the worldís most experienced cataract surgeons.Because of his
was able to get the first YAG [yttrium aluminum garnet] laser in private practice in the U.S. Columbia Presbyterian in New York got it first, then we got one.î
The YAG is much more accurate and gives much more flexibility to eye surgery than conventional methods, Ausmus
says.ìWhen it came to us, it just turned out that I had an interest in it and started working with it.î He
explains how it is so useful to cataract patients.ìAfter you do modern cataract surgery, you leave a little membrane intact that is a barrier between the interior and posterior chambers of the eye.By leaving this membrane intact, this makes the operation 500% more safe for the retina - there are 500% fewer complications to the surgery.
For years, I helped with the laser procedures,î Ausmus
says, ìand at one point, I had more experience with these than anybody else in the U.S. PAs can really get involved in some interesting things in the frontiers of medicine.Eventually though, in 1990, the people who made the rules for Medicare decided that because these were invasive procedures, theyíd no longer pay for PAs involved in this surgery.That was a fascinating part of my PA life, but Iíve moved on - and now am involved in treating conditions and problems associated with dry eye.î
began focusing on medical conditions of the eye, there were four people who greatly influenced his
says.The first two were at the University of Alabama
, the second two were associated with his
first job out of school.ìI started the Surgeonís Assistant program [which was also the PA certification program, he
says] with Dr. John Kirklan, head of the medical school there.
Another plus of working with these two doctors, Ausmus
says, was that they also did acute medicine and surgery for Bryce Hospital
, a mental health hospital there.ìThis was important for me because they didnít have enough help and it gave me a chance to get experience in a wide range of medical [procedures].î
It was during this time that Ausmus
had a patient he
tried to save, and whose death has influenced Ausmusí attitudes in practicing medicine ever since.ìThe patient was around 90 years old, very ill and very frail and I went to put an NG [nasogastric] tube in him.When you do this,î he
says, ìyou should always have a suction machine at hand, just in case the patient starts vomiting - so you can keep the patient from aspirating [the vomited matter].Well, I got the machine, turned it on, checked it, got a nurse to help me, and started to insert the NG tube.Unfortunately, this frail old man vomited and aspirated; the machine wouldnít work, and he
ìIt turned out that the machine was defective in the most hidden way.There wasnít anything else we could have done; when the machine failed, we tried to suction the man by other means.There was, of course, an investigation by both the hospital board and the nurses board, and they both found no fault, that we had done all that we could.The only reason to tell this story,î Ausmus
says, ìis that you come to realize eventually, that it ëainítí all glory - that in some cases, no matter how hard you try, you canít always cover everything.But I still carry it around with me, and it adds to my humility and to my caution.î
An early case, with a happier outcome, involved a patient, an anesthesiologist, who was in an ICU when Ausmus
first saw him.ìHe had gallbladder disease, and massive peritonitis has set in, as well as septicemia.Heíd been seen by a number of doctors, experts, and even an infectious disease specialist, but he
was just a mess.î Ausmus indicates that the patient was headed downhill fast.
ìAfter everybody else had left, I sat down and looked at his
charts, and the result of about 40 cultures heíd had.I made out a little graph of what we were treating and what the cultures had shown, and sure enough, it turned out that there was one organism - a gram-negative bug - that we werenít treating.We started the man on one more antibiotic, and I left for the day.The next time I was on duty, I didnít see him in the ICU.He
had recovered!î Ausmus says that this is illustrative of ìthe one great thing that PAs have that a lot of other medical professionals donít have: a few extra minutes to sit down and really think about all aspects of a patientís condition.ìI saw this patient nearly 20 years ago,î he
says ìand I still consider him one of my great triumphs.î
...After nine years in the job in Tuscaloosa, Ausmus says he ìstarted looking around and read in a medical missionary magazine that an ophthalmologist in Tarpon Springs, Florida, needed help.
I came here, and Iíve done pretty much only medical ophthalmology since then.
ìOf late, Iíve been [treating] these dry eye problems, and thatís been very rewarding.You need to give a lot of TLC, and you have to do a very careful investigation of each patientís other conditions, because there are a number of conditions that can impact dry eyes.Everybody over the age of 50 is subject to getting dry eyes, and some are effected at younger ages,î Ausmus
notes that in severe cases, it can threaten a personís lifestyle or even a career.
ìOne case that has had a wonderful outcome at this point, is that of a young dentist who was considering retiring because he
was suffering from a syndrome that left him with very dry eyes.It was getting to the point that he
couldnít tolerate the bright lights he
had to work under,î he
remembers.ìWe treated him with different [artificial tear solutions], with some anti-inflammatories, and with mast-cell stabilizers,î Ausmus
underwent plastic surgery to tighten his
lids and reduce the fissure [that is, to reduce the surface area of the eyeball that is exposed to the drying air].We were able to get him back to functioning pretty normally, and since heís only in his
early 40í, heís no longer considering retirement.î
At St. Lukes, along with Ausmus
, there are four other PAs practicing very specialized eye care.
Tom Loyd and Bob Gritter are both experts in the field of ocular anesthesia, Ausmus
thinks there are many opportunities for PAs to consider in the field of eye care.He
earlier PA practice, before he
began working with eye patients.He
often dealt with people who were very ill and with their families.During that period, he
says, ìthere was a wonderful bonding with the patient and with the families, but there were many times that as a real, caring member of the healthcare team, you had to help them get bad news and share the grief with them.î There are pluses in every area of PAs practice, but he
says that the very frequent successful outcomes in eye care are extremely gratifying.William Ausmus earned his Bachelor of Science degree in Allied Health Sciences from the University of Alabama, Birmingham, in 1973.He was certified the same year as a PA, with an emphasis as a Surgeonís Assistant, also at the University of Alabama.He
has published a number of papers on the subject of dry eye problems.