Blind Spot - The Eye Doctor's Podcast

The traditional paradigm is that when a patient presents with acute angle closure due to pupil block, a peripheral iridotomy (PI) must be performed immediately. But in reality, is this always the best approach? Is it safe to treat medically for a period of time before the PI? In which situations might a PI actually exacerbate the acute angle closure? Dr. Ike Ahmed joins the podcast.

We all know that keratoconus is very highly associated with eye rubbing. But in general, the widely held belief has been that keratoconus is just associated with eye rubbing, one of multiple factors that leads to the condition. But have we gotten it wrong? Is eye rubbing not merely associated with keratoconus, but actually the sole causative factor of keratoconus? Has there been a huge blind spot in our basic understanding of keratoconus development and progression? Dr. Damien Gatinel joins the podcast.

Acetazolamide is a common and important medication used in ophthalmology. It is used as a treatment for both high intraocular pressure and high intracranial pressure. Yet despite its many uses, many ophthalmologists feel nervous when prescribing it due its potential side effects and the concern of sulfa allergy. And while caution is always a good thing, have we perhaps overstated the risks with acetazolamide to such a point that we don’t use it enough? What exactly is sulfa allergy, and does it even apply to acetazolamide? And how dangerous is acetazolamide, and how should we be counseling patients when prescribing it? Dr. Deborah Friedman joins the podcast.

Learn more about Dr. Friedman at www.neuroeyes.com

A central retinal artery occlusion is arguably one of the worst ocular events that can occur, given its extremely poor visual prognosis. As such, our efforts to find an effective treatment for CRAO have been extensive, but in many regards, inadequate. There are certain treatment options that we all learn in residency to try and halt a CRAO, but for the most part, many of these techniques are fairly unproven and don’t work so well. So what does actually work? And is the evidence for TPA strong enough that we should be routinely recommending it in appropriate cases? Dr. Rishi Gupta joins the podcast.

Learn more about Dr. Gupta at https://rishiguptamd.com/about/

Learn more about Dr. Gupta's books at https://rishiguptamd.com/textbooks/

Over the past two decades, Botox and Fillers have changed the landscape of cosmetic plastic surgery, including the field of oculoplastics. But how exactly to Botox and Fillers work, and more importantly, how should patients be counseled on these elective treatments? And from a philosophical standpoint, has the world of cosmetic surgery gone too far in 'de-aging' the population and perhaps further stigmatizing the natural process of getting older? Oculoplastics specialist Dr. Harmeet Gill joins the podcast.

Blepharitis is a common diagnosis, but it’s also an umbrella term that encompasses many different clinical disorders which require varying treatment approaches. Many patients struggle with chronic blepharitis, where it’s tough to find an effective treatment. So what exactly is the best approach to blepharitis? How does one differentiate staph blepharitis from demodex? What are the most effective treatments on the market? And from a preventative standpoint, what exactly is lid hygiene, and is it something we should routinely be recommending to our patients? Dr. Ashley Brissette joins the podcast.

Check out Dr. Brissette's Eye Care Products
www.dailypractice.com

Follow Dr. Brissette on Social Media
Instagram @abrissettemd
TikTok @abrissettemd

Flashes and floaters is one of the most common presenting complaints to eye care professionals. And while most of us understand the general pathophysiology of the vitreous separating from the retina, some of the nuances may not be as clear. Why do flashes and floaters persist so differently in patients? Why do flashes and floaters continue even after a vitrectomy? How common are retinal tears when one experiences new symptoms? And how, ultimately, should this affect our guidelines for monitoring patients who have new flashes and floaters? Dr. Efrem Mandelcorn joins the podcast.

This episode is sponsored by Canadian Eye Care Today. Access the journal at https://canadianeyecaretoday.com

Viral conjunctivitis is one of the most common presentations to eye care professionals. It’s typically easy to diagnose, and traditionally, the treatment has simply been cool compresses and observation. But have we been too lax in our treatment of viral conjunctivitis? What, if any, are the roles of steroids, iodine, and antivirals in the treatment of this common condition? Dr. Francis Mah joins the podcast.

Over the past twenty-five years, LASIK has become one of the most commonly performed ocular procedures. As refractive surgery has become more popular in general, LASIK still remains the mainstay option in younger non-presbyopic populations. Whereas eye care professionals used to be more hesitant about recommending LASIK, the sentiment has largely shifted. But how safe is LASIK and other refractive surgeries? With it becoming so common, have we perhaps overlooked some of the shortcomings of LASIK? Or alternatively, is the boom in refractive surgery justified and actually an important part of the progression of ophthalmology? Dr. Guy Kezirian, Founder of the Refractive Surgery Alliance, joins the podcast.

Lipiflow and IPL have become mainstays in the treatment of meibomian gland disease. But while they might be effective in some cases, they are also quite expensive to patients. Which begs the question – how effective are lipiflow and IPL when compared to more conventional treatments? Is there a way to predict which patients will benefit most from these treatments? Ultimately, how should Lipiflow and IPL factor into the treatment algorithm for meibomian gland disease in a way that is clinically advantageous while also cost-sensitive to the patient? Dr. Ashley Brissette joins the podcast.

Check out Dr. Brissette's Eye Care Products
www.dailypractice.com

Follow Dr. Brissette on Social Media
Instagram @abrissettemd
TikTok @abrissettemd

Femtosecond Laser Assisted Cataract Surgery (FLACS) has been around for over a decade, yet there isn’t necessarily consensus amongst the eye care community as to how this technology should be implemented within cataract surgery. Some advocate strongly for FLACS, citing greater reliability and precision than traditional cataract surgery. Others have argued, however, that even if the femtosecond technology has improved accuracy, this doesn’t necessarily mean that it translates to better cataract surgery results. Dr. Eric Donnenfeld joins the podcast.

It is not uncommon for parents to come into the pediatric ophthalmology clinic with concerns that their child is myopic. For many of us, especially in years past, we might have said ‘Don’t worry about it. There’s not too much we can do anyway.’ But as the rates of myopia have continued to increase over the last several decades, more attention has been given to this topic. Some have even referred to a ‘myopia epidemic’ that has developed. So why is this important, if at all? Should we be concerned about the rising rates of myopia? What is causing this? And ultimately, should our concern level be high enough to warrant starting treatment in some of these patients? Dr. Rupa Wong joins the podcast.

Dr. Rupa Wong's Website
www.drrupawong.com/links

In a patient with pseudoexfoliation, there is a heightened chance of zonular laxity that could cause the surgery to be more challenging. While most of us can recite the general tenets of how to manage these cases in theory, it can be much more challenging when dealing with the situation practically. How can we predict pre-operatively whether there will be significant zonulopathy? How might we minimize zonular trauma in such cases of zonulopathy? Dr. Deepak Megur joins the podcast to share pearls regarding preoperative assessment, capsulotomies, hydrodissection, nucleus disassembly, and use of capsular tension rings.

Dr. Deepak Megur's YouTube Channel - https://www.youtube.com/@DrDeepakMegur

Many patients have begun to undergo genetic testing for age-related macular degeneration (AMD) to get a better understanding of their risk profile and possible advice on preventative measures they can take. But what exactly does the research show about the genetics of AMD, and what does genetic testing actually look for? And perhaps most importantly, how, if at all, does an understanding of one’s genetic propensity for AMD, ultimately affect treatment? Dr. Brian Ballios joins the podcast.

Even for the more experienced surgeon, a white cataract likely raises their adrenaline level just a tiny bit. Perhaps the biggest concern is – what if I start operating, and I get the dreaded Argentinian flag sign? Or less dramatic, what if the rhexis starts running out and the case becomes more complicated than expected? The reality is, white cataracts can be tough. But are there certain ways to predict when a white cataract might be more complex? What are some effective techniques that can help us maneuver a challenging capsulorhrexis that seems to want to run out to the zonules? Dr. Brian Kim joins the podcast to share pearls on operating on white cataracts.

Dr. Brian Kim's YouTube Channel
https://www.youtube.com/channel/UCv0ywA2HPDmfHpEkB_02_Tg

When a patient presents to you and you’re concerned about the diagnosis of optic neuritis, it can sometimes feel a bit tricky. On the one hand, the patient’s vision can be quite poor and the systemic implications of such a diagnosis can be quite significant; on the other hand, the teaching for some time has not been so definitive on what, if anything, we should do in the short-term. So what does the current evidence show? What is role for steroids? How urgent is an MRI? How essential is an accurate diagnosis? Neuro-ophthalmologist Dr. Andrew Lee joins the podcast.

Dr. Andrew Lee's YouTube Channel
https://www.youtube.com/channel/UC5HcfsELV0W9AqtvJvpQQSg

A chalazion is typically quite easy to diagnose, and for the most part, we know that it will resolve, either on its own, or with a fairly simple surgery. But for as common as a chalazion is, there isn’t necessarily a uniformly agreed upon approach to this condition. How long does it typically take before one resolves on its own? When is it reasonable to offer surgery? Is it better to wait until the eyelid is less inflamed, or is it OK to proceed with treatment fairly soon if the patient wants it dealt with right away? And while chalazion excision is considered one of the ‘simpler’ surgical techniques in ophthalmology, is that really the case?

Dr. Ric Caesar - http://www.richardcaesar.co.uk

Herpes Zoster Ophthalmicus (HZO) can cause multiple ocular issues, most commonly in the anterior segment. What is the role of long-term antivirals and steroids? Is the potential havoc wreaked by HZO more so related to the virus or the inflammatory cascade it initiates? How long should patients be kept on antivirals? When is it safe to administer the Shingles vaccine? Dr. Clara Chan joins the podcast.

The peripheral iridotomy (PI) is one of the most common procedures in ophthalmology. In theory, the PI is performed to open up a narrow angle, both to prevent the chance of angle closure glaucoma, and to treat any component of chronic angle closure. But what does the evidence actually show? Practically speaking, how effective is the PI in preventing angle closure? What would happen if we were a bit more conservative in when we chose to do PIs? Dr. Davinder Grover joins the podcast.

Dr. Grover's You Tube Channel - https://www.youtube.com/@davindergrovermdmph7981

Dr. Grover's Practice Website - http://www.glaucomaassociates.com/

When a posterior capsule rupture occurs during cataract surgery, the standard teaching is that we do an anterior vitrectomy if the hyaloid face is broken and vitreous comes forward. But why is the anterior vitrectomy so important? Is it always 100% necessary? And what are some tips on performing the anterior vitrectomy as safely and effectively as possible. Dr. Uday Devgan, aka The Cataract Coach, joins the podcast.

Check out The Cataract Coach at https://www.youtube.com/@UdayDevgan