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Clinical Pearls Archive from YO Info

 
6 Pearls for Capsular Catastrophes 09/17/2014
As my senior founding partner always says, “The only sure way to avoid any complications as a surgeon is to stop operating.” We will all inevitably experience the sinking feeling of causing a tear in the posterior capsule. Here are six surgical pearls for when the capsule breaks.
 
6 Pearls for Managing Astigmatism During Lens-Based Surgery 06/17/2014
Toric IOLs have been hailed for enabling improved surgical accuracy. But with that gain, refractive cataract surgeons have also become more aware of corneal astigmatism and its management. Compared to what we once may have thought, astigmatism management requires more surgical planning than just picking a toric power based on topography values alone. Surgeons must factor in various other considerations, including different nomograms, online calculators, the patient’s age, target for astigmatic correction and the relaxing effects of the surgical wounds. Here are six tips to help guide your thought process for surgical planning.
 
When to Say No to Elective Surgery 05/13/2014
Whether considering cataract extraction, blepharoplasty or an epiretinal membrane peel, many of the surgeries that ophthalmologists perform can be classified as elective. As surgeons, it is our responsibility both to provide care to patients and to prevent bad outcomes by avoiding procedures on patients determined to be poor surgical candidates. Here are a few considerations ophthalmologists need to address to ensure the best possible outcome, especially when a procedure is elective.
 
My Favorite Instrument: 9 Tips on What to Use When 03/18/2014
The right instrument can make all the difference during surgery. But as recent advances in use of femtosecond lasers show, instruments’ uses can change over time, changing common practice over time. What instruments do your peers prefer? The 2014 YO Info editorial board shares their favorite instruments and how they use them.
 
7 Pearls for Improving Your Neuro-Ophthalmology Diagnostic Skills 01/14/2014
Regardless of subspecialty, all eye care providers will encounter patients with neuro-ophthalmic disorders. Most diseases with potential for rapid vision loss or serious systemic morbidity are neuro-ophthalmic conditions and are often challenging to diagnose. As a result, neuro-ophthalmology represents a source of anxiety and frustration for many providers. Here are seven practical and easy-to-implement ways for all eye care providers to improve their neuro-ophthalmology diagnostic acumen.
 
Eyelid-Lesion Removal: Seven Important Pearls for the Young Ophthalmologist 05/14/2013
Eyelid lesions are common in everyday practice. Patients commonly present to their eye care provider complaining of a lesion growing near their eye. While many of the lesions are benign in nature, periocular malignancy is common. As such, appropriate documentation and biopsy techniques will lead to better patient outcomes and aid in further treatment, should referral to a subspecialist be required.
 
Seven Pearls for Your Resident Surgical Experience 04/10/2013
For residents embarking on surgical training, the journey from competency to mastery can be both demanding and overwhelming. Here are seven must-know pearls for getting the most out of your resident OR surgical experience.
 
Cramming for the OKAPs: Tips from Your 2013 YO Info Editorial Board 02/12/2013
The Ophthalmic Knowledge Assessment Program (OKAP) is a 250-item multiple-choice test that is administered to ophthalmology residents in each year of training. To help ensure that you perform your best on the OKAPs, the YO Info editorial board offers 26 pearls for the final six weeks of test preparation.
 
8 Pearls for Evaluation of the Glaucoma Suspect 12/04/2012
Glaucoma is the most common cause of irreversible vision loss. Early detection is essential to preserving vision in these patients who are often asymptomatic and rely on a thorough approach by their ophthalmologists to determine if and when treatment should begin. Here are eight steps to help formulate a methodical approach to these glaucoma suspects.
 
Ophthalmology Unplugged: 8 Pearls for Seeing Patients Without Power 12/04/2012
On Oct. 29, Hurricane Sandy made her predicted northwest turn toward the coastlines of New York and New Jersey, where it would produce an unprecedented storm surge. Over the course of the afternoon, the storm felled trees, downed power lines and flooded electric substations. By evening, the East River swept over the banks of Manhattan, flooding the Con Edison power plant located on East 14th Street and knocking out power throughout Lower Manhattan. These outages included the New York Eye and Ear Infirmary, where physicians, staff and patients were left with the daunting challenge: how do you practice ophthalmology during a power outage?
 
Clinical Pearls for Uveitis: Five Dos and Five Don’ts 07/16/2012
Uveitis can be challenging to treat for comprehensive ophthalmologists as well as retina and uveitis specialists. This heterogeneous group of ocular inflammatory conditions presents in all age groups and is often seen in patients with no family history or who are otherwise healthy. Listed below are five dos and don’ts to properly identify the etiology of uveitis and avoid exacerbating the inflammation.
 
10 Pearls for Open Globe Trauma Assessment 06/11/2012
1. Proceed with caution: Assume that any periocular or ocular trauma could be a ruptured globe. Avoid placing undue pressure on the globe until you establish that an open globe injury does not exist.
 
10 Surgical Pearls for Open Globe Repair 06/11/2012
1. General anesthesia or bust! The best situation is a controlled one under general anesthesia. If you practice in an area where open globe trauma is less common, confer with your anesthesiologist beforehand to ensure that the patient will be deep for the duration of the procedure (i.e., no bucking please), and that non-depolarizing induction agents are used.
 
10 Pearls for Getting the Most Out of Your Residency 04/16/2012
Ophthalmology residency training programs can be demanding. Often, residents “miss the trees for the forest.” The skills developed during this phase of our careers will set the foundation of our future lives in ophthalmology. Listed below is a selection of helpful guidelines to help you focus on the trees to develop your own forest, thereby becoming an efficient and content young ophthalmologist.
 
21 Pearls for the OKAPs: Tips from Your YO Info Editorial Board 02/13/2012
Since their development in the 1960s, the OKAPs have grown beyond their original intention of self assessment and program evaluation and gained new significance as a preparatory exam for the boards. To help ensure that you perform your best on the OKAPs, the YO Info editorial board offers these pearls of wisdom.
 
Seven Pediatric Ophthalmology Pearls 12/05/2011
Performing eye examinations on children can have its challenges, but also holds great rewards. I sometimes joke with my colleagues that performing eye examinations on children is close to veterinary medicine. At times, all you have to guide you is your observations during the course of the examination. Over the first five years of my practice, I have developed seven pearls that I have found to be helpful when examining children’s eyes.
 
Posterior Segment Imaging in Glaucoma: Which Tests to Use? 09/12/2011
The management of the glaucoma patient and glaucoma suspect has become more interesting as imaging technology has evolved over the past few years. Stereoscopic disc photography, HRT, GDx, time domain OCT, spectral domain OCT. Which ones should you use to help diagnose glaucoma? Which ones should you use to help monitor progression? There has been considerable debate among glaucoma specialists regarding the use of these imaging modalities and if one is superior to the others. If you are thinking about purchasing a new machine for your office, this article will give you some useful information on the clinical utility of imaging in glaucoma.
 
Clinical Pearls: Corneal Measurements for Premium IOLs 07/11/2011
As the baby boomers reach their 60s and begin to get visually significant cataracts, demand for premium IOLs is increasing, and with that comes high expectations. Corneal topography and accurate Ks will help you to better meet those expectations, both in determining the optimum IOL power as well as in the astigmatism correction. Here are eight pearls for getting the corneal measurements you’ll need.
 
The CATT: What Does it Mean for Treating AMD Now? 05/16/2011
Arguably the most exciting news from this year’s Association for Vision in Research and Ophthalmology (ARVO) annual meeting was the one-year outcomes of the CATT (Comparison of Age-Related Macular Degeneration Treatments Trial) study. This trial addressed the relative safety and efficacy of bevacizumab (Avastin) and ranibizumab (Lucentis), both manufactured by Genentech, in the treatment of age-related macular degeneration (AMD). These clinical pearls will be devoted to discussing the results of the trial and what they mean to us as clinicians.
 
A General Approach to Teaching Medical Students Ophthalmology 03/14/2011
In recent years, medical students across the country have had a deficit of knowledge in ophthalmology. This has been due to many factors, but principally to a lack of formalized education and clinical exposure during medical school. Given the limited exposure that medical students have to ophthalmology in medical school, it is of critical importance that ophthalmologists capitalize on whatever exposure medical students do receive to enhance interest in the field.
 
Five Pearls for the New Year: Advice for 2011 from YO Info’s Editorial Board 01/18/2011
Whether you’re struggling to maintain perspective in the present health care environment, uncertain which treatment for AMD to use on a patient or trying to figure out what type of practice setting you want to work on, our editorial board has a tip for you. Academy members can share pearls or ask questions in the comments (login required).
 
Preparing for Premium IOLs: Getting Started with Limbal-Relaxing Incisions to Correct for Astigmatism 12/06/2010
Why do you need to learn how to perform limbal-relaxing incisions? Limbal-relaxing incisions (LRIs) are used alone and in combination with implantation of toric and multifocal/presbyopia IOLs. As a resident, or if you are new to this technology, your best candidates are patients with astigmatism levels of 1.00 to 2.00 diopters of cylinder. You can quickly determine the degree of astigmatism by looking at your manual keratometry readings, then perform a corneal topography to confirm the axis and degree of astigmatism and to rule out any abnormal pathology, such as early keratoconus or irregular astigmatism.
 
Three Keys to Incorporating Latisse into Your Practice 10/18/2010
Successfully integrating the eyelash-growth prescription Latisse into your practice can present unusual challenges for the general ophthalmologist and the oculoplastics specialist, alike. First, although it is simple enough to offer your patients prescriptions for the medication, it may be difficult to build interest — to initiate or to encourage the dialogue. Second, because Latisse is applied by patients themselves, maintaining a substantial patient volume that is using the medication and following up regularly for Latisse refills can be difficult. How, then, may ophthalmologists overcome these challenges?
 
10 Pearls for Ocular Surface Disease 09/13/2010
The most common patients a comprehensive ophthalmologist will likely take care of in his or her practice are those with ocular surface disease, including dry eyes and blepharitis. Proper management of these patients often depends on identifying the primary problems and addressing all the contributing factors. Here are a few tips for making the proper diagnosis and treatment in patients with ocular surface disease.
 
Seven Reasons to Refer to a Retina Specialist 08/16/2010
By virtue of its nature, a comprehensive ophthalmology practice promises a broad variety of pathology and problem complexity. The ability to recognize diagnoses that warrant referral to a specialist strengthens the comprehensive ophthalmologist’s clinical acumen. The following is a list of common diagnoses that are best managed with the assistance of a retina specialist. It is by no means exhaustive; however, this list encompasses some of the most common indications for referral.
 
Incorporating Premium IOLs Into Your Practice, Part 2: Making the Recommendation 07/13/2010
Last month, we looked at the importance of initial patient education on cataracts and IOL options, as well as the optics involved in ensuring premium IOLs yield the most satisfied patient possible. This month we’ll look at making a good IOL recommendation.
 
Incorporating Premium IOLs Into Your Practice, Part 1: Laying the Groundwork 06/14/2010
When it comes to cataract surgery, we’ve found that one of the most important elements is laying the groundwork. Doing this effectively involves both patient education and a thorough corneal topography. In this article, we’ll look at how to provide initial patient education on cataracts and IOL options, plus the optics involved in ensuring premium IOLs yield the most satisfied patient possible.
 
Reading an OCT 101: Six Pearls for Reading an Image 05/26/2010
Optical coherence tomography (OCT) has revolutionized the diagnostic field of retina in many different ways. Here is a quick primer on how to read an OCT. (This example involves the Stratus Time-Domain model by Carl Zeiss Meditec, Inc., Dublin, Calif.)
 
Seven Clinical Pearls for Diagnosing and Managing Challenging Corneal Ulcers 01/11/2010
All of us have been there in residency: You get the phone call Friday afternoon for referral in of a “great teaching case” — i.e., a corneal ulcer. Come to find out, it’s not just limited to residency training. All kidding aside, corneal ulcers are one of the most common diseases referred to ophthalmology practices and can present some significant diagnostic challenges. The very first patient I examined in private practice had a contact lens-related central corneal ulcer that already had been treated for three weeks without improvement and with progressive thinning. I had to use almost all the “tricks” I learned in residency and fellowship to successfully treat this ulcer.
 
10 Clinical Pearls for Introducing Premium IOLs into Your Practice 08/17/2009
Premium IOLs are the buzz in journals, guest lectures and at many of the ophthalmic meetings. As residents and fellows, the patient population we treated often did not have the resources for a premium IOL, causing most of us to ignore the topic until sometime after training. Here are some clinical pearls I have learned while implementing premium IOLs during my first two years of practice.
 
Clinical Trials 101 07/13/2009
Every year, thousands of physicians participate in their first clinical trial. This is not only an educational experience, but also a humbling one. A clinical trial is an experiment performed on humans to compare the efficacy of two or more therapeutic options. The multi-center, randomized, masked, controlled trial is the gold standard of clinical research and produces the most reliable comparison of treatment modalities. Another essential aspect of a well-designed clinical trial is the random allocation of subjects to the experimental and control groups.
 
Optic Nerve Imaging Technology: The Necessary Evil? 05/11/2009
The growing use of optic nerve imaging devices has led to both excitement and frustration in being able to accurately diagnose and manage pre-perimetric glaucoma. In this article, I hope to give streamlined tips on obtaining and interpreting these often-confusing printouts, sharing some of the pearls and pitfalls I have learned along the way.
 
Transitioning from Supervised Cataract Surgery to Independent Cataract Surgeon: 12 Clinical Pearls 04/13/2009
1. Do not underestimate the transition. In your final year of training, surgery often becomes less challenging as your comfort level rises. Surgeons often assume the same comfort level will follow them to the real world. The reality is that operating on your own in a new environment can generate significant anxiety, and you suddenly miss having an attending surgeon by your side. Do not underestimate this transition and make every effort to prepare for it.
 
Seven Clinical Pearls for Examination of the Retina 02/10/2009
Examination of the retina can offer a spectrum of difficulties. It can be straightforward and easy in the young, cooperative patient without coexisting ocular disease, and it can be extremely challenging in some patients who are less cooperative and/or have coexisting eye diseases that preclude optimal examination. The following are seven clinical pearls for examination of the retina that I have learned during my fellowship and continued to refine and teach during my last four years in practice.
 
10 Clinical Pearls for Cataract Surgery 11/24/2008
The art of cataract surgery is an ongoing process of improvement for an ophthalmologist. Even when things become "routine," there are new and unexpected events that can occur that will challenge the best surgeon. Having performed more than 1,000 cataract surgeries over the last four years, here are the top ten pearls I've learned from my senior partner and mentor, Arthur J. Weinstein, MD, and friend, Alan Crandall, MD, Moran Eye Center, University of Utah.
 
10 Clinical Pearls for Treating Uveitis 08/18/2008
By the time a patient arrives at a uveitis clinic, he or she is usually very frustrated. The patient has seen multiple doctors, and not just ophthalmologists. He or she has been on a variety of corticosteroid, topical, oral or injectable medications and may have had several surgeries. The inflammation often comes back when the medications are tapered, and the patient still doesn’t have a “diagnosis.”
 
Clinical Pearls for Pediatric Ophthalmology 06/18/2008
Whether you are currently in your residency or in the early years of practice, providing children’s eye care requires a unique approach. Many ophthalmologists fear the child on their schedule due to the additional time required and complexities that comes with this examination. However, with the right approach and charm, caring for children can be a very rewarding and fun experience.
 
Eight Pearls for Reducing Errors in Eye Pathology 04/23/2008
Patient safety has become a major topic of interest since the publication of the Institute of Medicine’s landmark on medical errors in the United States in 1999.1 This benchmark report used published data concerning the frequency of medical errors in the United States. The findings showed that medical errors accounted for between 44,000 and 98,000 deaths per year nationwide and that medical errors cost payers, including the U.S. government, between $17 billion and $29 billion annually. Additionally, medical errors increase costs, induce patient harm and may result in the lost of your medical license.
 
Seven Pearls for Ensuring Excellent Visual Outcome after Corneal Refractive Surgery 02/22/2008
The popularity of laser refractive surgery is staggering, with more than 17 million procedures performed to date and an estimated 1.3 million procedures performed worldwide each year. While LASIK and PRK have grown in acceptance, relatively few ophthalmology programs have offered their residents significant training and experience in performing these procedures. For those of you who are new to corneal refractive surgery, I offer these few tips and pearls aimed at improving your personal experience with the procedures and, ultimately, ensuring the excellent visual outcome for your patients.
 
10 Clinical Pearls for Your First 10 Phaco Cases after Residency 06/13/2007
You are the new kid on the block, and yet you are-and must be-the boss. Communicate your needs and expectations to your staff, but remember that a calm and confident demeanor is necessary to avoid ruffling feathers during your first surgical days. How you shoulder this burden demonstrates your character. Remember that arrogance is often the mask of insecurity. If something is not going the way you want, look within yourself to find the fault. That's probably where it is.