The Lens Pod

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In this week's issue we discuss COVID19 and noninfectious uveitis, topical atropine in myopia, aqueous humor biopsy for retinoblastoma, and next gen sequencing of vitreous samples for vitreoretinal lymphoma.

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This week, we discuss:

• In patients with Fuch’s dystrophy, DSAEK + phacoemulsification achieved the best visual acuity 2 years post-op and lower rates of graft failure than DMEK or DSAEK alone.
• With increasing rates of hospitalizations related to syphilitic uveitis, this condition should not be forgotten on a differential for intra-ocular pathology.
• A new meta-analysis shows evidence that propranolol may be a good option for both prevention and treatment of ROP.
• While vitreoretinal lymphoma is a challenging diagnosis to make, attention to anterior chamber findings such as specific characteristics of keratic precipitates may help cinch the diagnosis.

Too busy to read The Lens? Listen to our weekly summary here!

In this week’s issue

• Neuro-ophthalmologists are in high demand, with 61% of consultations being called for acute life- or vision-threatening diseases.

• Microshunt implant success can be attributed to many factors including the use of intraoperative mitomycin C.

• IL-11 may play a helpful role in accelerating cornea wound healing and decreasing ocular surface inflammation.

• Virtual reality video-game based technology can be as effective as conventional visual field testing for pediatric glaucoma patients.

In this week’s issue: 

• Volume staging for uveal melanoma shows improved prognostication measures than current staging
• Longitudinal changes in the anterior segment may impact the iridocorneal angle in patients with prior LPI for angle closure
• Even mild visual impairment is associated with increased fall risk, as found in a Singapore epidemiological study
• A new homoplasmic variant in the ND5 gene was associated with a Leber hereditaryroptic neuropathy-like phenotype in a Slovenian three-generation family

In this episode we walk through a case of diabetic retinopathy (DR) with Dr. Al-khersan. This episode focuses less on the granular details of grading DR and more on how to interpret relevant information from a diabetic eye exam. 

Learning points from this episode:

Common causes for decreased vision in diabetes

• Vitreous hemorrhage

• Macular Edema

• Cataracts 

• Tractional Retinal Detachment

Common causes of decreased vision in ANYONE

• Misplaced glasses?

• Presbyopia

A framework for taking a solid ocular history for EVERY patient

• HPI, “what brings you in today?”

• Past Medical History

• Medications

• Drops, if using, frequency, which eye

• Past Ocular History

• Past Ocular Surgical History

• Allergies to drops

• Glasses Rx

Follow-up questions for the patient:

• Previous intravitreal injections (anti-VEGF, steroids)? 

• Have they been hospitalized

• Recent HbA1C, or common at home glucose readings

Ocular Vitals:

• External (bruising, BCC, lesions, proptosis, ptosis)

• Visual acuity, best corrected

• Pupils

• IOP

• EOM

• Confrontational VF

Slit Lamp findings associated with diabetes

• Rubeosis iridis 

• Hyphema

• Cataracts 

• Retinal Hemorrhage

• Vitreous Hemorrhage 

Imaging modalities 

• OCT

• Fluorescein Angiography 

The Lens Pod is a podcast intended for educational uses only and reflects the opinions of the hosts and guests.

In this week’s issue

• Mitomycin C during dacryocystorhinostomy may improve anatomic outcomes with less clear evidence for improved functional success

• Case series suggests the incidence of severe neutropenia after intra-arterial chemotherapy may be higher than previously reported

• For primary open-angle glaucoma, RNFL thickness measured by OCT may have lower diagnostic accuracy in eyes of African compared to European descent. 

• RPE culture volumes were found to influence RPE physiology and should be optimized for future in vitro studies

Too busy to read The Lens? Listen to our weekly summary here! We This week we discuss: Non-glaucomatous optic nerve atrophy and high myopia, signs and symptoms of dry eye, low level light therapy for post-op dry eye, fruits/vegetables and cataract prevention.

Too busy to read The Lens? Listen to our weekly summary here! In this week's episode, we discuss:

• Risk factors for visual impairment include older age, smoking, geographic location in the South or West regions of the U.S. with minority groups being disproportionately more affected.
• Female representation amongst U.S. ophthalmology faculty has improved, but representation of underrepresented groups has not changed significantly over time.
• Inter-day variation of tear fluid may serve as a disease biomarker, and many proteins in tear fluid serve functions in immune response and metabolism.

In this week’s issue

• Steroid and TNFα inhibitor treatments for uveitis may increase the risk of COVID-19 infection

• In a cross sectional survey of US adolescents, 25% had no vision testing within the past year

• Senile sclerotic optic disc damage had less visual field and optic disc progression compared with other forms of disc damage.

• Treatment with Tepezza significantly reduced EOM cross-sectional area in patients with thyroid eye disease

In this week's issue:

• Demographic and socioeconomic factors are associated with diagnosis and treatment outcomes of strabismus in children.
• An Aspergillus-specific lateral-flow device combined with ratiometric analysis diagnosed Aspergillus-induced fungal keratitis with high accuracy.
• A survey study finds that children who are unable to afford medical care and have public health insurance are most likely to have vision difficulty.
• In Stargardt disease (ABCA4 retinopathy), a specific genetic variant exhibits milder symptoms, better vision, and primary RPE damage.

In this week’s issue: 

• A retrospective study demonstrates that adverse SDoH are associated with decreased eye care utilization in patients with diabetic retinopathy.

• Gender bias did not appear to affect 2 ACGME ophthalmology milestones at time of residency graduation, although midyear differences existed. 

• COVID-19 vaccination may be associated with non-infectious uveitis in particular subgroups of patients.

• Postoperative endophthalmitis is a rare complication of intraocular surgery and incidence varies depending on the procedure performed. 

• Use of a 3D head-mounted digital visualization platform appears to be relatively safe and easily adaptable for cataract surgery.

Too busy to read the Lens? Listen to our weekly summary here! In this week’s episode we discuss…

• A retrospective study identifies risk factors related to decreased visual outcomes due to cystoid macular edema development post-cataract surgery. 

• Smartphone exophthalmometry can be used to accurately and precisely measure eyeball protrusion. 

• Ocular and facial Demodex overgrowth often co-occur and treatment with topical ivermectin for facial mites results in greater ocular eradication.

• A recent study describes oculocutaneous albinism genotypes and phenotype correlations in a cohort in France.

Too busy to read The Lens? Listen to our weekly summary here! In this week's episode, we discuss:

• A retrospective study reveals incidence and risk factors for endophthalmitis following glaucoma surgeries among Medicare patients.
• Dual use of e-cigarettes and cigarettes is associated with increased and more severe ocular symptoms in young users.
• Morning blood pressure surge may be an independent risk factor of increased visual field progression in normal tension glaucoma patients.

Too busy to read the Lens? Listen to our weekly summary here!

In this week’s issue: 

• Use of antihypertensive medications may increase risk of glaucoma and affect IOP. 

• Calcium channel blockers are associated with decreased inner retinal layer thickness on OCT and increased risk of glaucoma.

• A cohort study from Korea finds fibromyalgia patients at increased risk for optic neuritis.  

• Immune cell populations of patients with dry eye disease have increased T-helper cells associated with more severe signs and symptoms.

In this week’s issue: 

• Segmental proton beam radiation therapy proves to be an effective and safe treatment for iris melanoma.

• E-cigarette and cigarette users experience significantly greater severity and frequency of ocular symptoms than those who do not use these products.

• Corneal sensitivity testing may prove to be an effective proxy for screening of proliferative diabetic retinopathy.

• Early use of immunosuppressive therapy in the treatment of peripheral ulcerative keratitis in patients with rheumatoid arthritis demonstrates better inflammatory control, decreased recurrence, and improved visual outcomes.

In this week’s issue: 

• The leading causes of childhood blindness include retinopathy of prematurity (31.3%), nystagmus (8.1%), cataract (6.7%), and optic nerve atrophy (6.5%).

• Adjustable-focus spectacles are useful in under-resourced areas but may not be optimal for younger children and those with astigmatism.

• Choice of amniotic membrane may have little effect on visual acuity, but corneal surface amniotic membrane transplant could portend an increased risk for symblepharon formation. 

Too busy to read the Lens? Listen to our weekly summary here!

“Too busy to read the Lens? Listen to our weekly summary here! In this week’s episode we discuss…

• Blindness from trachomatous-induced corneal opacities increases with age and female sex, with significantly higher rates in the African regions.

• Climate conscious conferences: The 2019 in-person AAO meeting produced significantly more metric tons of CO2 per person than the 2020 virtual meeting. 

• A new study found that chloroquine-induced retinopathy is likely due to impaired ability of lysosome fusion with new endosomes, indicating a defect in lysosome reformation.

Too busy to read the Lens? Listen to our weekly summary here!

This week we discuss:

• (TW: suicide) A study on suicide risk after receiving a vision threatening diagnosis. 

• Anti-VEGF dose adjustments for neovascular AMD

• Fundus imaging and gold standard scleral depressed examination when looking for horseshoe tears. 

• An intraoperative dose of intravitreal bevacizumab following trabeculectomy with MMC and surgical outcomes.

This month we spoke with Dr. Jessica Randolph, Assistant Professor of Ophthalmology at Virginia Commonwealth University about Diversity, Equity, and Inclusion (DEI) in ophthalmology and how medical students can get involved.

Time Stamps:

7:00- Definitions; why DEI in ophthalmology important

20:30- Socioeconomic status and opportunities; Affirmative Action

27:27- Implications for patient care

34:10- Implicit Bias

43:42- Pipeline Programs for Underrepresented Students

Minority Ophthalmology Mentoring Program: https://www.aao.org/minority-mentoring

Rabb-Venable Excellence in Ophthalmology Program: https://www.rabbvenable.com/

Too busy to read The Lens? Listen to our weekly summary here! In this week's episode, we discuss:

• An extended 14-year randomized control trial demonstrated that laser peripheral iridotomy can aid in preventing progression to primary angle-closure glaucoma.
• Despite some improvement in the newer versions of artificial intelligence chatbots, their ability to generate scientific abstracts remains severely limited.
• Results from a retrospective cohort study reveals effects of intentionally halting anti-VEGF injections in patients with advanced neovascular AMD.
• CD63/81+ small extracellular vesicles are enriched in aqueous humor in eyes with retinoblastoma before treatment and in those with more significant tumor burden, suggesting that they are tumor-derived.

Too busy to read The Lens? Listen to our weekly summary here! In this week's episode:

• A retrospective study reveals demographic risk factors for open globe injuries requiring repairs and poorer visual outcomes.
• Mapping of access to laser eye surgery in 5 Midwest states did not reveal shorter travel times despite expansion of surgical privileges to optometrists.
• Twice-daily pilocarpine for presbyopia treatment showed greater improvements in distance-corrected near visual acuity compared to once-daily dosing
• Inhibition of CD11b, a component of the complement system, may provide a neuroprotective effect in optic nerve injury.
  

Too busy to read the Lens? Listen to our weekly summary here!

In these week issue:

A port delivery system with ranibizumab shows non-inferiority compared to monthly ranibizumab injections

Treatment with low dose atropine nightly for two years shows no difference in spherical equivalent or axial length compared to placebo

A new mobility outcome (MOST, MObility Standardized Test) is validated in measuring disease progression in patients with retinitis pigmentosa

In a mouse model of traumatic optic neuropathy, CD11b is significantly elevated in microglia near the site of injury

In this week’s issue: 

• Newly diagnosed glaucoma led to a higher risk of development of dementia, particularly in older adults and those with good visual acuity. 

• Pediatric lensectomy and intraocular lens implantation is associated with visual axis opacification, although risk of VAO was not impacted by age at time of surgery or IOL location. 

• New study reveals risk factors for cataract development after non-infectious anterior uveitis.

• Although rare, local recurrence of uveal melanoma is associated with greater mortality, particularly of smaller tumors as compared to larger tumors.

Too busy to read The Lens? Listen to our weekly summary here!

In this week's episode, we discuss:

• The new Assessment of IntraOcular Lens Implant Symptoms questionnaire was shown to effectively evaluate visual symptoms and satisfaction in patients receiving IOLs. 
• Demographics and social factors are associated with disease severity of microbial keratitis.
• A new study shows four-point flange intrascleral fixation as a promising technique for plate-haptic trifocal IOL dislocations.
• Investigating the role of RNA editing on keratins in keratoconus 

Too busy to read the Lens? Listen to our weekly summary here! In this week’s episode we discuss:

• In the MERIT trial, dexamethasone was superior to methotrexate and ranibizumab in treating persistent or recurrent uveitic macular edema 

• Telemedicine for eye disease detection in michigan identified higher rates of pathology in low-income community clinics compared to national disease prevalence rates

• A small cohort of keratoconus patients with successful repeat corneal collagen cross-linking (CXL) suggests repeat CXL may a be safe and effective option for progressive disease

This month we spoke with Dr. Jacquelyn O’Banion, MD, MSc, director of Emory Eye Center's Global Ophthalmology-Emory program (GO-Emory), about global ophthalmology and how medical students can get involved.

Time Stamps:

0:56- Defining global ophthalmology

6:40- Looking for a residency program with global ophthalmology? Ask follow-up questions!

10:30- What is “sustainable global ophthalmology?”

19:00- A lost skill and its relevance to global work

25:00- How foreign strategy can inspire domestic change

29:25- Did you know you could do a global ophthalmology fellowship? Explained here!

34:05- Dr. O’Banion’s advice for medical students looking to get involved in global ophthalmology

40:30- An AAO resource dedicated to looping trainees into global ophthalmology opportunities 

Too busy to read the Lens? Listen to our weekly summary here! In this week’s episode we discuss:

• A clinical trial investigates combination therapy with a new anti-VEGF agent, OPT-302, for the treatment of neovascular AMD.

• Artificial intelligence can be used to help predict best-corrected visual acuity in patients with diabetic macular edema.

• There is an increased incidence of Demodex blepharitis in post-operative cataract surgery patients.

• A mouse-model study identified sortilin as a potential pharmacologic target for the treatment of diabetic retinopathy.

Too busy to read The Lens? Listen to our weekly summary here!

In this week’s issue: 

• Low-fat dietary modification may increase risk of POAG in certain patient populations.

• A longitudinal, population-based analysis of patients with type 2 diabetes examines the systemic safety profile of intravitreal anti-VEGF injections.

• Early detection of abnormal corneal and lens densitometry emerges as a potential marker for diabetic keratopathy. 

• A retrospective study from India shows the benefits of medical therapy alone when managing multi-drug resistant keratitis. 

Too busy to read The Lens? Listen to our weekly summary here! In this week's episode:

• Age-related macular degeneration is associated increased risk of depression in a longitudinal study of patients from a Korean database 
• Exploratory analysis of ophthalmology literature attempts to make sense of productivity and citation metrics in ophthalmology research
• A sutureless ptosis repair surgery shows promising results in terms of eyelid elevation, symmetry, and complication rate
• The hypoxia-inducible factor 1-alpha transcription factor emerges as a potential therapeutic target for autoimmune uveitis

Too busy to read the Lens? Listen to our weekly summary here! In this week’s episode we discuss…

• Early treatment with steroids for MOG-related optic neuritis showed improved visual outcome in a retrospective study.

• African-American or Hispanic patients were more likely to be discharged home after hospitalization for ocular firearm injuries, while white patients were discharged to rehab or advanced care facilities.

• Long-term data from the Early Manifest Glaucoma Trial showed similar visual acuity and visual field data in the treated vs. delayed treatment groups.

• A deep learning model predicts age from fundus images and investigates the association between retinal age gap and mortality risk.

Too busy to read the Lens? Listen to our weekly summary here! In this week’s episode we discuss...

Poverty and its impact on glaucoma screening, cost effectiveness in cataract surgery, long-term immunomodulatory therapy vs. steroid therapy in symptomatic ophthalmia, and carotenoids in mouse models for retinopathy of prematurity.

Too busy to read the Lens? Listen to our weekly summary here!

In this week’s issue: 

• Anti-VEGF treats the retina … and the cornea? A new study suggests intravitreal injections improve ocular surface disease.

• EDI enhanced depth imaging-OCT proves particularly useful for evaluating optic disc drusen to answer the age-old question… is it papilledema or pseudopapilledema?

• Are cataracts after chemotherapy for retinoblastoma foregone conclusion? A recent study investigates

Too busy to read the Lens? Listen to our weekly summary here! In this week’s issue:

• One in eight glaucomatous eyes progresses fast, with progressive central vision loss associated with faster glaucomatous decline.

• Electronic health records and claims data is helpful to study prevalence and patient trends, but accuracy of data can fluctuate depending on the condition. 

• High blood pressure is associated with an increased risk of retinal vascular occlusion. 

• The genetic factor, T-box factor 3, is required for normal mammalian eye formation.

Too busy to read the Lens? Listen to our weekly summary here!

In this week’s issue: 

• Defocus incorporated multiple segments spectacles may slow the rate of myopia progression 

• ChatGPT can’t pass OKAP… yet 

• 5 year data suggest that iStents are safe for the corneal endothelium

This week we speak with Dr. Evan Waxman about community outreach in ophthalmology. Dr. Waxman is a comprehensive ophthalmologist at the University of Pittsburgh. He serves as a professor of Ophthalmology, Vice Chair of Medical & Resident Education, and Director of both the UPMC Eye Center Mercy and the comprehensive ophthalmology division. In this episode he teaches us about the Guerilla Eye Service, a community eye clinic that he founded over 15 years ago, in addition to providing helpful advice for getting involved in community efforts to improve vision health.

In this episode, we speak with Dr. Katherine Hu to learn how medical students and trainees can get involved in ophthalmology advocacy. Dr. Hu attended medical school at Saint Louis University School of Medicine, then completed her ophthalmology residency at the John A. Moran Eye Center at the University of Utah where she is currently completing a cornea fellowship.

Listen now to learn about current legislative policies impacting the field of ophthalmology, improving your confidence in public speaking, and the power of storytelling in advocacy!

Time stamps:

2:00- Check out Moran Eye Center’s “Moran Core” for foundational ophthalmology learning!

3:00- How do physicians, specifically ophthalmologists, contribute to advocacy?

4:00- The optometry scope expansion bill explained.

10:55- An avenue for medical students to get involved in ophthalmology advocacy.

15:00- Public speaking and how to feel more confident.

23:00- Advocacy reimagined.

27:00- The cardinal rule for being involved in advocacy work.

27:45- Believe in the power of your voice– especially as a trainee.

In this episode, we speak with Dr. Ben Szirth, PhD to learn about the utility of teleophthalmology in clinical practice and its relationship to artificial intelligence and community outreach in ophthalmology. Dr. Ben is the director of the TeleHealth Program at the New Jersey Medical School and leads the Vision Threatening Diseases screening community-based program at the Institute of Ophthalmology and Visual Science in Newark, NJ where he works with current medical students every week.

Episode Timestamps

0:20- Introduction

2:18- Learning about EyeNuk, Inc.’s EyeArt® and its ability to screen for vision threatening diseases 

3:24- Another interesting ophthalmology podcast recommendation!

5:40- Explaining how teleophthalmology in partnership with artificial intelligence allows us to bring advanced ocular care to disadvantaged communities

9:17- What is teleophthalmology? – Summarized.

10:00- A novel approach to monitoring Type 1 DM eye disease progression– at Disney World!

12:10- Dr. Ben’s open space model for his Vision Threatening Diseases Screening Program

15:20- Leveraging community leaders and peer advocates to establish and maintain lasting relationships within a community

17:30- Teleophthalmology offers a unique solution to improving access to care

18:31- Artificial intelligence research offers a system to validate the impact of teleophthalmology in ocular health and facilitates funding

22:20- Artificial intelligence and telehealth trend analysis

28:00- The surprising disadvantage of portable screening equipment

31:50- What does artificial intelligence research look like?

35:00- Deep learning explained

40:30- How medical students make a difference in community health

46:00- How teleophthalmology breeds innovation

*No participants of this podcast have any financial disclosures pertaining to research, products, or equipment discussed in this episode.

Description: 

In this episode, we speak with Dr. Jay Sridhar to learn what students should know before (or after) their first research project. Dr. Sridhar is an associate professor of clinical ophthalmology and the assistant residency program director at Bascom Palmer Eye Institute. During this episode he imparts meaningful advice for all students and provides helpful tips for the research beginner.

Episode Goals:

-After this episode, medical students will understand the value of finding the right research mentor.

-After this episode, students will learn the importance of time management, setting expectations early, and having a peer mentor or colleague proofread your work.

-After this episode, students will learn simple questions to consider when preparing to write a manuscript.

Time stamps:

Part I: Intro, Icebreaker, & Life Advice

1:48- Dr. Sridhar’s hang-gliding excursion

4:28- Discussing our inner voice and Dr. Sridhar’s podcast recommendation

6:00- Dr. Sridhar’s non-ophthalmology book recommendations

7:15- Seize the day and the additions of small moments

Part II: The Research Basics

10:20- The value of finding the right research mentor

13:20- Set expectations early, articulate how much time you can give, NEVER ghost

14:40- Early skills that any student can contribute

15:30- Have a peer mentor double check your work BEFORE sending to your PI

17:35- Don’t put all your research eggs in one basket/PI

18:20- Three branches of research: basic science, translational, clinical

20:55- Authorship order

Part III: Navigating your First Project

22:35- Start with one project

24:40- Sending a “cold” email of interest to a potential PI

26:00- Case reports

26:38- What’s my target journal?

29:05- What’s my backup plan

Part IV: Research as it applies to my residency application

31:28- How many publications do I need to be a competitive ophthalmology applicant?

34:00- Don’t participate in research at the expense of other medical student responsibilities

37:20- “Good medical students = good residents”

40:13- Helpful tips

46:00- Parting advice

Episode 9: Introduction to Ocular Oncology

Description:

In this episode, we speak with Dr. Carol Shields to get a broad overview of ocular oncology. Dr. Shields is Chief of the Ocular Oncology Service at Wills Eye Hospital and Professor of Ophthalmology at Thomas Jefferson University in Philadelphia. She completed her ophthalmology training at Wills Eye and subsequently did fellowship training in ocular oncology, oculoplastic surgery, and ophthalmic pathology.

Episode Goals:

After listening to this episode, medical students should be able to:

● Acquire a general understanding of the breadth of practice for ocular oncology

● Describe the common examination and imaging techniques in ocular oncology

● Describe common pathologies seen and procedures/surgeries performed in ocular oncology

Time Stamps:

Introductions - 0:30

What is ocular oncology? - 2:20

How did you discover ocular oncology?  - 3:30

How can students explore ocular oncology? - 5:00

How do you become an ocular oncologist? - 6:40

Overview of eyelid tumors - 9:05

Overview of conjunctival tumors - 15:05

Overview of conjunctival tumors - 15:05

Overview of orbital tumors - 23:25

Overview of intraocular tumors - 31:06

Additional resources - 42:50

Conclusions - 44:20

Links: https://www.willseye.org/

Description:

This week, we talk about ophthalmology emergencies and ED consults with Dr. Grayson Armstrong from Massachusetts Eye and Ear

Episode goals:

After listening to this episode, listeners should be able to:

• Appreciate the breadth of common ophthalmic emergencies and trauma
  
• Present a basic workup and have a differential for common ophthalmic complaints presenting to the ED
  

Time stamps:

2:30 How common are eye emergencies?

3:45 What are some of your favorite parts of ophthalmology?

4:47 What do you enjoy most about managing eye emergencies?

5:56 Benign and worst case scenario for the AAO’s 6 causes of urgent referral for ophthalmology

9:23 Red flags and what information you should always get when evaluating a patient

12:39 The outside-in approach for working up ocular trauma patients

14:10 Lid lacs at the medical student level

15:52 Exam techniques when working up vision loss

17:47 Painful vision loss differential and assessment

20:20 Orbital compartment syndrome tidbits

22:00 Painless vision loss

24:45 Red eye

28:36 Takeaways and tips for eye ED consults

Links:

Tim Root’s website - https://timroot.com/

AAO medical student website - https://www.aao.org/medical-students

AAO White Paper for things medical students should know - https://www.aao.org/Assets/edca7d7c-ccb0-4b97-bca4-66b4328a91fc/637157338302800000/appendix-of-ms-white-paper-with-links-pdf?inline=1

Video of cell and flare - https://timroot.com/cell-and-flare-in-the-eye-video/

Ophthalmic Edge Acronym app (great resource for rotations!!)- https://ophthalmicedge.org/physician/ophthalmic-acronyms-app-available-now/#

Eye Tea Official Twitter - https://twitter.com/eyeteaofficial?lang=en