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Show NANOS NEWS The North American Neuro- Ophthalmology Society on the Internet The North American Neuro- Ophthalmology Society ( NANOS) initiated its Internet presence in 1995 with a private, unmoderated electronic mail ( e- mail) discussion list called NANOSNET. This list was announced by conventional mail to the membership and by flyers at the annual meeting that year. Subscription to the NANOSNET list increased rapidly, and discussion became lively. At the same time, a simple World Wide Web page was announced as the official Web home of NANOS at http:// www. nanosweb. org. Then- President of NANOS John B. Selhorst, MD ( St. Louis, MO) suggested in 1999 that the committee structure of NANOS be augmented with an e- mail list for each committee's members. The President and Executive office of NANOS began communicating with the chairs of the NANOS committees through a list called NANOSCHR. By capturing the committee structure in a hierarchical mailing list structure, e- mail was used efficiently to coordinate the work of the diverse NANOS committees. In 2000, at the initiative of the NANOS Board of Directors, the standard means of communication with the membership became e- mail, using a new members-only list called NANOSLTR. NANOSLTR virtually obliterated the conventional mail required to communicate with the membership. North American N - Ophthalmology Societ1 Home - About NANOS • Meeting Information • Member Services • Patient Information BngpiEi Password: Login [ help] WELCOME TO NANOS About NANOS The North American Neuro- Ophthalmology Society ( NANOS) is a professional organization of more than 400 members who are fully trained ophthalmologists or neurologists. It seeks to promote the field of neuro-ophthalmology by supporting all forms of education, encouraging research, fostering clinical expertise and maintaining cordial exchanges. Accordingly, NANOS and its members sponsor an annual scientific meeting, publish the Journal of Neum- Ophtfralmologt/, recognize young researchers, contribute to numerous professional seminars and provide an e- mail discussion list for lively clinical exchanges, NANOSNET. [ More...] NANOS Members Login to update your member profile, pay dues on- line or submit an abstract [ Login] JNO ONLINE The Journal of Neuro- Ophthalmology is now available online at http:// www. jneuro-ophthalmology. com Patient Information Information now available about Neuro- Ophthalmology [ More..] Find a Neuro- Ophthalmologist [ Physician Referral] Login | Contact Us | Join NANOS Important Dates NANOS 2004 Renaissance Orlando Resort at Seaworld in Orlando, FL March 27 April 1,2004 Renaissance Hotel Website NANOS 2005 The 2005 Annual NANOS Meeting will be held at the all new Copper Mountain Resort, Copper Mountain, Colorado February 13- 17, 2005 Copper Mountain Website Title page of NANOS Website, 2003. 88 JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 NANOSNews JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 The Web pages were revised in 2001 by a professional Web developer, leading to an improved menu and site navigation system, and a dramatic expansion in content. Preston C. Calvert, MD ( Alexandria, VA), the founder of the mailing lists and the author of the original NANOS Web pages, continues to manage the daily activities of the lists and to supervise the NANOS Web presence. Education. To advance the goal of continuing education of its members, the NANOS Web Education Committee was formed in 2002, and chaired by Edmond FitzGib-bon, MD ( Bethesda, MD). Working in concert with the Communications Committee and the Executive office, the Web Education committee has prepared the NANOS meeting syllabi for 1999- 2003 for Web access, and these have been made available on the Member's page. There is a file containing the Walsh meeting 2000 content based on the CD- ROM produced for that meeting. The Walsh 2003 cases recently have been placed on the Web site. A detailed Walsh meeting compendium put together by Larry Froh-man, MD ( Newark, NJ) for the years 1979- 1994 is also available, indexed by final diagnosis. A pilot project completed last year produced digital video of several NANOS meeting lectures. These streaming media files were placed on the Web site. As these initial efforts were well- received, the 2003 Walsh meeting presentations and some NANOS symposia were digitally recorded. These will be prepared for presentation as streaming media files on the Web site and posted in the near future. A number of contributed presentations on various topics have been collected in Microsoft Word or Powerpoint format and are available for download by members. Additional contributions are actively solicited. Major Web offerings for the future are the slide and video collections of William F. Hoyt, MD ( San Francisco, CA), Shirley Wray, MD ( Boston, MA), Kathleen B. Digre, Edmond J. FitzGibbon, MD ( Bethesda, MD), NANOS Web Education Committee chair. MD ( Salt Lake City, UT), and several other senior academic neuro- ophthalmologists in North America. These materials are being prepared as part of a large project organized by the University of Utah Medical Library. This project eventually will lead to a multimedia neuro- ophthal-mology collection on the Web. NANOS committees are working with other organizations to prepare a core neuro-ophthalmology curriculum for all levels of trainees to be available on the NANOS Web site. There is, as well, an increasing volume of practical practice management information on the site. The member's- only Web site offerings have been made available without charge to non- NANOS members abroad who have been approved by the NANOS International Affairs committee. This effort brings NANOS educational resources to physicians in eastern Europe, Asia, Africa, and South America. A list of fellowships in neuro- ophthalmology is now available on the Web site; included are telephone and e-mail contacts for each program. Patient Care. NANOS fosters discussion on issues of patient care through its NANOSNET e- mail discussion list. Participation in this list is not limited to NANOS members, but is available to all clinicians who are actively involved in neuro- ophthalmologic practice. As a result, this private, unmoderated list has more than 400 clinician members from all over the world, including representatives from 31 countries. Radiologic images, fundus photos, and other ancillary data can be circulated for comment. Patient confidentiality is carefully protected by the list monitors. A Web- based archive of all NANOSNET messages is maintained at http:// nanos. neuro. som. jhmi. edu. This archive may be searched by NANOS members using a Web interface. 89 JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 NANOSNews Based on the popularity of the NANOSNET list, a separate list for pediatric neuro- ophthalmology called PEDS- NEUROOP- L was initiated in 2001. This list includes members of NANOS and of the American Association for Pediatric Ophthalmology and Strabismus ( AAPOS). There is a list called NANOSWIN for the use of the NANOS Women in Neuro- ophthalmology group. Similar archives are maintained for these lists. Patient Information. Through its Web site, NANOS provides information to the patients and family members of patients with neuro- ophthalmologic disorders. The offerings include a description of the field of neuro- ophthalmology and what to expect from a consultation with a neuro-ophthalmologist. Contact information for NANOS members can be obtained for each major geographic region of North America using a simple graphical map- based interface. There are carefully edited patient information sheets for several common neuro- ophthalmologic disorders, including, for example, such conditions as optic neuritis, myasthenia gravis, and cranial palsies. According to usage statistics, this is one of the most popular features of the NANOS Web site. It is available in large print format. Research. The Internet and World Wide Web provide a rich set of tools to allow collaborative research on clinical issues important to neuro- ophthalmologists. NANOS has begun making investments in the infrastructure necessary to facilitate this form of research. The first undertaking is the Idiopathic Intracranial Hypertension Registry, which began collecting data this year. This pilot project is the initial phase of a broad effort to study major neuro- ophthalmologic problems. The Web database programming used to develop this pilot is designed to be reusable in future projects to reduce future software development costs. Organizational infrastructure. The limited financial resources of NANOS make it imperative to use the most cost- effective means to organize and run its operations. Much of the cost of postage for the many mailings has been saved by switching to electronic delivery of information by e- mail using the NANOSLTR mailing list. It carries meeting announcements, member surveys, President's letters, and many other official communications. Members may now pay their dues online on the Web site using secure communications. A member profile is maintained for each person and may be updated directly on the Web site. NANOS depends on active volunteers to serve on its standing and ad hoc Committees, which perform much of the essential work of the organization. The Committee structure has been recreated in a set of e- mail lists that allow the Committee chairs to communicate rapidly and efficiently with each committee member. This structure extends down to the subcommittees. There are now 31 NANOS e- mail lists. The NANOS President can coordinate the entire effort using the NANOSCHR list. The annual NANOS meeting announcements are made by the NANOSLTR e- mail list. The Web site is used for online meeting registration and payment of meeting fees. Online abstract submission via the Web site is now standard. The NANOS Mission Statement, organization bylaws, current list of the NANOS officers, Board, and committee members are listed on the Web site. Positions available in neuro- ophthalmology are posted and distributed to a mailing list of interested persons. A member search page is available by name and geographic criteria. Technical Implementation. The NANOS Web site is hosted by a commercial vendor with full capabilities for new extensions such as streaming media. The site is maintained by professional Web master Jeff Collins. He has done the sophisticated programming necessary to permit the Web site to provide its advanced capabilities to NANOS members. The NANOS e- mail lists run under the Listserv software, hosted on a dedicated machine. This e- mail server was recently upgraded to allow faster archival searches as well as greater speed of list operations. Future Plans. Future Internet activities of NANOS will be limited only by the imagination of the users and designers. Some proposals at different stages of development include a digital interactive text of neuro- ophthalmology with multimedia and animation components. Members may develop online decision- support tools to enhance clinical decision- making with quantitative methods. The world- wide community of neuro- ophthalmology may be drawn closer together by eventual live Webcast of meetings in North America and abroad. The idiopathic Jeff Collins, responsible for the sophisticated programming necessary to permit the Web site to provide its advanced capabilities to NANOS members. 90 © 2004 Lippincott Williams & Wilkins NANOSNews JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 intracranial hypertension study pilot will lead to greatly expanded collaborative neuro- ophthalmologic clinical research based on the Web. Our services to neuro- ophthal-mology patients will increase, possibly including moderated patient discussion forums. The continuing education of our diverse membership will be fostered by further development of skills transfer materials, including online how- to tutorials, video, and animation. The Web site will offer expanded educational materials for residents in ophthalmology and neurology. We also will provide appropriate materials for general ophthalmologists, neurologists, internists, family practitioners, and emergency physicians. Additional suggestions and participation from NANOS members are welcome. Preston C. Calvert, MD Alexandria, Virginia Edmond J. FitzGibbon, MD Bethesda, Maryland A Virtual Neuro- Ophthalmology Library ( NOVEL) in Utah A collaborative effort between the North American Neuro- Ophthalmology Society ( NANOS) and the Spencer S. Eccles Health Sciences Library is producing a virtual education library of digital neuro- ophthalmology materials at the University of Utah in Salt Lake City. With a $ 500,000 3- year Information Systems Grant from the National Library of Medicine, Nancy Lombardo, Systems Librarian, Principal Investigator, and co- investigators Kathleen B. Di-gre, MD ( Salt Lake City, UT) and Larry Frohman, MD ( Newark, NJ) will digitize significant collections of slides, video, and other media pertaining to neuro- ophthalmology and make them available to educational users throughout the world via the World Wide Web. The project has been generously seeded with the collections of two prominent neuro- ophthalmologists: William F. Hoyt, MD ( San Francisco, CA) and Shirley H. Wray, MD, PhD ( Boston, MA). Dr. Hoyt has contributed his extensive collection of optic disc slides, gathered over more than 40 years. Dr. Wray has contributed her collection of patient videos covering a wide range of neuro- visual disorders. Material from existing collections and from individual faculty around the world will be solicited to create a comprehensive collection covering the major subject areas within neuro- ophthalmology. Materials ultimately will be added to the Health Education Assets Library ( HEAL), a national multimedia database of health sciences multimedia materials. The NOVEL collection also will be accessible via a Website such that users will be able to browse by subject, collection, or case. The Web Education Committee of NANOS will be organizing the peer review process to ensure that the materials are of the highest caliber. All material will be indexed with metadata conforming to the standard set of fields in the Dublin Core, with extensions as defined in the HEAL database. The Dublin Core is a standard set of 15 metadata elements designed to facilitate resource location on the Internet. By using this standard set of indexing elements, we increase the usability and searchability of the descriptions of each item in our collection. ( For more information on the Dublin Core Metadata Overview, go to http:// dublincore. org/ usage/ documents/ overview/). Metadata will be collected from the content expert ( contributing neuro- ophthalmologist) for all material. Eccles librarians and NANOS members will create a controlled vocabulary to allow consistent search retrieval from the database. NOVEL will be searchable from many directions- anatomy, pathology, clinical features, disease, and imaging. This library will serve as a worldwide teaching resource. Interested students will be able to access fascinating neuro- ophthalmic problems, and teachers will be allowed access to the library to supplement information. The library also can be used for research. The language of the metadata may be helpful in producing a method to categorize neuro-ophthalmic disorders. All material will remain under the copyright of the contributor. Those who donate large collections will be given a " brand" symbol. For example, Dr. Hoyt's collection is branded with the kangaroo, Dr. Wray's with a sailboat and rainbow. Animations will be developed to illustrate difficult concepts. The University of Utah already has demonstrated its prowess in this field with an animation of the vestibular ocular reflex ( http:// medstat. med. utah. edu/ kw/ animations/ hyperbrain/ oculo_ reflex/ oculocephalic2. html). The Eccles Health Sciences Library Website will post news of the progress on the project. There is currently a database prototype at http:// content. lib. utah. edu/ cgi- bin/ browseclient. exe ( select EHSL- William F. Hoyt Neuro- Ophthalmology Collection from the pull down menu). A website prototype can be viewed at http:// medstat. med. utah. edu/ neuroophth/ Hoyt. Nancy Lombardo, MLS, Kathleen B. Digre, MD Salt Lake City, Utah Larry Frohman, MD Newark, New Jersey 91 JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 NANOS News Ophthalmic Subspecialty Fellowship Accreditation and Ophthalmic Subspecialty Certification: Still Hot Issues The debate over accreditation of fellowships in ophthalmic subspecialties and the issuing of subspecialty certificates in ophthalmology has heated up again. Although accrediting ophthalmic fellowships had been previously dismissed as financially unworkable, the issue came up again in the fall of 2003 when the American Society for Oculoplastic and Reconstructive Surgery made a formal request to the American Board of Ophthalmology to issue a " Certificate of Added Qualification" ( CAQ) in oculoplastics. The impetus for this move was that some oculoplastic surgeons had encountered difficulties obtaining surgical privileges for procedures that they considered themselves qualified to perform. Other specialists, entrenched in credentialing committees, were denied their right to perform these procedures without evidence of specific training. The oculoplastic surgeons decided that a CAQ would alleviate this problem. The American Board of Ophthalmology turned to the American Academy of Ophthalmology ( AAO) for advice. In the meantime, the Accreditation Council for Graduate Medical Education ( ACGME), responding to pressure for higher quality assurance, proposed accreditation of all fellowships in ophthalmic subspecialties and issued a request for comment from individual subspecialty societies. At the North American Neuro- Ophthalmology Society ( NANOS), an Accreditation and Certification Committee, co- chaired by John L. Keltner, MD ( Davis, CA), and Ralph Sawyer, MD ( North Potomac, MD), had been studying this issue. Acknowledging the need for assuring quality training at the fellowship level, this committee also recognized that fellowship accreditation, as proposed by the ACGME, would mean: 1. That independent clinical activity of the fellow could not be billed. This would include assisting residents in surgery. 2. Fellowship positions would be counted as part of the allocation of residency positions in some parent institutions, as determined by the federal agency whose funds underwrite house officer salaries. Fellowship positions at academic medical centers that are considered less remunerative to the medical centers might be dropped. Private practice- supported fellowship programs, which do not depend on federal support, might be the only ones to survive. It is possible that these programs would not be as observant of the ACGME guidelines concerning continuous quality improvement, or as nurturing for research as those based in academic institutions. 3. Duty work hours would apply to fellows as they do to residents. This would create havoc for patient care staffing mandates in the significant number of neuro-ophthalmic training programs that have but one trainee. NANOS also expressed the concern that CAQs for all ophthalmic subspecialties might lead to the pitting of one subspecialty against another. Each subspecialty might then lay claim to a domain of practice that would exclude other subspecialists and general ophthalmologists. Furthermore, NANOS doubted that holding a CAQ would solve the American Society for Oculoplastic and Reconstructive Surgery's problem. Given these problems, NANOS, as well as other members of the AAO Council, opposed the ACGME plan and the call for the CAQ. So did the Association of University Professors in Ophthalmology ( AUPO), which proposed developing an alternative pathway for fellowship accreditation. At the same time, the Association of University Professors in Neurology established the United Council for Neurologic Subspecialties, made up of members of the American Academy of Neurology, American Neurologic Association, and the Society for Child Neurology to develop its own pathway for neurologic fellowship approval. NANOS named Dr. Keltner and Steven E. Feldon, MD ( Rochester, NY), to be its representatives on the AUPO task force. They began reviewing the United Council for Neurologic Subspecialties proposal and updating its fellowship guidelines published on the NANOS Web site ( www. nanosweb. org). The AAO Council, responding to these negative feelings, informed the ACGME in November 2003 that there was a consensus against ophthalmology subspecialty accreditation and asked for a delay. In December 2003, Susan Day, MD ( San Francisco, CA), chair of the Ophthalmology Residency Review Committee of the ACGME, wrote to Stephen Podos, MD ( New York, NY), executive vice president of the AUPO, to inform him that the process for seeking ACGME accreditation of fellowship training programs would be on hold. Larry Frohman, MD Newark, New Jersey Kathleen B. Digre, MD Salt Lake City, Utah 92 © 2004 Lippincott Williams & Wilkins NANOSNews JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 David A. Weinberg, MD: Neuro- Ophthalmologist, Oculoplastic Surgeon, and Entrepreneur It is not very often that you can link the words " entrepreneur" and " neuro- ophthalmologist," but in the case of David A. Weinberg, MD, they go together. Although there are a lot of interesting stops on his road to neuro- ophthalmic success, his most unusual isn't neuro- ophthalmic at all, but the managing of an Internet medical management company called MEDPEAK, which he co- founded in 2003. Why start an Internet " dot com" joint venture in the first place? Dr. Weinberg offers this insight: " a year or two ago, I experienced a little midlife crisis... I even thought of creating a board game by the name of ' Midlife Crisis.' I decided to pursue some sort of entrepreneurial endeavor . .. involving the least capital investment: an Internet business." Dr. Weinberg approached MBA Resources, a very successful physician office management group in Vermont, and they partnered to begin offering services online to physicians nationwide. MEDPEAK's primary goal is to help physicians run their practices more efficiently and provide guidance in business matters. But it also provides access to PubMed, information about CME events and medical meetings, as well as links to medical societies and other websites of potential interest to physicians. Perhaps the most exciting part of the company is the ease of access to experienced and knowledgeable people who manage medical offices and will answer questions about office management, insurance billing, and personnel issues within 48 hours for a reasonable fee. And all online- no calling or sending snail mail and waiting for replies. The website ( www. medpeak. com) is easy to navigate. Dr. Weinberg was born in Bethpage, Long Island, but raised in Massapequa, NY, which is, he says, pronounced locally " Matzohpizza" in honor of the town's Jewish- Italian melange. His father was a general practitioner, and one of Dr. Weinberg's two brothers is a physician who is now attending law school. During high school, Dr. Weinberg was seriously involved in playing keyboard in a band, a destination he believes that years of classic piano lessons can lead to, whether your parents intend it or not. Despite local keyboard fame, he chose medicine. During a 6- year combined college/ medical school program at Rensselaer Polytechnic Institute and Albany Medical College, he found that ophthalmology offered the perfect access to young and old patients, surgery and medicine, and a reasonable lifestyle. After ophthalmology residency in Cincinnati, he decided to enter ophthalmology private practice with a group in Meriden, CT. After several years in general ophthalmology practice, he sensed the pull toward two loves: neuro-ophthalmology and orbito- plastics. With the understanding of his wife Rebecca- a critical consideration given that their family now included two young daughters- Dr. Weinberg ditched a private practice income and lifestyle to become a fellow, for 3 years! There was a year of neurology- based neuro- ophthalmology with David Kaufman, DO, in East Lansing, MI, then a year of ophthalmology-based neuro- ophthalmology at the Wills Eye Hospital in Philadelphia with Peter Savino, MD, and Robert Sergott, MD, and finally a year of orbito- plastics at the Jules Stein Eye Institute in Los Angeles with Henry Baylis, MD, Robert Goldberg, MD, and Norman Shorr, MD. In 1995, Dr. Weinberg joined the faculty at the University of Vermont, his practice divided 50/ 50 between orbit/ plastics and neuro- ophthalmology. Currently, he is an assistant professor of surgery ( ophthalmology) and assistant professor of neurology at the University of Vermont College of Medicine. Like all clinical faculty at the university, he works at Fletcher Allen Health Care, a level one trauma center. There is no ophthalmology residency program, but he has teaching responsibilities for medical students and residents in other specialties, and his own fellow, Adam Cohen, MD, who is learning both neuro-ophthalmology and orbito- plastics. He hopes to generate research in orbital blood flow with quantitative power Dopp-ler. With Peter Rubin, MD, he co- founded the New England Oculoplastics Society ( NEOPS), which boasts 45 members. He is currently serving as president of the Vermont Oph-thalmological Society. He considers Vermont " a great place to live and raise a family... we hope to stay here for many years to come." And far off in the future, when his daughters Elena, 12, and Sara, 10, and son Jonathan, 2, have successfully negotiated college and he has negotiated the associated tuition, he would like to retire from clinical practice, or at least slow down enough to bicycle, take jazz piano lessons, learn some foreign languages, travel, and maybe go to business school. Once an entrepreneur, always an entrepreneur. Lyn A. Sedwick, MD Orlando, FL 93 |
