For the entire last year, the only true surgeries that I’ve performed as primary surgeon were pterygia–those bat-winged conjunctival growths on the medial bulbar conjunctiva. I would typically rip the entire bat-wing off with some Westcott scissors and scrape down the cornea with a #57 blade. Most of the time, I used a battery-powered diamond burr to smooth out the cornea–that’s how the wimps do it. Afterward, I transpose a part of the superior bulbar conjunctiva over to cover the exposed wound. It typically took me 30 minutes (on a good day) to finish the case.
In these cases, I never entered the eye (intentionally).
Last week, I performed an anterior capsulotomy on a 10-month old girl. This involved loading up the Accurus vitrectomy surgical system to chew up the phimosis that developed after cataract surgery. This was a relatively simple procedure, involving an anterior chamber maintainer and another 23G port for instrumentation. However, it was my first attempt at intraocular surgery. The feeling is different. When you’re working inside the eye, there is a sense of uncertainty, even when you have direct visualization of your work. The eye is like a ball–you’re working on the inside without opening it up. It was an even stranger feeling to run the vitrectomy system without ever having performed cataract surgery.
Running the vitrector (without having broken a posterior capsule) was a blast. The little pieces of capsule eddied toward the probe head at different rates, depending on how much I depressed the foot pedal. Before I knew it, I had chewed up the phimosis, and the case was completed.
I feel that I have been initiated.
medicine
ophthalmology
On average, I’d say my clinic patients spend at least 3 hours in total at every appointment. Sometimes they are here even longer, if I send them for imaging. Most of the time in the clinic is spent waiting. Additional, many patients arrive at least an hour before their scheduled appointment, adding to the wait.
I try to explain to them that there is no need to arrive so early, especially if the normal wait is already painfully long. Apparently there is a loss of communication. I suspect that there is a rumor among the patients that arriving early at an appointment translates to leaving early. This is as likely to happen as winning at Pai Gao Poker.
I once had a patient who I needed to follow daily for a herpetic corneal ulcer. After four days, he simply stopped showing up. Later, he told me that it was impossible for him to work if he spent hours at the eye clinic daily. Other patients of mine come to clinic ad lib, for prescription refills only. Then there’s the majority of them who sit patiently for 3 hours in the waiting room to be sent to fluorescein angiography for 2 more hours for a proliferative diabetic retinopathy (PDR) workup.
Indeed, to be a clinic patient is to be a special patient.
medicine
medicine
Several months ago, I signed up for TruthOnCall, a new VC company designed to survey physicians on commonly asked questions. As a physician, you can offer to complete surveys via SMS for reimbursement $10 apiece. From a financial standpoint, the deal sounded potentially lucrative, depending on the number of surveys you complete.
Unfortunately, I have yet to receive any surveys in the months that I’ve enrolled. Perhaps they are a front to harvest physician data? Or have they run their fund dry?
In actuality, I think that there is a limited market for ophthalmology-based medical opinions. The service appears to mediate data harvesting. In order for the physician to receive a survey, there much be a client investor on the other end to field medical questions. No funding, no money. Simple as that.
Are there any other physicians out there who have actually received surveys or been paid by TruthOnCall? Let me know!
medicine
medicine
I saw a guy in the clinic several weeks ago who sprayed Hongo Killer in his eye. He had a 100% epithelial defect with descemet’s folds. The cornea was pretty much in endothelial shock, although he was not hypotonous.
I chuckled when he showed me the bottle. I suppose that it was entertaining only because of my limited Spanish knowledge and I had been basking in our underground clinic’s flickering fluorescent lights the entire day.
medicine
medicine, ophthalmology