The reality is that the world only has one Rafa, but about 700 new ophthalmologists finishing their residency training annually in the U.S. alone.  Some will be better surgeons, but all of us will [hopefully] be able to perform safe surgery for our patients.

Fortunately for us, the ability to become an efficient, skillful surgeon doesn’t require  innate superhuman ability, only practice and attention to detail.  Seven months ago when I performed my first phacoemulsification, my cut to close time exceeded that of my large incision extracapsular cases.  Now I can probably perform 5 routine cases in the same amount of time.

Interestingly, the total number of cases I’ve performed in 7 months has been limited.  However, I think that there are several principles to follow when learning surgery (other than the need for experience):

• Operative time often correlates with early postoperative result.  In general, the longer you mess with tissue, the more bruising you get. In cataract surgery, this translates to cornea edema.
• The speed of the surgery does not correlate with how quickly you move your hands, but rather how efficient each movement is.
• Read the point above AGAIN. Each movement should have a clear purpose to help move you one step closer to finishing the case successfully.
• Know what to do before you enter the OR. Learn the steps of the case, and have an idea what to do when basic complications arise.
• Learn from your peers. Watch their videos and figure out how they get out of trouble.

Lastly, go in with confidence! We all have good and bad days. The good surgical days will come if you believe in it!

Eyelash glue is typically applied externally at the natural eyelash base.  Additionally, liquid eyeliners are often used to mask excess glue from the lashes, along with mascara for adding volume.  During the day, these layers will collect grit from the air and collect along the lash line.  By allowing dirt to fester on the eyelashes at night, you are begging for an infection.

There are approximately 50 meibomian oil glands on the upper lid margin, along with the follicles within each of the eyelashes.  Each on of these orifices can become inspissated with oil and become inflamed.  In my general ophthalmology clinic, I often see clogged oil glands presenting as styes, external blepharitis, meibomitis, and cellulitis.  Most times, these infections can be managed using warm compresses and topical medications.  Rarely, the infections can become so severe that inflammation tracks behind the orbital septum–in these cases, both vision and livelihood can be threatened.

False eyelashes during sleep? No way. Vanity should have limits too.

Indeed, this explanation captures the essence of the problem, but for most people, having astigmatism does not mean that you have been cursed with a football-shaped eye.  For those my Chinese readers, astigmatism is written as, “散光”. (Mandarin: sǎn guāng; Cantonese: saan2 gwong1)

Again, for MOST people, astigmatism is a condition OFTEN completely correctable with contact lenses, glasses, or refractive surgery, assuming that there are not other underlying issues in your eyes.

In order for the eye to transmit a clear image of what is in front of us to our brain, light travelling into our eye must be focused directly onto the retina.  There are many conditions that can prevent light from reaching the retina, and astigmatism is one of them.  For most issues, astigmatism involves the cornea, a clear structure in the front of the eye that is responsible for bending light entering the eye onto the retina.  For those of use that are near-sighted (myopic), light is focused in front of the retina. For far-sighted folks (hyperopic), light is focused behind the retina (optically speaking). When we visualize this system in the two or three dimensional planes, light at different axes can be bent at different angles, resulting in a variable focus onto the retina. This is astigmatism.

One can have myopia or hyperopia with astigmatism. These two categories are not mutually exclusive.  Your ophthalmologist can accurately diagnose astigmatism and offer treatment recommendations.

In keeping with a concise entry, the following is a list of some tasks I accomplished today. You can decide which ones are reasonable or outright ludicrous:

• Emptied my garbage can into the dumpster: a patient threw a banana peel and apple core in it at 9am–I did not want my exam room to smell like banana the entire day
• Checked my patient’s vision, dilated, them, and filled out a driver’s license renewal form.
• Refused to fill out a disability application for a free Metrocard on an otherwise healthy 33 year-old guy who supposedly had a back injury before he moved to this country. He also had 20/15 acuity.
• Called a primary care physician’s office for records.
• Faxed physical exam requisitions to physician’s office.
• Cleaned the computer keyboard with alcohol swabs.
• Faxed forms to schedule my surgical cases.
• Asked surgical scheduler why he did not fax my surgical cases.
• Spent 2 hrs entering clinic notes on our broken EHR.
• Glared at technician who bypassed my exam lane 3 times while attempting to “find” me to place a patient chart. I was the only physician examining patients in the entire hallway of lanes.
• Called patient to remind her for surgery for tomorrow.
• Performed forced ductions on a STAT 9pm consult in the operating room for someone s/p orbital floor fracture repair. ENT had already closed up the incisions.

2006: OD: -1.00 -1.50 x 080 OS: -7.00 -0.50 x 040

2007: OD: -1.25 -1.00 x 099 OS: -8.50 +1.00 x 160

2008: OD: -1.00 – 0.75 x 095 OS: -7.50 – 1.00 x 060

Even at first glance, there are multiple inconsistencies in these notes. The refractions came from a large academic practice, and the 2006 and 2007 refractions even came from the same optometrist. The patient had never undergone any eye surgeries, but was an elderly person.

Why the hell was the OS examination from 2007 written in plus cylinder notation? The conversion doesn’t even match up with either of the other two exams. If you look only at the right eye, the axis changed every year, as did the cylindrical power. As far as I understand, there are published tables on the tolerated range of axes for a given astigmatic correction. A correction of 1D with an axis fluctuation of up to 19-degrees (80 to 99) does not seem tolerable.

Unfortunately, I don’t have the acuity for each refraction to verify the results.

Due to legal pressures, I was forced to remove it online. This is unfortunate, because there are no other freely available, web-based calculators. Granted, most modern A-scan devices have these formulas built into them, but there is something to be said for crunching a few calculations without hunting down the scanner in the building. Too bad.

A few issues to note when repairing corneal lacerations with foreign bodies:

• Make note of the direction of entrance. In some instances, it is easier to remove the foreign body from the direct it enters the globe.
• Composition of foreign body. If plant matter is involved, think of Bacillus cereus. You’d want to cover this organism with the appropriate antibiotics.
• Do not inject gentamicin intracamerally. You will kill the retina if anything greater than 100-ug goes intraocular.
• Make note of the tension of the sutures passed. At times it is tempting to tighten the knots as much as possible, but that is often unnecessary. You just want a water-tight seal without inducing too much astigmatism.