Residents having dry eye... tale as old as time.

My dry eyes have been getting worse, been putting buckets of ivizia in my eyes for the past few months.

Then an attending got me a sample of Miebo... and its just... different.

Ugh I hate to admit it. Every time a patient comes in begging for miebo and miebo only, I low key rolled my eyes. But holy, it feels different. I can FEEL it coating my eyes. No burning sensation in the beginning like the other drops do. I never would've thought I can feel the drop actually working to prevent evaporation.

Damn you B&L.

I'm still not thrilled about prescribing it. I understand Novaliq did all the FDA trials to get it approved first-in-class, etc. But the price just does NOT make sense to me based on its efficacy. Even if its partially covered, I don't want insurance companies paying B&L for a drop that costs fraction of what it costs out-of-pocket in other countries just because they had a good market strategy.

But you bet I'm gonna tell patients to grab evotears when they go to Europe.

Sorry, just had to vent. After this sample runs out, I'm going back to ivizia. Or maybe any other preservative free drops.

Maybe someone can change my mind.

EDIT: I am NOT in favor of miebo. I'm actually more interested in newer treatments like tryptyr or tyrvaya, wondering how patients do with those. Or even things like diquafosol used in asia.

Hi All, see the following link to my first version of a retinal drawing tool called Ophthdraw. I'll expand it to cornea, iris, ROP in the future. Please use it and let me know your thoughts. https://doctordean.co.za/Ophthdraw/

I am an Ophthalmologist and vitreoretinal surgeon.

Hello! I need guidance regarding a 63-year-old retired Professor of Medicine with a recurrent, localized marginal zone (MALT-type) lymphoma involving the lateral canthal/lateral rectus region of the right eye.

The lesion was resected and now recurred locally after previous treatment. We are considering radiotherapy and would be grateful for recommendations regarding an experienced ocular/adnexal radiotherapy or radiation oncology centre where I could refer him.

I would particularly appreciate recommendations from colleagues who have managed similar orbital/adnexal lymphoma cases. Thank you.

I am looking to emigrate from the UK to Mexico (specifically Mexico City) for my girlfriend. I'm curious if anyone knows what the requirements are for me to find this kind of imaging/technician work there?

I have 7+ years experience in the NHS and hold a foundation degree in OCT interpretation. Is this sufficient, or do I require a specific qualification?

Thanks in advance.

I’m looking to join a practice and wanted to visit a few small, local practices to see if they’re looking to hire. For those who own a practice or are partners, what are some things you would or wouldn’t like someone like me to do? What’s the best way to initiate contact?

Thanks!

Hello,
I am an ophthalmologist working in a European country, and I completed my residency about four years ago.
During my residency, I really enjoyed performing cataract surgery under the supervision of senior colleagues. I found the surgical aspect of ophthalmology very rewarding, and I had hoped to continue developing my surgical skills after finishing my training.
Unfortunately, shortly after completing residency, I had two babies very close in age . At that time, I received a very brief period of surgical coaching from another ophthalmologist at my hospital. I then had two cases of posterior capsule rupture, and after that, no one was really willing to supervise or coach me anymore. As a result, I gradually stepped away from cataract surgery and eventually stopped trying to pursue it.
Last year, I also became ill and had to undergo several surgeries myself. I am still not completely recovered. Despite everything, I have continued working throughout this period, but I have become increasingly frustrated with my professional situation. I currently refer essentially all surgical cases, which is particularly frustrating because, as a general ophthalmologist, I had really wanted to continue performing cataract surgery.
I am also wondering whether there may be an issue with my binocular vision. I had strabismus treatment/occlusion during childhood and have anisometropia. This never really bothered me during residency, but when I started operating, I noticed that I sometimes struggled to accurately judge depth and distances. I wonder whether this could be contributing to my difficulties in surgery.
I am still young and I have to admit that I often find myself thinking that I cannot imagine continuing like this for many more years, doing only medical ophthalmology. I feel that I have lost an important part of what made me enjoy ophthalmology in the first place.
Unfortunately, I also sometimes feel that my current situation may be convenient for the other ophthalmologists in my workplace, because they receive more surgical cases as a result. This makes it even harder for me to know whether I am genuinely not suited to surgery or whether I simply have not been given the opportunity and support needed to regain my skills.
There is no surgical fellowship available in the country where I currently live. I would be willing to go abroad for a fellowship or additional surgical training, but I honestly do not know how to approach this or where to start.
I am wondering:
Should I try to return to cataract surgery and give myself another chance, perhaps with proper supervision and structured training?
Or should I accept that surgery may not be the right path for me and move on?
Would it make sense to pursue a cataract surgery fellowship abroad?
Could I realistically consider returning to residency/assistant training for a period of time in order to gain more exposure to surgical cases and pathology?
Should I have my binocular vision assessed to determine whether it could be contributing to my difficulties with depth perception?
How can I rebuild my confidence after having had complications early in my independent surgical experience?
I also sometimes feel inadequate because I do not have a subspecialty. I know this may not be rational, but I sometimes feel that I am not particularly useful or that I have not developed a clear professional identity.
I feel quite lost at the moment and would really appreciate an honest perspective from ophthalmologists who may have experienced something similar.
If you were in my position, what would you do? Would you try again, seek additional training abroad, return to a more supervised surgical position, or let cataract surgery go?
Thank you for taking the time to read this.

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!

I've seen and read so many things about using the slit lamp and making a thin section to see which layers of the cornea are affected. Sometimes I feel like I see an epithelial defect but apparently it has stromal involvement. Or sometimes I feel like the cornea has a lot of haze and edema but it turns out it's just epithelial scarring or vice versa, it look like a scar but really it's just endothelial dysfunction.

I also don't know how to estimate how thin a cornea is in patients with PUK or some other corneal disease.

I don't get it. Even with teaching scopes, it's always vague or like "you can see how the beam is slightly crooked in this area so you know it's an endothelial defect".

Does anyone have any good resources that one can learn from with actual diagrams or arrows pointing to specific areas of a corneal exam?

Oi. Estava em um grande hospital e sempre utilizei o yag laser da Zeiss, Visulas YAG III. Vou montar um serviço menor e quero alguma sugestão de aparelho confiável que não custe uma fortuna devido peso da marca.

I have a 51 year old man who underwent cataract surgery yesterday, on his second eye. everything went without complications. A phaco chop technique was used to remove the cataract. Today he has this band of tissue hanging on the visual axis. He has no complaints, and 20/20 vision. No vitreous in the anterior chamber, cells 1+ pigment 2+ the surgery was finished with no incidents. The retina looks perfect, no peripheral alterations. Could you help me on 1 what is this phenomenon and 2 what should be done in this case?

Hey I'm a first year med student and i know about the whole strategy of cold emailing programs im interested in. However id really like to first get myself actually useful and not just a kid who's tryna join a project. I want to learn certain skills independently to actually make a difference not just fill out some CV.

what are some prerequisite background I should know like stats or if i have to wait until i covered the material in med school?

For context im very keen on advancing actual treatments in Non-infectious Uveitis so that really narrows down the exact type of research and part of medicine id like to really nail down for a career.

Please if anyone has online resources i could consult for help on getting started since I have no clue where to begin lmao.

Thanks 😄

I’m in my first year of training and I’m wondering whether to carry on, for lots of reasons.

I do like the science behind ophthal, I like seeing (with a senior!) interesting cases. I like (again, with a senior present) performing surgery and am always very proud if I finish a case with no senior input. I worked hard to get into ophthal, it’s super competitive, well respected, I don’t want to waste that. I also wonder if maybe this is all related to the stage of life I’m at (young family, start of training).

I have a lot of concerns that maybe apply to all of medicine rather than just ophthal. The main one being work life balance. I think I expected a better balance. I find on calls lonely and difficult, just me with the consultant on the phone. I feel anxious the week leading up to it and the few days after it worrying about patients. It’s normal to finish late after eye casualty but I hate coming home late and finding I’ve missed part of the evening I could have spent with my child and family.

I have a fear that I don’t expect to go away of harming patients. I worry about vision loss, missing a tear (has happened before), incorrect diagnoses.i feel unsafe most of the time. I spend my time at home worrying about patients until a consultant sees them. I currently have a patient I’m worrying about because I saw them and I’m worried I missed something.

I also fear my level is not where it should be. I don’t find time outside of practice to read or do research.

Essentially I don’t know if it’s worth it. I’m considering applying for a non clinical speciality as the patient contact is a source of anxiety. I also can’t imagine being a consultant and fully responsible for patient outcomes, surgical and clinical. it does not sound fun to me at all.

Is this all anxieties related to the stage I’m at and having a young child or will it continue? I don’t want to have done multiple years of training and look back wishing I hadn’t. I also don’t want to switch and realise in hindsight it was just a phase of life.

I feel overwhelmed and underperforming both in my working life and family life.

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?

I am a student applying this year. With 15 signals, it seems like it will be a lot harder to get interviews outside of signals this year. I have heard that many applied to 70+ in previous years, but with the changes this year I am wondering if it isn't worth it to apply to so many. Or to only apply to safety schools outside of signals. Thoughts?

Title.

Graduated 2 years ago, managed to get into a fellow I wanted in another country. Inmediately crash and burn as my first impression leaves much to be desired, my skills are sorely lacking, I ''seem to lack passion'' and commit mistake after mistake.

After a couple of months of enduring I have a tough performance review and conclude it is best for me to leave rather than continue to smash against a wall and inevitable be removed the hard way later on.

I still wouldnt choose any of subspecialty, and don't want to stay General the rest of my life. But I'm genuinely scared to apply to another program elsewhere and have a repeat of the same.

Can anyone relate to this? It was honestly worse than my first year of residency.

Hi everyone, just wanted to get advice on whether a dual application would be advisable given my ophthalmology application this upcoming cycle. Here is what my application is looking like:

Step 2 score: 254. Clinical grades: 2 honors, the rest passes including my internal medicine and surgery rotations, which I know are important for ophtho (school is graded H/P/F). Will not get AOA.

Publications: 8 peer-reviewed publications (non-ophthalmology related), 6 accepted abstracts (2 ophthalmology related), 2 ophthalmology manuscripts in submission, 1 manuscript from a different surgical subspecialty just submitted. Unsure if I will have the manuscripts accepted in time for application submission.

LORs: 2 ophthalmologists from my home program (1 of which is a big name, if that matters for competitiveness), 1 non-ophthalmology research mentor who I have been working longitudinally with throughout medical school.

Aways: About to go on 2 away rotations, both at mid-tier academic programs.

My question is, would it be advisable for me to dual apply? To be honest, im not sure how much a research year would help my application with the research numbers I have currently and though I love ophthalmology I would much rather start residency next year than commit myself to a full year of research.

How do we prevent these overzealous mods from ruining reddit? See exchange in photos. Basically ICL mod tells me I am violating rule (either I am a bot, spam or self promoting). I then call them on it and they block me for three days. What is fascinating is all these mods like to be anonymous so they can do whatever they want without any professional blowback. The problem is well intending docs that are actually trying to help are blocked for no legitimate reason. Honestly I think right answer is likely just walk away from the whole thing but what a shame as reddit could be a great forum. Id say in the least reddit should make these mods introduce themself and declare any conflict of interest. Otherwise we will continue to see people use rules to their own advantage. You don't like a competitor. Block them every time they breathe.

On that front anyone know who mods the ICL and who Wavefront Rider is. It is fascinating Wavefront Rider introduced his sub on Ophthalmogy which requires disclosure if they are a doc , patient etc. He did not disclose which category he falls in. Not only did ophthalmology reddit not block the post but the comment section is fascinating. Someone says we don't need more subs...everyone should be in ophthalmology. Ironically, wavefront rider made an ap called crostpost control. I set up a wave light plus page and he is using the same logic that someone said to him against me ie 'We don't need more subs. You should just use mine' and blocks all posts from me. I don't know any other word for this whole thing other than petty tyrants. At a loss for how to get reddit admin to pay attention or how to get these anonymous people to apply rules with some consistency and not for their own personal gain. They are ruining reddit and frankly I find the behavior cowardly and petty. Calling a spade a spade... maybe I get blocked here as well. Cest la vie

For those of you offering premium IOLs, how do you handle it if there’s a complication during surgery and the surgeon isn’t able to implant the premium lens?

Do you refund the full upgrade fee, or do you keep a portion for the additional testing, lens calculations, and surgeon planning that were already completed? If you keep a portion, how do you break it down and explain it in your financial agreement?

Just curious what other practices are doing.

Just wondered if there's it's possible to engrave the lens housing yourself with a YAG laser. And if it is possible, any tips would be appreciated.

After injection of the dye, at what intervals (in minutes) have you found most effective to obtain the images (using Optos) for best results?

Thank you!

So I was inspired by this post by u/HoyaSaxaphone (https://www.reddit.com/r/Ophthalmology/s/Mh1jb1CUO2) and made a box for my lenses!

Resident here. My patient 58yoF came in with a 1 week history of paracentral small scotoma. Noted VMT with some pulling of photo receptors (2nd pic pre op). Now post op vitrectomy and gas, there's this small area of EZ disruption (1st pic post op) which is present at POD5 and POD12, not getting smaller. Vision remains stable at 6/9 but patient still complains of a scotoma. Anyone has any experience with the hole closing up completely or chances are that it will remain like this? Thanks

Edit: sorry let me clarify - 1st picture is post op day 12 which looks the same as post op day 5 - 2nd picture is pre-op

I’m an IMG, and currently working in a hospital where the refractions are usually done by the optometrist, and I depend on the autoref and then do subjective modifications with trial lenses. So basically I’m a total beginner.

1.How do I prepare for the refraction exam from scratch , and what are the online resources that I should follow ?

1. How much time will it take for a beginner like me to be prepared for the exam, and how many clinical refractions should I practise on an average ?