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M.D. NEWS August 1999
The new gold standard of cataract surgery - in fact, the definition of world-class ophthalmology - has emerged from the offices and creative genius of Baldwin County's own Joseph F. Gravlee, Jr., M.D. From the very fertile and inventive mind of Gravlee have come innovations and inventions that are changing the status quo of cataract surgery. The outstanding surgeon has so many firsts attached to his name that some have jokingly asked him if his middle initial stands for "First." Gravlee was the first physician in the area to use the no-stitch, self-sealing incision for cataract surgery; the first to use topical anesthesia for cataract surgery, thereby eliminating the need for a retrobulbar needle injection of anesthesia around the eye; the first to use a foldable lens implant (which lessens the size of incision needed for insertion); and the first to do cataract surgery on anticoagulated patients. He was the first physician in Baldwin County to do a corneal transplant and the first to use "piggybacked," stacked intraocular lenses. According to Bill Wall, area manager of Staar Surgical, the leading manufacturer of technologically advanced intraocular lenses in the U.S., "Dr. Gravlee is one of the most accomplished and innovative cataract surgeons in the country. He uses the smallest routine cataract incision in the state of Alabama, only 2.5mm, which is impressive." Most recently, Gravlee was the first surgeon in Alabama to implant the toric astigmatism-correcting lens. "Normally, when we take out a cataract, we put in a regular spherical intraocular lens, " says Gravlee. "This implant compensates for corneal astigmatism. It's an important new tool to help our patients be less dependent upon glasses. Some 20 percent of cataract surgery patients are candidates for the new lens," explains Gravlee. As impressive as these accomplishments are, however, the contribution of Gravlee that is likely to have the most effect on the field of cataract surgery is the Gravlee Safety BevelTM, for which the imaginative Dr. Gravlee holds a U.S. patent and has international patents pending.
The most recent of Gravlee's three medically related patents, the Safety Bevel, has single-handedly defined the future of standard of care of cataract removal. Gravlee's instrument - a new tip for the phacoemulsification probe - is both more efficient and safer than present methods. "It's a new design of the tip that performs a sharper, cleaner cut of the cataractous material, while at the same time making pickup and removal of the material easier through better fluid flow and occlusion characteristics," explains Gravlee. "At the same time, " continues Gravlee, "the safety of the procedure is enhanced and made more predictable due to the beveled design of the tip." Gravlee has performed over 1,200 cataract removals with insertion of soft, foldable implants under topical anesthesia using the Safety Bevel tip with a complication rate far below the national average. "I designed it to be the safest possible probe for intraocular use," says Gravlee. "The national rate for the complication of unplanned vitrectomies is four to six percent. Mine with the Safety Bevel is 0.3 percent." Gravlee explains that the Safety Bevel probe is, from a mechanical standpoint, safer for two primary reasons. First, if the fragile posterior capsule "trampolines" up, it has to travel a longer distance to encounter the metal tip. Second, if the posterior capsule does touch the metal tip, it is less likely to rupture because it most likely will hit the flat surface of the Safety Bevel prove (see illustration). "One case in particular that convinced me that the new tip is safer," recalls Gravlee, "is when the posterior capsule of one of my patients unexpectedly trampolined up and hit the probe so hard that I could feel the impact in my hand. After I remembered to start breathing again, I was amazed to see that the posterior capsule was still intact."
"Beyond the mechanical reasons for improved safety," continues Gravlee, "is the fact that because of the improved cutting characteristics of the Safety Bevel, you don't have to use as much phacoemulsification energy to remove the cataract, thereby reducing the amount of destructive ultrasound waves for the surrounding tissues to absorb. "We were all taught in medical school," continues Gravlee, "'First, do no harm.' In my opinion, it is therefore a surgeon's duty to minimize the surgical trauma and to do it in the most organized and safest way possible for the patients." Gravlee points out that in April of this year, a paper was delivered at the American Society of Cataract and Refractive Surgeons by Robert Schnipper, M.D., of Jacksonville, FL,. which independently and with no financial interest, confirmed Gravlee's own findings. "I must confess," admits Gravlee, "that I am obsessed with cataract surgery. I think about it all my waking hours and even make the surgical moves in my sleep. I want to be the best cataract surgeon I can possibly be so my patients can get the best results possible anywhere." Another of Gravlee's patented medical devices, interestingly, is a new design for the common hypodermic needle. The Gravlee design makes a smaller incision so it is less painful. It is also safer since it makes a smaller "circumlinear" incision as opposed to a larger hole. "All venipuncture and arterial punctures really should be done with the new needle since they are less likely to leak," explains Gravlee. "Also the sterile and purulent abscess rates associated with needles should decrease since tissue plugs or inadvertent biopsies are not formed and deposited at other sites with this design." The extremely focused and creative ophthalmologist actually comes from a long line of creative thinkers. An uncle, the late Clark Gravlee, M.D., a former OB/GYN in Birmingham, held patents on several instruments, and his father, Dr. Frank Gravlee, a retired veterinarian and patent holder, has created and produces a special nutritional formulation, Farriers Formula, that is saving the lives of horses around the world by stimulating the growth of sound, healthy hooves. Gravlee knew from an early age that he wanted to go into medicine. One notices an almost inbred, innate sense of purpose and love of healing about Gravlee. "Medicine and surgery are the only professions I've ever really been exposed to" remembers Gravlee. "One of my earliest memories - it must have been around age four - is of jumping off a stool and hiding under my dad's surgical table in the veterinary clinic after experiencing an unexpected arterial bleeder in my face! The only way that I ever got to see my father was if I followed him into the clinic and barnyards and later in his career into the research facilities and clinic laboratories. Many of the sights, smells and hands-on experiences - like pulling calves - are indelible upon my memory." Gravlee's proclivity toward innovation was demonstrated early by his first invention, a pair feeder for laboratory animals, and by his first patented invention which was an ultrasonic tissue processor. The inventions were combined into a series of high school science fair projects which captured a first place award at the 1972 International Science and Engineering Fair. "My uncle Clark Gravlee was really a mentor to me, and I always though I would become an OB/GYN like him. But a big obstacle stood in my way," explains Gravlee with a big laugh. "I really need my sleep and I just didn't think I could function properly with catnaps between labor contractions!" Searching for a specialty that would allow him to put his skills to the highest use, Gravlee chose ophthalmology. After undergraduate training at Washington & Lee and the University of Alabama, Gravlee graduated from Tufts University School of Medicine in Boston. He did an internship at Baptist Medical Center in Birmingham and his residency at the University of Alabama in Birmingham.
In 1985, Gravlee and his wife, high school sweetheart Glenda Ritchie of Birmingham, settled in Fairhope and he opened his practice under the name of Bay Eyes. Today, he has additional offices in Gulf Shores, Foley, and opening in January, Daphne. In 1986, the Gravlee's bought a former hotel on Mobile Bay in Fairhope and named it "Away at the Bay." Now a bed-and-breakfast, the structure has been turned into a spacious residence for the Gravlee family which now includes two sons and a daughter. Additionally, there are six charming suites in the popular bed-and-breakfast. Occasionally, out-of-town patients will stay at the inn, allowing Gravlee to make evening rounds from the comfort of his home. "I can share my home with them, and they can enjoy the beauty and magnificence of the sunsets over the bay with their new-found vision," says Gravlee. The web site for the bed-and-breakfast is www.awayatthebay.com. Dr. Gravlee refers to his wife Glenda as "a real partner." She manages the bed-and-breakfast and also handles the accounts payable for his practice, which currently includes three optometrists and 14 staff members. When not at work, Gravlee enjoys sailing, bird hunting, chess and exploring the Internet. He's been a member of the Fairhope Rotary Club for many years, having served a term as president of the club. He was recently presented Rotary's highest honor, the Paul Harris Fellow Award. He is active in the St. James Episcopal Church of Fairhope. "It makes me humble and thankful," says Gravlee, "to know that I have been blessed with a wonderful wife, family, community and the ability to serve God, who is the great physician." Gravlee is certified by the American Board of Ophthalmology and the American Board of Eye Surgery. He is a member of the Society of Excellence in Eye Care, a select group of 100 surgeons who are advocates for eye patients and the quality of care they receive. What does this creative and trend-setting physician see for the future of ophthalmology? "Well," says Gravlee, "I see the intraocular contact lens (ICL) as the alternative to LASIK. It is reversible. The problem with LASIK (laser assisted refractive surgery) is that it permanently weakens the cornea. Also, it creates a subtle scar in the surgical area that leads to night blindness and loss of contrast sensitivity. Although LASIK can be lucrative for the doctor," Gravlee continues, "I have been telling my patients to wait for the ICL approval by the FDA or go out of the country to get it done where it's already approved. There's an excellent web site for those wanting more information at www.staar.com." Gravlee expects the new product and procedure to be approved in the U.S. within a year. Gravlee also predicts that intrastromal rings will be promoted in the future but the problem with them, he explains, is that they create a circular white scar over a period of years which is cosmetically unacceptable to refractive patients. "And, of course, cataract surgery is going to continue to improve. I'm working on that now!" says Gravlee with a confident smile. "I'll tell you, I'm real high on this guy," says James Stewart, chairman of the board of directors at South Baldwin Regional Medical Center in Foley, "He's such an innovator. Besides my relationship with him as chairman of the hospital board, I'm also a patient of his. He did cataract surgery on both my eyes, and now I've got 20/20 in both eyes. The difference is like day and night." Precisely because of his tendency to be always looking for innovations, because of his unquestioned commitment to patient welfare, and because of his willingness to put his creative acumen to practical use in his profession, Dr. Joseph F. Gravlee, Jr. has become the "go-to-guy" in the field of cataract surgery. Indeed, his reputation and abilities are attracting referrals, patients and accolades from far and wide. And he's putting Baldwin County on the map as a center for world-class ophthalmic surgery.
Photos: Richard Anderson Written by: William Bruce
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