Originally published in January 2003 Business People-Vermont

The Eyes Have It

Ophthalmologist David Chase has been on the cutting edge of ophthalmic surgery since long before LASIK was an everyday word.

by Cal Workman

Back before Lenscrafters and Pearle Vision administered eye exams, there was a collection of ophthalmologists like David Chase, M.D., who provided all the services needed by people with vision problems. Chase's continuing commitment to total family eye-care has helped his practice, Vermont Associates in Ophthalmology, and its Pine Street office grow into one of Chittenden County's largest practices. It is the only practice offering the three "o's" ophthalmology, optometry and optical services at one location, but what makes the practice really unusual is an added "o" for operating room, the only in-house surgical room for eye operations in the state.

David Chase, M.D., is at the core of Vermont Associates in Ophthalmology, his full-service Burlington eye care clinic that offers the four "o's": ophthalmology, optometry and optical services plus a fully-fitted operating room for eye surgery, the only one of its kind in the state.

A team of specialists and a fully fitted surgical room have their advantages. Patients can expect quick, thorough and expedient service without scheduling multiple visits to multiple places.

Chase and a staff of 13 deliver a complete range of eye-care services under their roof, from administering eye exams, dispensing eyeglasses and fitting contact lenses to prescribing medication for diabetic patients, treating cataracts and glaucoma. They also perform LASEK surgery. Surgery is Chase's passion.

"Ophthalmology is the queen of all specialties, no question about it," insists Chase with a grin. "Everyone secretly wants to be an ophthalmologist. They may not know it at first but they do eventually. This isn't work at all. It's fun."

Chase diagnoses and treats eye diseases and performs cataract, glaucoma, corneal and retinal laser surgeries from a convenient ambulatory operating room located steps away. He set up the surgical center out of need and frustration.

"We moved out of the hospital because we had difficulty getting any operating time. Someone was always on the phone trying to schedule a time," says Chase.

While Chase has a history with a long list of patients, several of his referrals now come from Dr. Vincent DeVita, the newest member of the team.

A physician who specializes in low vision, diabetic patients, and pediatric optometry, DeVita describes his role in the practice as the "primary entry point."

"If you have a headache, you don't head straight for the neurosurgeon. You see your primary care doctor. I'm the family's primary eye-care physician with an emphasis on disease detection. If you see me for blurry vision, 90 percent of the time, I can take care of it. If not, I will refer you to Dr. Chase or another appropriate specialist." A native of Binghamton, N.Y., and a self-professed "ski nut," DeVita was attracted to Burlington because of the area's great skiing, but he stayed for the practice. He expresses great respect for his associate.

"He is an excellent, A-plus surgeon. His outcomes are incredible. We've formed a great team effort. Dr. Chase wants to concentrate on surgery, which is what he does best, and he wants me to care for younger people so all his patients are well taken care of."

After an eye exam with DeVita, the patient, now armed with a prescription, can walk across the hall to select a pair of frames at Viewpoint Optical. Bill Perron, licensed optician and manager of Viewpoint Optical, which is affiliated with the practice, has been in the business of fitting frames for nearly 20 years. Out of a space of approximately 1,000 square feet, he carries nearly 600 frames to serve a diverse customer base with varying tastes from those searching for a "basic bread-and-butter design" to those wanting a more modern, trendy look like the seemingly invisible "drill mount" frames. He says his association with the practice, along with its location, is a big plus for business.

Bill Perron is the licensed optician and manager of Viewpoint Optical, which is affiliated with Vermont Associates in Ophthalmology.

"We're centrally located downtown, and our early opening hours are convenient for businesspeople working in the area," he says.

Perron notes that more businesses are offering some kind of vision plan as part of their benefits packages, and more insurance companies are covering eye care, a good sign, he says, that everyone is "recognizing that eye care is an important part of a person's overall good health."

Calling the administrative shots for the practice is Brianne Chase, Chase's wife of 40 years and CEO of the business.

"She makes sure we're up to snuff on all government regulations," says Chase.

Brianne also oversees the administration of the team of nurses, technicians and administrative assistants. She has run the office ever since Chase went into private practice, while also raising their three children and volunteering for the Flynn Theatre, serving once as chairwoman for its capital campaign.

Working side-by-side with a spouse isn't always a walk in the park. "She has to hear all my complaints and has to deal with it," says Chase. "As for me, I'm working for the office and, therefore, indirectly for her, so I have to hear, 'We can't do this, and we can't do that, because ...' a lot of times."

Chase admits if it weren't for his continuing interest in ophthalmology, he probably would have retired long ago, like the majority of his graduating class. Rising overhead costs, mounting insurance premiums, increasing government regulations and an endless and growing amount of paperwork make it less attractive to stick with it and more challenging to make ends meet.

Melissa Lozier (left), ophthalmic assistant, and operating room coordinator Mary Clairmont, RN, are two of 13 staff members at Vermont Associates in Ophthalmology.

"The cost of business keeps going up and the amount of reimbursement continues to go down," says Chase. "I try not to pay any attention to it. I've said to Brianne, 'When it costs me money to run the practice, let me know.' She hasn't said that yet."

Mike Powers, the clinical manager at First Health, a pharmacy management company, is glad Chase is in practice, because he might need an eye surgeon one day.

"If I had to have an operation on my eyes, he's the one I'd go to," says Powers. "My mother traveled all the way from Saratoga Springs, N.Y., to have Dr. Chase perform surgery on her two cataracts. He is an excellent surgeon who really wants to do what's best for his patients."

Powers has served as a pharmaceutical expert on Chase's peer review committee for more than 15 years. Part of a team of independent advisers, Powers and others meet quarterly with Chase and review diagnoses, charts and outpatient drugs with him to fulfill the requirement of operating a surgical ambulatory center.

Besides Chase's skill, Powers is impressed by the entire office and its efficiencies. "They review and address every possible issue, from keeping track of how long a person sits in the waiting room to whether anyone fell in the parking lot."

Powers met Chase as a patient. During one visit, Powers questioned Chase about a prescription, and rather than take offense, Chase welcomed his comments. He invited Powers to join his peer review committee because, as Powers puts it, "He doesn't want anyone on his committee who is going to simply shake his head in agreement to everything."

The world of medicine was very different in 1968 when Chase hung out his shingle on Outer Lincoln Road in Essex Junction. At that time, doctors simply filed for insurance and started accepting patients, he says. Today far fewer professionals are going into private practice on their own. Instead, they join groups, because they can no longer meet the rising costs of going it alone. Even though his profession is medicine, Chase claims the margins are very small.

"If I'm in a program accepting Medicare or Medicaid, it doesn't matter what I charge. I may charge $6,000 for an operation, and they'll pay $600. Twenty years ago for the same procedure, I was reimbursed $2,500." He adds, "I have to accept Medicare. If I was in Manhattan with a worldwide reputation, I could choose to cater only to the rich. Here, if you opt out of the system, you'll never get a case. Not in Vermont."

To trim expenses, Chase says a lot of doctors are eliminating raises or cutting salaries, a step Chase is not prepared to take. Everyone thought LASIK technology would "save us all from financial doom," says Chase, "but it hasn't."

LASIK surgery corrects refractive errors: myopia, hyperopia and astigmatism. The surgeon cuts a flap in the "stroma" using a laser so delicate and precise it can cut a strand of human hair. A portion of the corneal tissue is removed, which reshapes the cornea and adjusts its focusing power.

Chase was one of a small group of doctors who conducted the original therapeutic studies for Summit Technology, the manufacturer of the laser, and was one of the first in New England to equip his practice with laser technology.

"I was doing LASIKs before most of the doctors who advertise from Montreal or around here were even out of medical school," quips Chase.

Despite years of experience in LASIK, he is not a fan of the procedure. He performs a newer procedure called LASEK, which achieves the same effect through a less invasive surface technique.

"Most LASIK procedures turn out OK, but if they don't, it can be a disaster, he says. "No one knows how much material to leave in the bed of the cornea, and complications can develop if you take out too much."

Some of these complications include infection, damage to the optic nerve and inadequate healing.

"I went to a LASIKs meeting in Boston at the New England Ophthalmology Society, and they spent the entire time informing us on how to protect athletes' eyes at sporting events. Why do a procedure on someone who wants to see better so they can do sports and then force them to wear these horrendous eye-protective glasses? The whole thing seemed insane to me."

Chase's Yankee practicality is inbred. He was born and raised in Lancaster, N.H., a town of 3,000 "that hasn't changed in 100 years." He attended the University of Vermont for both his pre-med and medical studies, graduating from the Medical College in 1962, "when the Vietnam war was just warming up." During his internship at New York Upstate Medical Center in Syracuse, he became hooked on ophthalmology.

David Chase's practice is preparing to expand its 5,500-square-foot space in the next few months, which should improve overall patient flow. Among those who will benefit are Liza Jarrett (left), optician's assistant, Dina Fraid, office coordinator, Arlene Engels, receptionist, and Sandi Roberge, who works at reception and billing.

"I was doing a two-week rotation in ophthalmology, and a bunch of residents invited me to go to the Onondaga County Ophthalmic Society meeting on the 14th floor at a downtown hotel. When we got there and opened the door, there were at least 60 guys over 80 dressed in bow ties. I thought, 'This has got to be a great specialty if they're still in practice.' And it is a great specialty. It's a whole world apart."

Along with all graduating medical doctors, Chase was drafted into the service but through the Berry Plan, he could have chosen a deferment for specialty training. Instead, he joined the Navy and spent a year as a medical officer for a naval transport ship that performed maneuvers off Norfolk, Va. The following year, he practiced internal medicine at the naval hospital in Portsmouth, N.H. He remembers his naval service as a great experience that provided him with both great teachers and practical hands-on experience.

Following his military service, Chase moved to Indianapolis, Ind., to serve a three-year residency at Indiana University Hospital. Rather than stay in Indiana and fill one of 100 openings for ophthalmologists, Chase wanted to return to Burlington after he completed his residency. He spent a short time in Essex Junction before moving his practice to Pearl Street in Burlington. His practice steadily grew, and Chase added an optician and technicians. Eventually he grew out of that space and moved, in 1984, to his current location in the Mansfield Professional Building at 183 Pine St.

His practice is once again poised for growth, preparing to double its 5,500-square-foot space. The expansion will add at least two additional examination rooms for DeVita and double the size of Viewpoint Optical, while improving overall patient flow.

With more than 30 years of practice under his belt, Dr. Chase shows no signs of slowing down. He'll be in practice, he says, "as long as I'm up and kicking."

Originally published in January 2003 Business People-Vermont