Retinal Physican Blurb: Our Man in Saipan

I'm not sure why I seem to be bursting upon the national scene at the moment. There was the recent interview by Ophthalmology Times, and now this piece that appears in Retinal Physician. There is also an upcoming story in Ophthalmology Management.

I'm trying to raise some money for a scholarship fund at Brilliant Star School, to allow low income children on Saipan to attend the school, so I'm hoping that the stories will lead to some benefactors. In any event, it seems to be my fifteen minutes of pseudo-fame. I can't say "fame," because, after all, these may be international magazines, but really, they're ophthalmology publications. In the Retinal Physician magazine, I'm wedged between stories titled "Antecortave Acetate Has New Target" and "OPKO Gets Key Patent for siRNA Drugs." The subtitle of the second piece is -- and I'm not making this up -- "But Controversy Erupts Over siRNA Concept." That context very nicely sums up the level of my fame.

I recently found out that the title of the story is a play on words from a 1970's sitcom called "Our Man in Rataan" about a journalist assigned to a god-forsaken post at the ends of the earth.

The best part of the story is where they refer to Marianas Eye Institute as "one of the best-equipped eyecare practices in the Asia-Pacific region." That's something Saipan can be proud of.

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Our Man in Saipan
Dr. Khorram Finds His Tropical Island

David Khorram, MD, who received his retina training during residency at Northwestern University under Lee Jampol, MD, is the only ophthalmologist on the Pacific island of Saipan. Dr. Khorram passed up a retina fellowship because he wanted to practice in a part of the world that had a great need for an ophthalmologist. After doing some research, he chose the Pacific islands, and after a year practicing in American Samoa, he made his way to Saipan.

Over the course of the past 15 years, Dr. Khorram has built the Marianas Eye Institute into one of the best-equipped eyecare practices in the Asia-Pacific region, providing a wide range of both retina and general ophthalmology procedures.

He is also active in civic activities on the island, writing a weekly newspaper column and organizing a national soccer team [I think this is a reference to being a founding board member of NMIFA]. He recently published a collection of his columns in a book titled, "World Peace, a Blind Wife, and Gecko Tails" (available through Amazon.com). Dr. Khorram and his wife, Mara, have four children ages 3, 5, 7 and 9.

Dr. Khorram reports that he sees "a ton" of diabetes-related eyecare problems but almost no cases of macular degeneration, which he attributes to the island's relatively young population as well as genetic factors.

Saipan, which is located about 120 miles north of Guam, is the capital of the United States Commonwealth of the Northern Mariana Islands and has a population of approximately 60,000, many of whom are contract workers and not permanent residents.

The island was the site of fierce fighting in World War II as the United States established a base on Saipan for B-29 bombers that could reach the home islands of Japan.

On the mend

My back is much better. It's still bad, but yesterday I didn't have any screaming episodes, and I seem to be able to move around a bit better.

We closed the clinic yesterday afternoon and took a staff outing to PIC for our first Marianas Eye Institute Olympics. I was tempted to participate, but Russ, or CEO on former PIC Clubmate, wouldn't even let me carry the clipboard. But I did get to wear one of the cool rhinestone studded caps, brought out especially for the occasion.

Last night, Mara and I went to a wedding. Our friend, Peter Loyola, who is one of the island's tennis coaches/stars, had recently become reacquainted with Dinna, the bride, while on home visit to the Philippines. Peter and Dinna were in school together from the second grade through high-school. Peter asked us to be "sponsors" of the wedding, which is a tradition in either the Filipino culture, or the Catholic church. I'm not sure which. I had to ask a few friends from both cultures about the significance and duties, and no one could really give a satisfying answer, but it seemed to be a combination of best man/maid of honor, groom's men/bride's maids, and godparents all rolled into one. There were about ten sponsors. The wedding and reception was held at Claret at Fiesta Resort. It's one of my favorite rooms on the island. It was an honor to be asked to participate in the ceremony.

Jake Shimabukuro Concert

I saw Jake a few years ago when he was here, and it was a phenomenal evening. (I wrote about it in my book.) This a concert you don't want to miss. He's one of the biggest entertainers in the world. He's in Melbourne next week playing at the music festival there, and he was on Conan O'Brien recently. Marianas Eye Institute is one of the sponsors of this concert... see, right there by Jake's left foot.

MarianasEye.com in Lava

Here's what we did for 45 minutes today after the conference.

Arrival in Waikiki

We made it to Hawaii, on the way to the Hawaiian Eye Conference on the Big Island. I love this place. We got in last night and walked out of the airport to catcha taxi to our Waikiki hotel, and were greeted by a limo. Did you know the meter is the same rate as a regular taxi? Nice.

Melonie and Emilly, with driver behind Mel.

Paparazzi shots

We got to our Waikiki hotel. Russ took off to meet up with an old friend for dinner. Mel and Emilly and I went down to Wolfgang Puck's and had pizza. One of Mel's cousins who works for medical referral came by and surprised her and the three of them headed out to see Honolulu, getting in after midnight.

I walked down the Waikiki strip, which I love. It's a place of everything. Every few feet there is some street "performer" (and I use the word loosely) trying to make some money. Here is a guy dressed in a monkey suit, standing on a crate, with his buddy playing the ukulele. Hey, you know this is America.

In the morning we walked around Waikiki in the daylight, picking up some souvenirs. Waikiki has to be the most famous beach in the world and one of the greatest tourist strips on the planet.

View from my hotel room

Statue of Duke

Saipanese Tourists in Waikiki

At the International Marketplace in Waikiki

Center for Advanced Diabetic Eye Care Opens

(From Today's Saipan Tribune. The story is generally accurate.)

Marianas Eye Institute's Dr. David Khorram, MD, chief executive officer Russ Quinn, Saipan Mayor Juan B. Tudela, Public Health Secretary Joseph Kevin P. Villagomez and Deputy Secretary for Public Health Administration Lynn Tenorio lead the ribbon-cutting ceremony for the Center for Advanced Diabetic Eye Care on Beach Road, Garapan Friday. (Jacqueline Hernandez)

By Rianne Pangelinan-Brown
Reporter

The Marianas Eye Institute held a grand ceremony yesterday for the opening of its new $200,000 Center for Advanced Diabetic Eye Care, which features the latest technology in eye care.

According to Marianas Eye Care chief executive officer Ross Quinn, the center was built specifically to address the ocular needs of the islands' diabetic population. The CNMI has one of the highest rates for diabetes in the world, third only to Nauru and the Pima Indians.

The expansion project includes the Ocular Coherence Tomography, a breakthrough eye scan technology that provides detailed color CAT-scan like images of the structures of the eye.

OCT helps guide a doctor's evaluation and treatment of a patient's diabetic eye diseases, particularly glaucoma and retinal disease.

According to Marianas Eye Institute owner and ophthalmologist Dr. David Khorram, the OCT is used at least five times a week. “It really is a huge necessity. We wish we can use it less,” he said.

The center also features a digital retinal photography and flourscein angiography. Marianas Eye Institute is one of the first two centers in the United States to acquire the specially designed high-resolution digital camera.

“With this camera, we are able to document the level of diabetic eye disease and its response to treatment. Digital photography allows you to instantly see what is happening inside your eye and to better understand your diabetes and our recommendations,” Khorram said.

The advanced cataract removal system is another one of the advanced technologies the Marianas Eye Institute implemented. It is one of the world's most sophisticated pieces of surgical equipment for restoring vision. It uses digitally modulated ultrasound to remove cataracts and provides for a gentle procedure with enhanced safety and rapid recovery time.

Another equipment is the biological modulator. It is used to treat diabetic eye disease at a molecular level.

According to John Garland of the Advanced Medical Optics in California, “Dr. Khorram uses the latest extraction techniques that are being used at U.S. mainland facilities. Your patients in the CNMI are truly getting a world-class cataract operation.”

Public Health Secretary Kevin Joseph Villagomez said the new center will lessen the need to send people to off-island referrals.

“When we send people off island for eye care, it is really for severe cases. It usually requires us to send that person there in less than a day because of needed surgery that cannot be done here.”

But with the installment of the new center for advanced diabetic eye, “that will lessen the need for travel and the need to wait for visiting specialists who are here one week and gone the next,” said Khorram.

He added he understands the financial burden that diabetes can bring to individuals and families. “For this reason, we established the Eye Foundation Fund. We want to make sure that you get the care you need, even if you cannot afford to pay for it. It is our commitment to the community.”

“What is more important here, I think, is that we are improving the livelihood of the people of the Commonwealth-and we can never put a price to that,” said Villagomez.

The two ophthalmologist of the Marianas Eye Institute includes Dr. Mark Robertson, OD and Khorram. Both doctors have received national recognition in eye care. [Mark is an optometrist, not an ophthalmologist.]

For more information, visit Marianas Eye Institute.

I'll let you guys sort this one out

Here is a young woman who I have been seeing every day for the past 10 days or so. She was a passenger in a motor vehicle accident and got popped in the eye by the airbag. Now before you go home and dismantle your airbag, keep in mind that this is a little like getting chaffed by a life jacket.

What do you see? What happened? Get it right (or even close) and I'll buy you two matinée passes to the movies.

And no, Mark, Melonie, Thelma, Joanne, Emilly, Lin, Yvonne, and all the rest of you at Marianas Eye Institute cannot play.

Staff Outing

Every couple of months, the staff at Marianas Eye Institute plans an outing. This month, we closed the clinic on Friday afternoon and headed down to American Memorial Park for a picnic and a softball game with our families. I learned two things. First, if you're out of shape, softball actually is an aerobic activity. Second, man, those Chamorro girls can hit that ball! I'll post more pictures later, especially when Mark sends his. It's hard for me to believe that this institution supports so many people and their families. And this isn't even everyone!

The Power Techs and their Men




An MEI tradition of the "Goofy Pose" group photo.




"Burger on Foil" by Mel Norita.
(We support budding artists.)

Medical Care in the CNMI & Saipan

A few people have recently come across this column in Google searches for CNMI's health care. I wrote the column two years ago for the Saipan Tribune. It was picked up by the Pacific Report out of the University of Hawaii and distributed through them. I'm posting it here as a supplement to Jeff's recent post.

I’ve always said that our health care system in the CNMI is among the best in the region, and that the overall quality of physicians here is as high as in other rural communities anywhere in the United States. Yet our population is medically under served. The resources for care, though good, are limited. There are not enough doctors to serve our population. The public health care facilities are often short of supplies and specialists. On the operating room wall there hangs a quotation from Dr. Howard Tait, who served as the CNMI’s orthopedic surgeon for many years. Speaking to other surgeons, he said, “If you have to have everything you need to do the case, you probably shouldn’t be here.” Strangely, these are the very reasons that many of us choose to practice medicine here. We get personal satisfaction from making a difference to the people we serve, and we learn from the challenges of not having everything we need.

The US Department of Health and Human Services routinely evaluates the access to care in all US jurisdictions and gives each geographic area a Health Professional Shortage Area (HPSA) score. This HPSA score is an indication of how badly doctors are needed in an area. The scoring system used by the Department of Health and Human Services takes into account such factors as the number of doctors available for the population, and the travel times to the nearest available source of care. The higher the score, the worse off a region is, and the more badly doctors are needed. A HPSA score of 25 is bad, 1 is great.

How do you think the CNMI ranks on this list? Well, it’s pretty bad – in fact, among the worse. For non-metropolitan areas in Region IX, the highest shortage award goes to the FSM, with a HPSA score of 25. There is no other area in the entire US with a greater need for doctors. This is followed by a few Indian Reservations in Arizona, California and Nevada that have HPSA scores between 21 and 19. Next comes American Samoa with a HPSA score of 20. And then, the CNMI with a HPSA score of 18. A HPSA score of 18 is bad. It is an indication that despite having one of the best hospitals in the region and having great doctors on the island, we are among the most under-served areas in the entire country. Guam fares much better than we do, with a score of 8. Many Indian Reservations have better HPSA scores and less of a doctor shortage than we have.

Areas that have doctor shortages typically do everything possible to bring in more doctors. There are tremendous challenges in bringing in new doctors to the CNMI. After all, the area is underserved for a reason. If it were considered a great place to practice medicine, there wouldn’t be a shortage in the first place. This is one of the reasons that our public facility is constantly short of doctors and specialists. There has to be a compelling reason for people to move half-way across the world, to an unknown land, far from their families, and take a pay cut to work under challenging circumstances.

In my case, I had always wanted to work in an under-served area and to feel like I was making a real difference to the people I served. When I arrived in the CNMI 12 years ago (now 14 years ago) as a government employee, I thoroughly enjoyed establishing the first eye care services at CHC. It was a challenge, and I was able to make a big difference quickly. We saved the government hundreds of thousands of dollars in referral costs, and I had the privilege of making life better for my patients. After five years at CHC, my wife and I decided to make the CNMI home and realized that this would be difficult to do while working for the government. Each year there were questions of whether or not funding would be available for my position and whether or not my contract could be renewed. I had also reached the limit of what I could build under the government system. I came from one of the best training centers in the US, and I wanted to bring in the best eye care technologies to the CNMI. The emphasis of CHC was rightfully on providing primary care to as many people as possible with the limited resources available, so it just wasn’t possible to spend money on the more advanced technologies I was requesting. For these reasons, and with the enthusiastic support and encouragement of the administration I entered the private sector. And this is where I believe the future of improving health care in the CNMI lies. We will always need a government supported hospital. But one of the keys to addressing our poor HPSA score, and building a stable medical community is to encourage the development of private medical practices.

Most of us in private practice came to the CNMI as government employees. Dr. Tony Stearn’s venture into private medicine resulted in the establishment of FHP (now PacifiCare), and more recently of Marianas Medical Center. Dr. Hocog and Dr. Aldan built Saipan Health Clinic. Dr. Ahmad Al-Alou established Pacific Medical Center. Tony Glad built Island Medical Center. And most recently, Dr. Norma Ada has opened Medical Associates of the Pacific. Together, these practices, along with my own, remove the burden of some 60,000-76,000 office visits from the shoulders of the government facility each year. Private practices provide stability and continuity of care. The average number of years that each of the physicians in private practice has served in the CNMI is somewhere between 10-15 years. We put down roots. Those of us in specialty care like myself, provide support to other physicians, like those in the emergency room, when complex cases arise. Private medical offices are more likely to invest in the most advanced technologies which raise the level of care for the whole population. It was Dr. Al-Alou at PMC who had the vision and the means to bring the first CT scanner into the CNMI. Marianas Eye Institute brought in technologies that most eye care practices in the US mainland don’t even have. Private medicine raises the level of care available to you.

I share these benefits because I believe that stimulating the development of private medical practices can be more actively pursued in the CNMI. In Guam, we see that the entire medical care system, like that in every other developed jurisdiction in the United States, is built upon a strong and healthy private practice model. We need to actively attract doctors into private practice. As a community and a government we may wish to consider the big picture of health care, and of our severe physician shortage, and consider which legislation, policies and regulations -- which decisions -- will move us closer to addressing our doctor shortage, and which will take us further away. Quality health care for the greatest number of people is a guiding principle that can serve as a touchstone when considering the impact of various decisions.

Being medically under served is just part of the reality of living on a remote tropical paradise with a relatively small population. It's as much a function of geography and demographics as anything else. Sure, things could be better, but people will still die for reasons that would not exist in LA. There are trade-offs for everything. If you live in LA there are certain trade-offs. I'm raising four kids here, by choice, and I'm intimately familiar with the shortcomings of the health care system. Yes, something might happen out here that results in a worse outcome than if I were living in LA. But overall, I'm okay with it. For most of us here, where we live is a choice. For me, Saipan wins out over LA (and Aukland and Honolulu and Sydney and Tumon and every other spot on the face of the earth.) This is where my heart is.

More on the blood situation later.

"I'm not kissing that worm!"

Here is the new ad we're running in the Tribune. What do you guys think? (Click on the photo for the enlarged version.)

Needle in the Eye

It's gory eye picture time.

This is from last Friday. I'm injecting a drug into the eye. The photo is taken from the top of the patient's head, so you can see the eyebrow at the bottom of the picture. The needle is going into the inferior eye. That big metal thing is a speculum to keep the eye open. You can see a bit of my gloved finger holding the needle on the patient's cheek. That's the orientation.

I do this a few times a week. Most of the time I'm injecting a "wonder-drug" called Avastin into the eyes of people with severe diabetic eye disease. One of the problems with diabetes is growth of new blood vessels or "neovascularization". The standard treatment is to blast them with a laser, but sometimes you but in all the laser you can, and the blood vessels still grow. Avastin is a biological drug that neutralizes the molecule that sends the signal for new blood vessels to grow. The molecule is called VEGF, which stands for vascular endothelial growth factor.

Avastin was developed by Genentech to be given intravenously for treatment of colon cancer. Most cancers rely upon growth of new blood vessels to nourish the cancer mass. Avastin kills colon cancer by interfering with the growth of the blood vessels that feed the cancer. An amazingly smart (and courageous) ophthalmologist, Philip Rosenfeld (MD, PhD) from Bascom Palmer Eye Institute figured that this VEGF inhibitor ought to work for growth of new blood vessels in the eye. About three years ago, he injected it into the eye of one of his patients, and the next day, the new blood vessels were gone. That injection has revolutionized the care of both diabetic eye disease and macular degeneration. I met Phil earlier this year in Hawaii, and he's one of the nicest, most generous smart guys I've ever met. We've been in touch by email since then, and he's helped me identify some top-notch retinal surgeons in Japan.

Avastin was approved by the FDA for use in colon cancer, but in the US, we're allowed to use a drug "off-label," meaning we can use it for treatment of conditions for which it was not specifically approved, as long as we let the patient know it's an off-label use. At Genentech, the same company, was developing a VEGF inhibitor to be specifically used in the eye -- sort of a cousin of Avastin. They were in the midst of the FDA study phase when Phil decided to try Avastin and it worked. They invested millions to get the new eye drug through the FDA approval process, only to have their own drug compete with it through "off-label" use. The cost of the new eye drug, $2,000 per dose (yeah, three zeros). The cost of Avastin per dose, less than $200.

You usually need to get the injection every six weeks or so. The cost difference is huge on a cumulative annual scale.

Anyway, I really enjoy this part of my work -- the procedures. During my internal medicine training at the University of Chicago, my co-residents found out that I was going on to do an ophthalmology residency. Many were envious. But one said, "Are you kidding. He's going to make a living sticking razor blades and needles in people's eyes." Yeah, and I love it.

Blogging Can Save Your Sight

Here is a nice post from Melissa's blog. Thank you for the compliments!

The power of the bloggers... and a visit to Marianas Eye Institute

I woke up Sunday with a crusty eye. Gross, I know. I started getting a little worried about it yesterday, so I sent Dr. Khorram an email about my symptoms, and to get his opinion on whether or not I should be seen. Now, I have never met Dr. Khorram face to face, but we've each left comments on our respective blogs, and because of that, I felt comfortable emailing him. He quickly emailed me back, and told me that since I was sensitive to light, I should be seen asap.

I went in this morning. I have a corneal ulcer. It hurts, and it looks gross. But he's putting me on antibiotics, and drops that I have to put in every hour. He said I'll be seeing a lot of him until this gets resolved. The good news is I got new glasses, so I don't have to wear the ones I broke and glued back together in London.

So, thanks, Dr. Khorram!! Thanks for the exceptional service, and thanks for keeping me from going blind! I enjoyed meeting you in person, although I would have preferred to meet in a less serious setting. I am continually amazed by the friendships and professional relationships that are fostered by something as menial as me writing my random thoughts down for the world to see.

Viagra: The Rise is in the Eye of the Pill-Holder

This week's photos aren't as gory as last week's Worm in the Eye, but they are fascinating nevertheless.

There is a retinal disorder called "Central Serous Retinopathy" (or simply CSR). In this disorder, the thin layer of nerves and blood vessels that coats the inside of the eye - the retina - forms a fluid-filled elevation -- a blister. It happens right in the area of the macula which is that specialized part of the retina that sees the clearest and is used for your straight ahead central vision. So, it's "Central" because it involves the central vision, it's "Serous" because it's a blister, and it's "Retinopathy" because it's a disorder of the retina.

In the photo, I've marked the outline of the blister with arrows, and on the cross sectional Ocular Coherence Tomography ("OCT") below, you can clearly see the elevation of the retina and the fluid in the blister, which shows up as black. The thickness chart below shows a green zone which would be the normal contour of the macula, and the black line which marks the actual elevation of this macula -- plenty elevation. (The OCT is amazing technology. It's been around for about 3 or 4 years, and we purchased one when the units became commercially available. It's revolutionized the practice of ophthalmology. We can see things that we simply could not see before. It's like a very high resolution CT scan of the eye, but uses light instead of X-rays, to capture the images. If you want to see it in action, stop by Marianas Eye Institute.)

Central Serous Retinopathy blurs the vision, sometimes causing objects to appear "morphed" (straight lines appear curved, people look like cartoons). It usually occurs in one eye, but can affect both eyes. It comes on for no apparent reason, usually in men in their 30's and 40's. It goes away without treatment over a 3-6 month period, and usually the vision returns to normal though sometimes it can remain slightly blurred. In rare circumstances when it doesn't resolve, we can find the area of leaking, blast it with a laser, and speed up the resolution of the blister.

Over the past year, we've been seeing a lot more of Central Serous Retinopathy. Recently an association between Viagra use and CSR has been reported. Take Viagra, and the elevation of the retina occurs. Stop Viagra and it goes away. Use Viagra again, and it comes back. There is no clear explanation, but now we ask everyone with CSR if they are using Viagra.

A weird bit of eye news worth sharing.

Happy Anniversary

Yesterday was the 9th anniversary of the opening of Marianas Eye Institute. It's hard to believe it's been nine years! Mara and I were both working for the CNMI Department of Public Health at the time, and decided to quit our jobs and undertake building a world-class eye clinic on Saipan. We took our life savings, borrowed money, and entered the world of private health care. Having given away our government jobs, we had no place to live, so we just put a door in the hallway of the clinic, and lived in half the building. Mara was six months pregnant with our first child.

We would be over there until midnight every night trying to sort through all the business stuff -- accounts receivable, billing, chart of accounts, all the details of running a medical practice that no one teaches you. But we did it! It's been an amazing journey.

Over the years we've had visiting medical people from Australia, Hawaii, Japan, and the mainland US who have universally been struck that such advanced technologies and systems have been put in place on this remote island. Very few practices in the mainland US have the broad combination of advance technologies that we have at Marianas Eye Institute. I'm a tech freak, and I like to keep up on things, but I think the main driving force has been the fact that there is nowhere close to send patients for specialized testing. We purchase the new technologies simply to give our patients the highest standards of care available.

I'm proud of what we've accomplished. We have a team of really talented people, starting with Mark Robertson, who sees most of the patients and Russ Quinn, who serves as CEO, and great locally trained eye care team, technicians and administrative staff. I feel lucky to work with them all.

Yesterday was an opportunity to pause and think about where we started and how far we've come. And because new stuff is always in the pipeline, we are in the midst of adding even more advanced technologies over the next few weeks. I'll keep you posted.

Advanced Cataract Surgery at Marianas Eye Institute

We made the business section of today's Saipan Tribune. (That's the Commonwealth Health Center's two cataract surgery technicians, Lea Estinopo and Chris Batenga, in green). Here's the full story:

MEI Acquires New Device for its Cataract Patients

Marianas Eye Institute has purchased new equipment that improves the recovery time and enhances the safety of cataract surgery. The new device, called the Sovereign Compact cataract removal system, enables the surgeon to efficiently remove a patient's cloudy cataract using digitally modulated ultrasound.

Marianas Eye Institute CEO Russ Quinn and medical director Dr. David Khorram met with representatives of Advanced Medical Optics in Hawaii to arrange purchase of this newest technology.

“Advanced Medical Optics had announced the release of its latest Sovereign Whitestar technology, and we were eager to provide the latest and best for our cataract patients here in the CNMI,” explained Quinn.

A cataract is the clouding of the eye's lens and is part of the aging process that affects more than half the adults over 60. It is also very common in diabetics in whom it occurs at younger ages.

With over 2 million cases performed each year, cataract surgery is the most common surgical procedure in the United States.

The two Marianas Eye Institute official said they felt it was imperative to purchase this new equipment in order to continue providing the most advanced techniques and the highest quality care.

“With this brand new technology, there is nowhere in the world that is more up to date with cataract surgery technology than Marianas Eye Institute,” said Quinn. “We pride ourselves in providing world-class eye care. We have a multi-year agreement with Advanced Medical Optics to provide ongoing technology updates, ensuring that our cataract surgery system remains state-of-the art as new advances are made into the future.”

Prior to this new technology, the Marianas Eye Institute has been using the phacoemulsification technique (or “phaco”) since 1999. This type of cataract removal technique allows the cataract to be dissolved using ultrasound, and removed through a tiny incision, just over 2 millimeters in size. In most cases, stitches are not even needed. The procedure takes about 20 minutes and patients are home and back to their regular activities the same day. Khorram said it is virtually painless.

“This new Sovereign Whitestar technology is a major upgrade to the “phaco” technique. It is even gentler on the eye, and promises faster, easier recovery,” said Khorram. “We have used the Sovereign Whitestar cataract removal system for 14 patients so far, and it is an amazing piece of technology. For example, during the cataract surgery, the Sovereign Whitestar measures the pressure inside the eye 50 times per seconds and makes adjustments which make the surgery very smooth.”

To install the new “phaco” technology, AMO regional technician, John Garland, visited the CNMI from California for the first time and was impressed with Khorram's surgical skill. “He uses the latest cataract extraction techniques that are being used at U.S. mainland facilities. He has a brand new phaco machine which is the latest on the market and his microscope was recently upgraded to have the best view possible. Your patients in the CNMI are truly getting a world-class cataract operation,” said Garland.

Garland also praised the facilities, noting that it is more advanced than most in the US mainland. “I was very impressed with Marianas Eye Institute's office, overall organization, and cataract surgery facility. The office set up is a higher quality than most ophthalmologist offices here in the U.S. Very few facilities here have the advanced electronic medical records that Marianas Eye Institute has and very few have the ability to custom-make their own lenses for glasses. I was very impressive with the friendly extremely helpful staff.”

For more information visit Marianas Eye Institute or call 235-9090.

Wax Museum of Saipan

Every couple of months, our staff at Marianas Eye Institute gets together for a staff outing. Recently, we’ve gone to race go-carts, played beach volleyball, gone to PIC happy hour, and now last week, visited the Wax Museum of Saipan.

I’ll have to tell you, I was impressed. I don’t remember ever being to a wax museum before. After all, there never seemed to be much appeal in seeing statues of a bunch of famous people. You’re there to look at the wax, and ooh and ahh at how lifelike/waxlike everything appears.

Well, the Wax Museum of Saipan is different. In fact, it’s really not about the wax nor the statues. It’s an interactive lively museum of the history of Saipan. I learned a few things about our history that I had wondered about and hadn’t understood from visiting other museums on Saipan. Saipan history is depicted in scenes using life-size statues and figures. It is amazingly well done. It starts with the pre-history of the Marianas, and moves, room by room and scene by scene to the present day. The grand finale is a replica of the Governor’s Office, where you can sit at the desk, flags behind you, and have your photograph taken.

Each scene has a written description of the scene in English, Korean, Chinese and Japanese. The reading is brief enough that you get a good idea of the history without having to spend more than a minute reading – great for those like me who get a bit restless in museums.

The photographs throughout the museum are beautiful depictions of past and present scenes of Saipan life. There are sound effects and lighting effects, which bring many of the scenes to life.

The museum has also produced a documentary interviewing some of the local survivors of World War II. It’s playing in the reception area, and is worth seeing.

For local residents, the admission price is about the cost of a movie. If you are looking for a family outing, a place to take the kids on the weekend, an educational trip for your classroom, or a place to take a date, the Wax Museum of Saipan is a worthy option. I plan on going back.

The Wax Museum of Saipan is located in the heart of Garapan near GIG Discotheque. You may reach them at 233-7447. Support this great addition to Saipan.