If you got to this page through the website, you probably already know who I am. I have always had an interest in computers beginning in my childhood when my father would bring home bits and pieces of electronics including lots of relays. I used these relays to create simple computers which got a bit more sophisticated when I learned to use transistors. I actually built some “core” memory based on articles from practical electronics although I confess that I never got it to work. Later, the school bought a PDP computer on which I spent several months creating a program to calculate square roots in machine code. As you might imagine my square root program was really not that useful. I have also always had an interest in math and physics and my undergraduate training was in both. I was assigned a lab with Dr Seth in the Physics department and my task was writing a graphing program (no off the shelf programs in those days) to explore the connections between the electromagnetic and strong force. We published a paper:
Seth, Buzard, Picard, Bassani: 87 SR. (d.p) “88 Sr. Reaction”, Physical Review C, 10: 1928-1938, 1974.
At the same time I met two of the most extraordinary men of my life, Dr Bernard Abraham and Dr John Ketterson. Almost everything I know about experimental physics is due to these two men. I attended Stanford University where I got a Masters Degree in Applied Physics. If you want more on my early life with pictures of computers and people, go here:
I did my internship at LA County Hospital and my residency at the Jules Stein Eye Institute at UCLA. The program was headed by Dr Bradley Straatsma seen above in the center of the picture. Dr. Straatsma has been the recipient of numerous national and international awards in ophthalmology. He has delivered more than 50 distinguished lectures and is author of over 500 scientific publications.
I decided to become a corneal and refractive specialist and did a fellowship with Dr Richard Troutman, the leading corneal specialist of the time.
Dr Troutman is considered the father of modern corneal surgery and among many other things, I learned to do the Torque-Antitorque penetrating suture pattern for penetrating keratoplasty (corneal transplant or PK), wedge resection and corneal relaxing incisions from him.
As part of the fellowship I had the privilege to spend time in Bogata, Colombia with Dr Jose Barraquer. He was a remarkable surgeon and a wonderful man to just spend time with. Unfortunately he died not too long ago and is missed by everyone.
Dr Barraquer is considered the father of refractive surgery and invented keratomileusis, the forerunner of LASIK. The instrument that allows us to do LASIK today, the microkeratome, was invented by Dr Barraquer. This instrument allows us to cut a thin layer, or cap, in the cornea which then allows us to modify the shape of the cornea and to improve vision.
I left my fellowship in 1986 to join Dr Steven Shearing, inventor of among many other things the intraocular lens. Steve was my friend, my mentor and unfortunately died recently.
Dr Shearing developed the first compressible lens in the 1970s, revolutionizing cataract surgery by placing springs on the implants to keep them in place. He patented and received widespread recognition for the Shearing intraocular lens, which allows millions of people to enjoy better eyesight.
I was the first corneal surgeon in Nevada, specializing in corneal and refractive surgery. I kept busy doing lots of cornea transplants and became the director of the Las Vegas Eye Bank, later the Nevada Donor Network. I remember my first New Years Eve doing a dozen cornea transplants because no one else in the country wanted the corneas! It goes without saying that I received a strongly worded letter afterwards reminding me that the OR staff did not get to celebrate New Years.
I was the first to identify the cause of post keratoplasty astigmatism, the microdehiscence, a localized sector of poor wound healing, often with an epithelial plug. I also developed the first technique to repair the problem using additional sutures, The Additional Suture Technique. Previous techniques of removing sutures actually made the problem worse and led to unstable refractive errors and shortened graft lifetimes. A surprising little fact, 0.1 mm of wound spreading will lead to one diopter of astigmatism.
I developed the largest refractive surgery practice in Nevada and one of the largest in the United States. At first I performed radial keratotomy, developed corneal relaxing incisions for astigmatism and the first enhancement operation for incisional keratotomy, the “Tickle“. I was the first to develop a biomechanical model of the cornea in the context of incisional refractive surgery, including the first length-tension (strip extensiometry) measurements of sclera and cornea.
I developed the first slit lamp refractive surgery for astigmatism which is still used widely today for post-cataract astigmatism. With the assistance of Doug Mastel we gave many courses on the management of astigmatism using the knife that I invented specifically for the operation.
To document these and many other techniques, I published a book with Dr Troutman in 1992, Corneal Astigmatism. It was a popular book and went through several reprintings. The material in the book formed the basis of a very popular course at the annual American Academy of Ophthalmology (AAO), “Surgical Management of Astigmatism“, that I taught for many years at first with Dr Troutman and then with my close friend Miles Friedlander. The course was unique in that it had both a 2 hour lecture period and a 2 hour wet lab where we taught surgical techniques under their own microscope.
I became an assistant clinical professor at the University of Nevada Medical School and at Tulane University in New Orleans where I went often to teach with Dr Friedlander.
I performed one of the largest series of Automated Lamellar Keratoplasties (ALK, the precursor to LASIK), and developed a double blade technique to obtain remarkable accuracy for the time.
When the Excimer Laser was introduced by Dr Stephen Trokel, for laser vision correction in 1996, my very large refractive practice was converted almost overnight into the first large scale LASIK practice which was visited by hundreds of ophthalmologists. I received the VISX Star award twice, beginning in 1997 and again in 1999. Due to my early pioneering studies in irregular astigmatism I became a professor at Tung Wah in Hong Kong.
I also made contributions to cataract surgery, the most important of which was the “Blue Line Cataract Incision“. This incision was a much safer incision that could be performed quickly with a specially designed diamond knife and improved upon the unstable previous clear corneal incision. In a series of articles I explored the safety of the incision.
I next focused on the accuracy of the intraocular lens calculation with the “Touch and Go Technique” for ultrasonic axial length measurement. With this technique and the use of the IOL Master we achieved a 95% 20/40 or better uncorrected rate of vision and 100% accuracy of +1 to -1 diopter correction.
Finally, I developed a technique for safely exchanging the IOL thus providing the first enhancement technique for cataract surgery in addition to my technique of correcting astigmatism at the slit lamp.
With these developments, cataract surgery became a true refractive procedure, capable of treating nearsightness, farsightedness, astigmatism and presbyopia. I coined the term “Refractive Phacomulsification” to reflect these developments in lens surgery.
For some time refractive surgeons and I in particular were aware of refractive drift after refractive surgery, particularly for patients in their 50’s and older. I was the first to relate these refractive changes to changes in the structure of the human lens and to suggest that refractive correction in patients above age 50 should be performed on the lens rather than the cornea. I named the procedure “Lens Exchange“, emphasizing the exchange of an incorrect lens (often with early changes of cataract) for a correct IOL. Given the safety, efficacy, and accuracy of the procedure, Lens Exchange gained a large following which continues today. For many years I taught a course at the American Cataract and Refractive Society on the Lens Exchange procedure with Dr Bruce Wallace on Lens Exchange surgical techniques.
In 2001 I wrote a book with my long time friend Miles Friedlander and my fellow at the time, Dr Jean-Luc Febbraro which summarized the developments in cataract and Lens Exchange surgery. Dr Febbraro went on to take on the teaching with Dr Hamza Khan at the annual AAO course on the “Surgical Management of Astigmatism” which is still being taught.
My practice had grown so much that we had to expand to a new building and 1998 we began building the two story, 36 thousand square foot Buzard Eye Institute with its own 3 room operating theater. The clinic had 12 examination rooms with a large comprehensive eye testing center with all of the latest instrumentation.
After 23 years of practice, I retired in 2006 to indulge my interests in history, travel, photography and food. I maintain a popular blog, Travel to Eat, where you can see my pictures from around the world as well as recipes and food history. As you can see from the above picture taken last year in Paris, I am much more relaxed now and I am enjoying my retirement. I did not blog on ophthalmology for a while after my retirement but I have decided to begin now since I have so many pictures, lectures and videos which I would like to share.
I am extremely thankful for the training I received and for the opportunity to help thousands of patients from around the world. For my teaching and publications I am listed in Who’s Who in America and in the Who’s Who in the World. My other awards are listed in the web site. This site is meant to be an interactive forum where patients and physicians can ask questions and I will do my best to answer them.
My Web Sites:
Travel to Eat: http://traveltoeat.com/
Computer Stuff Home: http://computerstuffhome.com/