Five Questions With: Dr. Paul Koch

Dr. Paul Koch of Koch Eye Associates has written extensively in his field, including seven textbooks on eye surgery, and has served on several boards, including the Scientific Advisory Board of the American Society of Cataract and Refractive Surgery and the Executive Board of the Outpatient Ophthalmic Surgery Society. / COURTESY CONSTANCE BROWN
Dr. Paul Koch of Koch Eye Associates has written extensively in his field, including seven textbooks on eye surgery, and has served on several boards, including the Scientific Advisory Board of the American Society of Cataract and Refractive Surgery and the Executive Board of the Outpatient Ophthalmic Surgery Society. / COURTESY CONSTANCE BROWN

Dr. Paul Koch of Koch Eye Associates earned his undergraduate degree from the College of the Holy Cross in Worcester, Mass., and his medical degree from Tufts University School of Medicine in Boston. He completed his residency in ophthalmology at Manhattan Eye Ear and Throat Hospital.

Koch has written extensively in his field, including seven textbooks on eye surgery, and has served on several boards, including the Scientific Advisory Board of the American Society of Cataract and Refractive Surgery and the Executive Board of the Outpatient Ophthalmic Surgery Society. The recipient of two Lifetime Achievement Awards and the Senior Honor Award from the American Academy of Ophthalmology, and chief medical emeritus of Ophthalmology Management Magazine, Koch spoke with Providence Business News about current issues affecting ophthalmologists and their patients.

PBN: What differentiates Koch Eye Associates from its competitors, and what are the challenges – regulatory, cost of equipment, insurance reimbursements or other issues – to launching and maintaining an ophthalmology practice?

KOCH: Koch Eye Associates is a large, vertically integrated comprehensive eye care practice that is perhaps best known for its pioneering work in modern small-incision cataract surgery and refractive surgery, including LASIK. In addition to our many offices throughout the state, we also operate the only exclusively eye Ambulatory Surgery Center in Rhode Island. We offer a comprehensive range of specialty services – from general eye examinations to specialty care for cataracts, glaucoma, vitreo-retinal diseases and other ophthalmic subspecialties. We have a center dedicated to aesthetic surgery and LASIK with the most modern technology. We are both a primary care location for our patients and a referral center for complicated cases from throughout southern New England.

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The challenges you mention are just the tip of the iceberg. It is almost impossible for a young doctor to hang a shingle here these days because of the very high burdens each office faces, including challenging federal regulations and very low insurance reimbursements compared to other parts of the country, while our overhead here is higher. We are required to conform to certain mandates, such as very expensive electronic records, even though their value remains unproven so far in our specialty.

For these reasons, we are finding fewer and fewer of our colleagues maintaining a traditional solo practice while the rest seek relief from group association.

PBN: What’s involved in Koch Eye Associates’ position as a training center for the New England College of Optometry, and do you play a role in this training, as well?

KOCH: Koch Eye Associates has had a long relationship with the New England College of Optometry and has been a clinical training site for many optometry students, particularly those interested in eventually working in Rhode Island. Our training is unique among their rotations, because we emphasize medical training that complements the optical training they receive in other locations.

Our training is not simply exclusive to the optometry school. We also conduct fellowship training programs in cataract surgery, LASIK and the medical treatment of retinal diseases such as diabetic retinopathy and macular degeneration. Our fellows have already completed their residencies and could have gone into practice but decided to obtain additional training to develop further expertise in these areas. We are proud that several of our fellows have joined our group because their training gives our patients a consistency among our medical staff.

PBN: Koch Eye Associates was acquired by Candescent Partners in Boston in 2011. How has that acquisition changed your practice and autonomy? What was Koch Eye Associates’ motivation to be acquired?

KOCH: The acquisition was a positive step for all of us. The role of Candescent Partners is to manage the business side of the practice; the medical practice and autonomy remains with the medical staff. We have an active physicians’ advisory board and I am the chief medical officer. From a medical viewpoint, we deliver care that we feel is best for our patients.

On the other hand, the other challenges we face that include human resources, governmental regulations and insurance coordination are now the responsibility of Candescent Partners and not of Koch Eye Associates. It’s been a wonderful partnership, with business professionals handling the business and the medical professionals handling the medicine.

Patients have benefited in several ways; perhaps the most telling is this: Physicians constantly want access to the newest technologies to keep our practice at the very front edge of eye diagnosis and treatment. Our business partners help to make that happen, allocating the resources necessary to upgrade our technologies and facilities.

PBN: Koch Eye Associates has offices with ophthalmology, optometry and optical services in Johnston, Providence, North Kingstown, Wakefield, Warwick and Woonsocket, along with a newly opened office in Cranston. Do you worry about over-saturation of the Rhode Island market?

KOCH: Rhode Island is a very interesting market. We, like the rest of the Northeast, have a large senior population, but we also have one of the largest 55-65-year-old concentrations in the country. As such, in the next few years, our senior population will grow faster than in most other places. The challenges facing medicine that we discussed earlier has caused ophthalmologists to retire at a rate faster than we can train new ones. Going forward, we will have fewer eye doctors to care for more patients, which brings Koch Eye Associates back to our role as a training center for optometrists and surgeons.

We are aware of communities in Rhode Island where the optimal ratio of eye doctor to population is below what we would like, and even more places where specialty ophthalmologists are needed. However, we continue to study and evaluate whether we need to expand to another location in Rhode Island or across state borders.

PBN: What does the future hold in eye care?

KOCH: A generation from now, eye doctors routinely will be doing things that right now are fantasy.
Already, we are using a femtosecond (a millionth of a billionth of a second) laser to perform cataract surgery with a level of precision and safety we never dreamed of, even a few years ago. LASIK is performed using scans to map subtle shapes on the cornea that we could never before identify.

Clinical studies in the United States on an eye drop show promise in softening the eye’s lens, which might postpone or actually eliminate the need for reading glasses. In Europe, another eye drop is being studied that has reduced and sometimes eliminated cataracts in mammals. That offers hope that cataracts might one day be treated with eye drops, rather than with surgery.

Many diseases that cause bleeding in the eye are treated with medications, not surgery or lasers, while lasers are used to treat glaucoma and allow patients to stop using irritating pressure-lowering eye drops. Advances in genetic testing, nutrition and nutritional supplements will allow us to anticipate which patients will be susceptible to certain diseases and customize preventative supplements that treat the condition in advance.

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