Practicing ophthalmology in Saipan

He is an ophthalmologist in private practice on the island of Saipan in the South Pacific.

Finding his island

"This was a very exciting time, and although I had the opportunity to pursue a career in academic medicine, my heart was set on serving a community that needed an ophthalmologist," said Dr. Khorram. "I had always wanted to serve internationally, so I sent letters all over the world, and ended up in the Pacific."

He spent a year as the director of ophthalmology at the Lyndon Baines Johnston Tropical Medical Center in Pago Pago, American Samoa, before going to the Commonwealth of Northern Mariana Islands (CNMI). For his first 5 years in Saipan, he worked at the Commonwealth Health Center before co-founding Marianas Eye Institute in 1998.

Different needs

Running an eye institute on this tropical island is different from doing so in the United States for several reasons, explained Dr. Khorram. "There are no subspecialists nearby for me to refer patients to," said Dr. Khorram. "I'm the only ophthalmologist serving the island. So when something needs to be done, I'm the one to do it.

"I handle a much broader range of cases than I would in the States," he added. "Many people here delay eye care, so I see a lot of end-stage disease. A good chunk of the cataract surgery that I perform is on white lenses. Diabetes is rampant, and a lot of people walk in the door for the first time with a vitreous hemorrhage."

The demographics of the island distinguish the practice, too. Dr. Khorram explained, "There is an indigenous population of about 20,000. People die young, often in their 50s. The rest of the population is made up of young, healthy contract workers from Asia who don't access health-care. I'm doing about 80 or 100 cataracts per year. That's just all there is on the island. Minimum wage is $3.55 per hour, and the average annual income on the island is around $11,000. So there isn't any significant disposable income for people to spend on the elective facets of eye care, which, from what I understand, is driving American ophthalmology-refractive surgery, presbyopic correcting IOLs, and cosmetic procedures. We provide a lot of free care and a lot of indigent care.

A wired practice

Technology plays a huge role in Dr. Khorram's practice-in part because he values it and in part because his remote location demands it.

"I think our level of technology is probably not typical for even U.S. mainland practices," he said. "When ophthalmologists from Japan, Australia, and the US have passed through and visited our office, they have commented that the combination of technologies in our office far surpasses typical comprehensive ophthalmology practices in their countries.