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I. Howard Fine, MD: teacher, innovator ... biker
Dr. Fine’s penchant for engineering has led him to many technologies and techniques, including a love of motorcycles.
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With more than 30 years of practice behind him, I. Howard Fine, MD, the engineer turned visionary ophthalmologist, is pleased with his career in ophthalmology.
Of course he values and enjoys his clinical work with patients. But Dr. Fine has also used his engineering training — he earned a bachelor of science degree from the Massachusetts Institute of Technology — to revolutionize many aspects of ophthalmology, particularly cataract surgery.
In the 36 years of his medical career, Dr. Fine has been a core clinical investigator on 45 ophthalmic products, he has personally designed or redesigned 29 instruments and he has developed 17 surgical techniques.
The mind of an engineer
“I was a little older than most of my colleagues when I chose my specialty. I was well into medical school — my junior year. That year I took a different specialist out to lunch each week. I wanted to know what they did, how happy they were with their specialty and so on,” Dr. Fine said.
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The last physician he took to lunch, almost as an afterthought, was an ophthalmologist. The surgeon pointed out that every year ophthalmology ranked first in career satisfaction of all the specialties.
“In this specialty you see people of all ages and groups. It is a highly therapeutic field. I got the feeling during medical school that you have to pick what you enjoy, and ophthalmology has been a great match. What I really wanted was to make a difference in patients’ lives, as well as in the field of ophthalmology,” Dr. Fine said.
Dr Fine said his engineering background has been helpful throughout his medical career.
“Engineers look at problems with assumptions and approximations; they eyeball the problem. I have always been able to look at the whole situation like that. I joke that most ophthalmologists must have been religion majors because they think everything is miraculous,” Dr. Fine said.
Not only does he like to eyeball the situation, he also likes to make sure his revolutionary techniques are easy to remember. Among some of the more memorable names are his “chip and flip” and “crack and flip” phacoemulsification techniques, the “dimple down” keratome technique, the “chop and flip” phaco technique in high vacuum and burst mode and the memorable “choo-choo chop and flip” phaco technique.
“I’ve tried to name techniques and instruments so doctors will remember the technique easily. There’s a great advantage to doing that,” Dr. Fine said.
He credited a number of his predecessors and mentors with inspiring his work, including Norman Jaffe, MD, and Charles Kelman, MD.
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“They were all a generation ahead of me, and they set an example for me. They helped me to understand the need to teach new techniques and enhance the ability of other surgeons. That way you magnify your own effect on patients,” he said.
Dr. Fine the engineer once worked out the math on this matter. By teaching a class of 33 surgeons, he could help another 10,000 patients a year. He said he tries to devote a third of his time per year to teaching.
“I’m very proud of the fact that I’ve been able to bring new technology and techniques to the profession. On an international level, doctors don’t have the problems that nations do. I’m Jewish, and I’ve been to Saudi Arabia to show new techniques to my Arabic friends. This always gives me hope,” Dr. Fine said.
A frequent international traveler and lecturer, Dr. Fine said he has been pleased to see some countries move away from Third World status toward more modern medicine.
“At previous International Congress of Ophthalmology meetings, we’ve always had a symposium among third world nations about river blindness. But at this year’s meeting, the Third World joined the First World in discussing the No. 1 cause of blindness worldwide, cataracts. The technology and training we have now just wasn’t available is developing countries years before. Some of them are doing remarkable things now. I feel a sense of pride about that,” Dr. Fine said.
Ethical considerations
“I am very concerned that doctors never forget the fundamentals of what it is to be a physician,” Dr. Fine said. “Even though a practice may be good for the government or for business, that doesn’t mean it will be good for the patient. We must follow our Hippocratic oath; we must always place the patient first.”
Dr. Fine, as a practicing surgeon and as a past president of the American Society of Cataract and Refractive Surgery, has urged physicians to be wary of where and in whom they place their trust.
“Comanagement is not good for our field,” he said. “We must speak to our patients preop and we have to be there for our patients postoperatively. We can never improve our own practices if we don’t follow our patients all the way through their procedures and follow-up. Patient and physician must act as a unit. The government and insurance companies are intruding on that relationship,” Dr. Fine said.
He pointed out that physicians, in general, live comfortable lives.
“We act in someone else’s best interests in caring for patients. I know I’m preaching to the choir here. There’s nothing wrong with making money. We do not profit from other people’s ill health. I don’t think it’s wrong for us to be high earners. We have to sacrifice our youth. We make the night calls to hospitals. In some ways, I don’t think it’s wrong to say doctors are grossly underpaid,” Dr. Fine said.
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“Of course, for some reason or another when people are healthy we tend to downplay health care, but when we become sick, we suddenly realize how important it is,” Dr. Fine said.
Improving technology and techniques
Dr. Fine is proud that his clinic is among one of the most technologically advanced centers in the world. Much of the advanced technology has come through Dr. Fine’s willingness to work with any and all manufacturers to improve their products.
One of the benefits of his work with technology has been the systematizing of endolenticular phacoemulsification. But not all his efforts have been successful.
“I’ve tried to make technology and techniques easier and safer. But some techniques I have failed at teaching. For instance, cortical cleaving hydrodissection — few surgeons use it. But on the other hand I’m proud I’ve been able to move many surgeons away from using high energy phaco,” he said.
Refractive future
Many surgeons and business leaders are now talking about the need to diversify ophthalmic practices to include both cataract and refractive surgery. Dr. Fine sees the future differently. He said it is more likely that the opposite is going to happen – cataract and refractive surgery will begin to converge.
He noted that most ophthalmologists perform cataract surgery, and that this may soon be a primary method of fixing refractive errors.
“Cataract and refractive surgeons have learned a lot from each other. The newer technology is taking us to refractive lens exchange. This one surgical procedure can take care of refractive error, presbyopia and cataract issues all at once.”
Dr. Fine said he prefers the term refractive lens exchange (RLE) to clear lens extraction.
“RLE can be done without intrusion by government and health care insurers, which will mean it’s a relief to Medicare. And with the fabulous new technology — in IOLs and phaco, new diagnostic tools, new systems for measuring accurately — these technologies allow for great results now.”
Dr. Fine noted that a number of surgeons have adopted RLE and it is proving to be a viable modality for refractive correction.
“It can be used on hyperopes, and no one is skeptical anymore,” he said.
In his own practice, he said, patients who have had RLE are among his happiest. He pointed out that accommodating and multifocal IOLs will be important elements of RLE.
Career and family
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He said 100% of his RLE patients are 20/30 or better and J3 or better. But he said the long term effects will not be known until 5-year results and longer are available.
“I look at my career as the most intellectual adventure of my life, with many personal friendships,” Dr. Fine said. “I love living in Eugene, Ore. It’s 60 miles to the ocean and 100 miles to the mountains. I have a very satisfying personal life. I’m also delighted to finally be a grandparent.”
To balance his active career and his close-knit family, Dr. Fine and his wife of 39 years, Vicky, take their entire family on vacations every other year, anywhere in the world.
But in addition to his family and career, Dr. Fine has another love — bikes. Harley-Davidson motorcycles to be exact.
“My personal life is filled with motorcycles. I never feel as alive as when I’m on my motorcycle. I have six Harleys. I ride almost every day – even though I was almost killed in an accident in 2000,” Dr. Fine said.
He and Richard L. Lindstrom, MD, rent motorcycles when they attend the annual Royal Hawaiian Eye Meeting and ride around the beautiful islands of Hawaii. They plan to ride through the Alps in conjunction with an upcoming meeting of the European Society of Cataract and Refractive Surgeons.
“In Eugene, I’m known as an eye doctor. I think people get a kick out of the fact I’m also a motorcycle rider,” Dr. Fine said.
His wife has been supportive of him in many ways throughout his life and career, he said, including his interest in motorcycles.
“I have no doubt in my mind that Vicky is the best thing in my life. She’s the most wonderful person I know. She’s beautiful and very athletic. When I was in residency she took an American Academy of Ophthalmology course so she could help me with my studies, and she has worked with me ever since. She organizes all my travel. She’s the greatest mate a person could ever want,” Dr. Fine said.
“A good marriage really enhances your life. It keeps you from getting down. A helpful mate lifts your spirits. I have had a lifelong passion for motorcycles but never acted on it. Vicky was the one who convinced me to get into riding motorcycles. After I was fighting with some billing issues one night, she suggested I should get a motorcycle as a source of relaxation. She’s been very supportive. After my accident, she took a lot of heat from a couple of my colleagues’ wives. They said, ‘You’re not going to let him get back on that bike, are you?’” Dr. Fine said.
He is also very proud of his three children. His oldest son is a Japanese conference interpreter. His daughter and her husband worked for Microsoft and retired at the age of 33, but quickly learned that the 30s are too early to retire. His youngest son works with him as a technician.
Practice partners
With regard to his practice, Dr. Fine said his associates Richard Hoffman, MD, and Mark Packer, MD, are great partners and wonderful surgeons.
“We have more technology in our center than any other surgical center in the world. We have visitors from all over the world. It’s been a great adventure. I couldn’t be happier in my career,” he said.
For the first time since he entered medicine, Dr. Fine just started this year to take a few days off. As a new grandfather and dutiful husband, he says it is time for him to spend more time with his family.
For Your Information:
- I. Howard Fine, MD, can be reached at 1550 Oak St., Ste. 5, Eugene, OR 97401; (541) 687-2110; fax: (541) 484-3883; e-mail: hfine@finemd.com; Web site: www.finemd.com.