The Lens Pod

In this week’s issue

• Subconjunctival steroid injection may be a useful alternative to topical steroids after cataract surgery 

• Older adults with visual impairments are more likely to be unfamiliar with the technology needed to access telemedicine 

• Glaucoma patients with more systemic comorbidities may be less likely to adhere to their topical medication regimen 

• Phase II trial for LHON found no significant changes in BCVA after topical elamipretide, post-hoc analysis showed improvements in central visual field.

• Single-nucleotide and rare coding variants in over 30 genes were associated with primary angle-closure (PAC) disease.

• Higher IOP variability and range is associated with faster rate of GCC thinning, suggesting that IOP variations may independently cause macular changes.

• Higher levels of saccharin were found in well-controlled AMD patients compared to those with chronically active choroidal neovascularization (CNV).

In this episode Dr. Kevin Schnieder, a resident at the University of Wisconsin Madison, walks us through what you need to know about orbital fracture as a medical student or resident on call. There are many great pearls for medical students who are starting to think about ophthalmology rotations, who have their first call shift coming up, or want to impress during their away rotations.

1:00- What is an orbital fracture?

1:40- How do people develop orbital fractures?

2:30- History & work-up

6:35- Imaging

11:20-Operative Management

16:50- Lid lacerations 

In this week's issue:

• Learn about the geographic distribution of oculofacial plastic surgeons and its correlation to socioeconomic demographics in the United States.
• A case series of patients with Pseudomonas aeruginosa keratitis shows increasing resistance and virulence and suggests a novel new therapeutic approach.
• A new model predicts axial length in children after bilateral cataract surgery to customize intraocular lens selection for the best visual outcomes.
• Proteomic profiles of aqueous fluid in those with diabetic retinal disease show signs of inflammation and neuronal dysfunction prior to clinical findings of retinopathy.

In this week’s issue

• Canalicular dexamethasone inserts may eventually become an option for lasting relief from inflammatory dry eyes

• Water-free formulations of cyclosporine are effective in treating inflammatory dry eye, but future studies comparing water-free to standard formulations will show if these changes lead to greater efficacy for this hydrophobic molecule

• Preoperative chlorhexidine reduces ocular surface bacterial load to a greater extent than povidone iodine - and is better tolerated

In this week’s issue

• Topical polihexanide (PHMB) 0.08% monotherapy shown to be an effective treatment for Acanthamoeba keratitis 

• Acetylcholinesterase-inhibitors may decrease risk of developing age-related macular degeneration

• Artificial intelligence deep learning algorithms accurately screen for diabetic retinopathy using fundus imaging with high sensitivity and specificity

• Obscurin, an abundant cytoskeletal protein, may be critical to maintaining extraocular muscle function

In this week’s issue

• There is no statistically significant increase in the risk of retinal artery and vein occlusions after COVID infection or vaccination

• COVID vaccination was found to have no statistically significant association with corneal transplant rejection

• Point of care ultrasound and OCT may prove useful in early screening of papilledema in children

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This episode we speak with Dr. Narmien Murdock about everything you need to know before your first away rotation. The beginning of the episode focuses on tips for being successful as a rotating student. At timestamp 39:30, logistics regarding the away application process are reviewed.

Quick tips:

- be on time

- say "yes"

- do not be afraid to ask how you can best fit in the flow of clinic

- be willing to learn

- send thank you emails/notes

- request feedback for presentations/assignments

In this episode, we finish our conversation with Dr. Al-khersan by asking him to help us learn indirect ophthalmoscopy and how to use a 90D lens.

In this episode Dr. Kevin Schneider, a resident at University of Wisconsin, walks us through Thyroid Eye Disease. There are many great pearls for medical students who are rotating in oculoplastics clinics or preparing for ophthalmology rotations in general!

Time Stamps:

1:25: Presenting symptoms of TED

2:59: Physical exam

6:39: Clinical scoring systems

7:50: Oculoplastic-specific exam 

13:50: Labs? 

15:45: Imaging? 

18:30: Course of TED

20:38: Counseling patients with TED

23:30: Surgical intervention

32:30: BCSC rapid fire

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.

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/

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 

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

In episode 0 of season 1 of The Lens Pod, we introduce the podcast hosts - Chris Le, Anne Xuan-Lan Nguyen, Sunil Ruparelia, and Emily Xu - and discuss the goals of the podcast, and give a peak behind the scenes and some things to look forward to with the rest of our inaugural season.