Blind Spot - The Eye Doctor's Podcast

With so may IOP-lowering drops on the market, it can be challenging to know which is the most appropriate drop to start a patient on for glaucoma.  How does one choose between the variety of prostaglandin analogs, beta blockers, alpha agonists and carbonic anhydrase inhibitors that are available?  When whould one choose monoterapy vs combination therapies?  How do the drops' side effect profiles influence one's first choice on which drop to start?  Glaucoma specialist Dr. Irfan Kherani joins the podcast.This episode is sponsored by Thea Pharma Canada - https://www.theapharma.ca Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

With the arrival of Eyezirgan (commercial available topical ganciclovir), we now have a more readily accessible preservative-free option for treatment of HSV.  So why is Eyezirgan a potentially important new player on the market?  How does one decide between oral or topical treatments for HSV, and is there a longer-term role for antivirals in the treatment of Zoster, in addition to just HSV? Dr. Parwez Hossain joins the podcast. This episode is sponsored by Thea Pharma Canada - https://www.theapharma.caBecome a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

Giant Cell Arteritis (GCA) is one of the most dreaded diagnoses in ophthalmology; not only can it cause vision loss, but it can also be life threatening.  So what is the threshold for going down the 'GCA diagnostic path'? When should one order an ESR and CRP?  When is the concern high enough to warrant a temporal artery biopsy, and when should steroids be started?  How is temporal artery biopsy changing our diagnostic alogirthm.  Dr. Andrew Lee joins the podcast. This episode of the podcast is sponsored by Thea Pharma Canada - https://www.theapharma.caBecome a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

While the terms 'tech' and 'AI' might seem overwhelming to the average ophthalmologist and optometrist, the reality is that the future of medicine will certainly be intertwined with these technologies.  So what exactly is 'health tech' in the context of eye care?  Dr. Lisa Jagan is the founder of Lid Express, an online platform that allows patients to submit photos of eyelid lesions to be reviewed by a team of oculopplastic surgeons in an expedited fashion.  She joins the podcast to share her experience developing an oculoplastics tech platform and the lessons she has learned along the way.  Lid ExpressWebsite - https://clarityeye.ca/services/lid-express/Email - lidexpress@clarityeye.caInstagram @lidexpressThis episode is sponsored by Thea Pharma Canada - https://www.theapharma.caBecome a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

As preservative-free eye drops become more common, one has to wonder why it is so important to reduce our use of preservatives.  What kind of toxicity do preservatives wreak on the eye?  And without preservatives, are eye drops still as effective and resistant to infection?  Especially in the realms of dry eye and glaucoma, how have preservative free drops started to change the landscape, and what can we expect moving forward? Denmark's Dr. Miriam Kolko joins the podcast. This episode is sponsored by Thea Pharma Canada - https://www.theapharma.caBecome a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

Acanthamoeba keratitis can be one of the most devastating diagnoses in ophthalmology, as it can wreak havoc on the cornea unlike few other microbes.  On the same token, if caught early, acanthamoeba can be treated quite efficiently and effectively, and patients can have minimal, if any, long-term visual sequelae.  Given acanthamoeba is such a dreaded diagnosis, just the thought of it can invoke fear into the ophthalmologist.  And while many of us might have a basic approach to acanthamoeba, we also surely have blind spots in our diagnosis and management of this condition, as evidenced by many patients being diagnosed weeks after it occurs. Dr. Chris Rapuano joins the podcast to discuss this important condition. This episode is sponsored by Thea Pharma Canada - https://www.theapharma.ca Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

For decades now, we have been able to offer anti-VEGF treatments to patients with wet AMD.  Yet for dry AMD, there have been few options we can recommend to our patients outside of AREDS formulations and lifestyle modifications.  But with newer scientific advances, there are indeed new classes of injectable medications that are now being offered to some patients wtih dry AMD.  Retinal specialist Dr. Ashkan Abbey joins the podcast to share the latest research. This episode is sponsored by Thea Pharma Canada - https://www.theapharma.ca Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

The Light Adjustable Lens (LAL) has taken the refractive world by storm over the past couple of years, with an excitement that rivals the enthusaism for the latest multifocals or EDOFs to come on the market.  So what's all the hype?  How does this lens actually work?  And even if the refractive results are impressive, do patients really want to wear UV-blocking lenses for weeks following surgery?  Is the time and cost investment worth it for patietns? Dr. Ralph Chu joins the podcast.  Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

One of the most common clinical presentations to ophthalmologist is 'the eyelid lesion'.  While sometimes it might seem obvious what the diagnosis is, other times it's tough to make a spot diagnosis or even to decipher whether the lesion is concerning or not.  So what are some helpful examination tips to help us discern the benign from the malignant?  Oculoplastics specialist Dr. Lisa Jagan joins the podcast to share an effective approach on how to decide what types of eyelid lesions warrant a biopsy. This episode is sponsored by Sun Pharma Canada - https://sunpharma.com/canada/Check out Lid Express to help expedite a patient's referral for an eyelid lesion - https://clarityeye.ca/services/lid-express/ Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

Extended depth of focus (EDOF) lenses have transofmed the intraocular lens (IOL) landscape.  As opposed to the binary choice of a monofocal or a multifocal IOL, there is an 'in-between' option that allows for more intermediate vision than monofocal lenses but less dysphotopsias than the mutifocal lenses.  How do these lenses work, how should we explain them to patients, and what are the factors that guide our decisions on lens selection? Dr. Eric Donnenfeld joins the podcast.This episode is sponsored by SunPharma Canada - https://sunpharma.com/canada/

Cataracts and AMD are two of the most common ocular pathologies.  But in patients who have both conditions, are there special considerations that should be taken into account?  Should cataract surgey potentially be delayed in AMD patients because a protective effect of the cataract?  Does cataract surgery exacerbate AMD and potentially lead to progression to geographic atrophy or conversion to wet AMD?  Dr. Ashkan Abbey joins the podcast. This episode is sponsored by Sun Pharma Canada - https://sunpharma.com/canada/

Pterygium surgery is one of the more common procedures performed by ophthalmologists.  Yet despite how common it is, multiple techniques are used by different doctors.  In this episode, Dr. Allan Slomovic joins the podcast to share tips on pterygium removal, indications for excision, and pearls on recurrent pterygia.  

July is Dry Eye Awareness month.  In this episode, five cornea specialists each contribute a tip on how to better diagnose and manage dry eye.  Speakers includ Dr. Clara Chan, Dr. Chris Rapuano, Dr. Ashley Brissette, Dr. Tanya Trinh, and host Dr. Zale Mednick. This episode is sponsored by Sun Pharma Canada

While there are specific guidelines for diagnosis, not every patient falls easily into a particular category of glaucoma.  Many times, it can be challenging to place some patients neatly into one of the glaucoma buckets.  So what are some tips that can help us in diagnosing these grey cases that may or may not be glaucoma?  And how does this impact treatment decisions? Are there certain cases in which it's okay to monitor a patient and wait for glaucoma progression?  Or should all patients suspected of having glaucoma be treated at the first visit? Dr. Irfan Kherani joins the podcast.

Recurrent Corneal Erosion Syndrome (RCES) is an extremely uncomfortable condition for patients to live with.  With so many management options, including ointments, bandage contact lenses, superficial keratectomy, anterior stromal puncture, and PTK, what actually works best?  Wills Eye Hospital Cornea Specialst Dr. Chris Rapuano joins the podcast. This episode is sponsored by Sun Pharma Canada - https://sunpharma.com/canada/

The incidence of musculoskeletal injuries in ophthalmology is probably higher than you think. Whether it's an acute injury or a chronic injury from poor posture and positioning, ophthalmologists and optometrists are at high risk for long-term back pain and other musculoskeletal problems, due to the nature of our work. So how can we better at keeping ourselves healthy, both in the short-term and in the long-run? Dr. R. Rishi Gupta joins the podcast. 

The toric intraocular lenses (IOL) is a mainstay in the treatment of astigmatism during cataract surgery.  Many people have different thresholds, however, for when they would consider a toric IOL.  What is the appropriate amount of astigmatism that warrants treatment with a toric lens?  Does the threshold vary if a premium lens is being used?  What lens implantation techniques can be implemented to achieve the best possible results with a toric lens?  This episode is sponsored by Sun Pharma Canada - https://sunpharma.com/canada/

LASIK has been the procedure of choice in refractive surgery for many years now.  But over the last decade, the development of SMILE has changed the landscape in refractive surgery.  Especially popular in Europe and China, many ophthalmologists are offering their patients SMILE in place of LASIK.  So what exactly is SMILE, and why do many view it as a superior alternative to LASIK?  Dr. Walter Sekundo, the developer of the SMILE procedure, joins the podcast. 

As excitement grows regarding the upcoming solar eclipse, anxiety is also increasing amongst patients.  How should we be counseling concerned patients regarding the solar eclipse and what precautions they should be taking to protect their eyes? Dr. Tina Felfeli joins the podcast. 

Traditionally, most of us were taught that after cataract surgery, a patient should be assessed on day one, week one, and month one.  But what are these recommendations based on?  Practically speaking, does our typical survellance of post-operative cataract surgery patients make sense, or are we overly dogmatic in our approach? Dr. Uday Devgan, aka 'The Cataract Coach', joins the 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 Websitewww.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 Channelhttps://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 Channelhttps://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