u/MyCallBag

Hi All,

Here is a quick and simple smartphone fundoscopy tip:
https://www.instagram.com/p/DcI328CiF2s/

The concept: always brace the phone on your body (vs floating the phone over the 20 diopter lens). Its similar to bracing against the patient's face during intra-ocular surgery.

Its easier to get the fundus in focus, and use the phone's controls.

Hope someone finds this helpful. Please share your tips!

Hi all,

I feel like ophthalmology is this repetitive, mellow field punctuated by the zets when you look at a post-op day one and they have a retained lens fragment or you're doing a phaco and you suddenly notice there's a tear in the capsule.

The 'zets' is like that sinking feeling in your gut that hits you when something terrible and unexpected happens. Like that unexpected 'oh shit' feeling that hits you out of nowhere.

Do you guys feel this way? Am I alone in this feeling about our profession? What are your "zets" moments?

Hi All,

I am a cataract specialist and amateur app/web developer. I just updated my practice's website to try to better explain to my patients their various options.

https://ullmaneye.com/premiumlens.html

Every surgeon/practice has a different philosophy and armamentarium of IOL's to choice from so my site not be applicable to you. But I thought it was worth sharing. My goal was just to simplify the options into a chart, but also allow users to scroll down to get some more information (without getting into the weeds, that's really for the consultation anyway).

Please let me know what you think and if you have suggestions to improve clarity.

If any of you have summary pages or tables that you found helpful, please share them. I’d like to try to learn from what other people are doing or found helpful.

*edit* things I’m going to change as a result of this thread:
- section on Monovision
- add section at type goes into monofocal details

*edit #2*
- added the monofocal section (need to work on graphics but don't have a video for it)
- added sentence of the table:
The table below assumes you want your eyes set for distance; for some patients a degree of nearsightedness may be ideal — or, for select patients, monovision.

Going to play around with other suggestions, thank you all for taking a look at it!

What do you all think of the idea to make Siri's response match the volume of the question you ask it?

Right now I'll sometimes speak softly or louder and the volume of the response is so jarring. I feel like a simple improvement would be to have it match the volume of the user like a real person.

Our ASC just adopted HST Pathways for their EMR.
Previously we were on paper and turnaround was pretty quick.
Now it seems like nurse and doctors are spending hours checking boxes.
Does anyone actually have a good experience with this EMR? Is there hope for efficiency with this thing?

This just walked into my clinic.

No pain, referred for 'corneal thinning'.

History of RA, just started Rituxan. What would you do?

Taken with My Call Bag

Hi,

I am a cataract surgeon and amateur app developer.

I just released a free tool to simulate create a capulorrhexis (important step in cataract surgery).

Initially I designed it for beginning cataract surgeons, but I've added a feature to simulate the effect of various intra-ocular lenses and even illustrate what femtosecond and Zepto capsulotomies look like.

Here is a video of it in action: https://www.instagram.com/reel/DZmuV4TiMkY/?utm_source=ig_web_copy_link&igsh=NTc4MTIwNjQ2YQ==

Because its really geared towards trainees and patients might be find it interesting, I made that part of the app totally free (no ads, no signup, no data tracking). You can download it here: https://apps.apple.com/us/app/ophthalmology-optometry-app/id6471442410

Thanks for letting me share and I hope you find it interesting!

Hi All,

I just released a capsulorrhexis simulator/game for free. No ads, no data tracking, and no trial necessary.

https://www.instagram.com/p/DZcljuViStA/

Obviously a simulator on a iPhone or iPad is EXTREMELY limited. But it lets you see the effect various intra-lenticular pressure and dilation. It also lets you simulate the Little maneuver.

Might also be cool to show patients the various cataract severity levels.

Really more of a fun game for me to make. Trying to get the physics to feel real. Please let me know what you think!

Michael

Just curious what everyone's experience has been with the new intra-vitreal injections for GA.

I haven't had 1 patient say they really notice a difference. It reminds me of the 'slightly better than nothing' iStent effect.

Have any of you all had patient's that were actually happy with their results? Like at least felt like it slowed down progression?

Can someone explain to me what is causing eye care providers to use Tobradex for dry eye syndrome?

It's infuriating to me.

These patients are pre-disposed to recurrent erosions and abrasions. I can't think of a worse idea. Lets irritate the eyes with tobramycin and try to grow an atypical infection with a steroid.

Sorry for the soap box post. Just saw a corneal ulcer patients with this history. Painful.

Hi All,

About slit lamp photography and how would it would be cool to be able to really capture the depth of pathology using stereoscopic techniques.

Basically taking a photo through each ocular and combining them into:
- wigglegram
- crosseye streogram or VR headset composite image (if you can trick your eyes into seeing this, its pretty cool)
- 3d glasses anaglyph

Wigglegram

crosseye streogram

focus in front of screen to create 3d effect

anaglyph for 3d glasses

Any thoughts?

I think its kind of a cool experiment.

Hi All,

Just wanted to share some tips for smartphone slit lamp photos. Curious to hear if anyone else has some tips on getting good photos. Here is a video breakdown too:

https://www.instagram.com/p/DYNot92iuEB

1. Turn on the Room Lights

I've found the sensor can have a hard time adjusting exposure as the oculars come in and out of focus. Turning the room lights on seems to improve this for me.

*Edit* TheGhostOfBobStoops suggested turning the lights off and lowering the slit beam to the lowest brightness possible. I think this sounds like a great alternative (basically both techniques are trying to minimize the difference in brightness between the slit lamp beam and ambient brightness.

u/dilateddrama suggested lumination system on the extreme temporal side to minimize the corneal reflection

2. Use a Diffuser

If you just want to take a quick image to follow lets say the size of an ulcer, using the diffuser can really help. You can also use scotch tape in a pinch.

*Edit* BigJarsh91 suggested taking out the plastic mirror in the slit lamp and flipping it around can also create an impromptu diffuser.

3. Brace with your 2nd Hand

I see some people press the phone directly onto the oculars. I've found bracing the phone with your 2nd hand maybe an inch away from the oculars is easier.

4. Lock the Main Camera

Probably the biggest problem people have is not locking the camera. I've seen people tap the 'flower' button to lock the macro mode into place. But ideally you want to lock the main camera. You don't need the macro sensor if photographing through the ocular, you just don't want the phone switching between cameras as the oculars go in and out of focus.

5. Use Burst Mode

You want to take a burst of photos. In a pinch you can also record with video and grab screenshot. Both are much easier than just taking a single photo.

6. Crop the Photo

I find it looks much better if you crop out the content outside the oculars.

What do you all do when taking photos? Any good tips I missed?

After playing around with some IOL calculator stuff, I just came to really appreciate just how incredible the ESCRS IOL Calculator really is.

They put out this calculator total for free, not restricted to ESCRS members, and doesn't have any annoying advertisements.

Can we all just take a second recognize how awesome that is? Also Barrett, Hill, and the rest of these IOL guru's that just put this stuff out there. Incredible.