Protecting Sight #106: The Genesis of Google. Cortex aspiration, retinoblastoma, the pursuit of presence, enneagrams, and Leaves of Grass.

Welcome to my daily learning journal. My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk – Sergey Brin + Larry Page: The genesis of Google. “Google co-founders Larry Page and Sergey Brin offer a peek inside the Google machine, sharing tidbits about international search patterns, the philanthropic Google Foundation, and the company’s dedication to innovation and employee happiness.” (ted.com)

This 2004 Ted Talk is remarkable and prescient. I love watching Brin and Page display an entrepreneurial spirit and curiosity. I also recommend John Doerr’s Measure What Matters, in which he writes about the process by which Google and other companies evaluate the success of innovative ideas (OKRs, objectives and key results).

2. Cataract Surgery – Uday Devgan MD – cannula for cortex aspiration. Dr. Devgan writes, “Bimanual irrigation/aspiration for cortex removal has an advantage: it is easy to switch hands and then access a full 360 degrees of the capsular bag. It does require a third incision, and perhaps for that reason, coaxial irrigation/aspiration is more commonly performed in the USA. We have shown examples of new instruments like the transformable I/A handpiece which allow easier access to the sub-incisional area. But what if you don’t have this extra instrumentation?” Great pearl.

3. Journal – Everett LA, Rahman SA, Afshar AR. A Pediatric Patient With an Asymptomatic, Unilateral Retinal Mass. JAMA Ophthalmol. Published online September 24, 2020. doi:10.1001/jamaophthalmol.2020.2040

A 4-year-old girl presents with an asymptomatic, unilateral retinal mass with no visible calcification or subretinal fluid in the right eye and no further remarkable history. What would you do next?

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4. Book Chapter – Walt Whitman – Leaves of GrassSparknotesWikipedia, and Gutenberg. Book 24 (Part I).

5. The Knowledge Project with Shane Parrish. Episode 91Russ Hudson: The Pursuit of Presence — “Author and co-founder of the Enneagram Institute, Russ Hudson, explains how the Enneagram was developed, how it helps us grow personally and with others, the nine interconnected personality types and what it means to be present.”

Shane Parrish continues to showcase thought leaders and cutting edge concepts.

Protecting Sight #105: What we learned from 5 million books. Suture fixated IOLs, the end of Goldmann tonometry, and Leaves of Grass.

Welcome to my daily learning journal. My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk – Jean-Baptiste Michel + Erez Lieberman Aiden: What we learned from 5 million books. “Have you played with Google Labs’ Ngram Viewer? It’s an addicting tool that lets you search for words and ideas in a database of 5 million books from across centuries. Erez Lieberman Aiden and Jean-Baptiste Michel show us how it works, and a few of the surprising things we can learn from 500 billion words.” (ted.com)

This 2011 Ted Talk shows early the power of Google Books and digitization. Google Books has transformed my research in US history and historical documents. Have never tried Ngram before and hesitate to take on a new addiction.

2. Cataract Surgery – Uday Devgan MD – compilation video: suture-fixated IOLs. Dr. Devgan writes, “This video features all sorts of suture-fixation techniques for securing IOLs in cases where there is limited or no capsular support. In this 10 minute video, we cover scleral suture fixation using buried gore-tex, securing an IOL to the iris, and even using the flange technique with suture material to make innovative support structures.”

3. Journal – Gazzard G, Jayaram H, Roldan AM, et al. When gold standards change: time to move on from Goldmann tonometry?British Journal of Ophthalmology Published Online First: 24 September 2020. doi: 10.1136/bjophthalmol-2020-317112

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4. Book Chapter – Walt Whitman – Leaves of GrassSparknotesWikipedia, and Gutenberg. Book 23.

Image

5. I enjoyed speaking at the Physicians Legal Issues: Healthcare Delivery & Innovation 2020. “Is a Bad Yelp Rating Making You Yelp? Management and Response to Patient Online Posts” Panelists: Ravi Goel @RaviGoelMD, Shannon Hartsfield @Holland_Knight, John Serpe @SerpeJones @abahealthlaw #HLS4U @ChiMedSoc #PLI2020

My free 1-hour talk on Protecting Your Online Reputation
is available on YouTube here.

Protecting Sight #104: Why we must confront hard historical truths. Acute retinal necrosis, Yag PIs, and Memories of President Lincoln: O Captain! My Captain!

Welcome to my daily learning journal. My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk – Hasan Kwame Jeffries – Why we must confront hard historical truths. “To move forward in the United States, we must look back and confront the difficult history that has shaped widespread injustice. Revisiting a significant yet overlooked piece of the past, Hasan Kwame Jeffries emphasizes the need to weave historical context, no matter how painful, into our understanding of modern society — so we can disrupt the continuum of inequality massively affecting marginalized communities.” (ted.com)

This is a Ted Talk that will shake you and inspire you. Professor Jeffries is a remarkable storyteller and confronts hard historical truths.

2. Cataract Surgery – Uday Devgan MD – Remove one nuclear half first. Dr. Devgan writes, “There are many ways to divide and emulsify the lens nucleus in cataract surgery. Some advanced surgeons will chop the nucleus into many smaller segments before removing a single one from the capsular bag. Others find it easier to remove one nuclear half first before going after the second hemi-nucleus. This is the technique that can be easier to learn because once the first half is removed there is much more working room within the capsular bag.”

3A. Journal – Ong SS, Postel EA. Sudden Unilateral Decrease in Vision in a Healthy Middle-aged Man. JAMA Ophthalmol. 2018;136(11):1299–1300. doi:10.1001/jamaophthalmol.2018.1375

3B. Journal – Laser Peripheral Iridotomy – Malik Kahook MD YouTube video review. Christopher K. S. Leung, MD and KEOGT Team text review here.

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4. Book Chapter – Walt Whitman – Leaves of GrassSparknotesWikipedia, and Gutenberg. Book 22 (Memories of President Lincoln)

O Captain, My Captain! (Wikipedia)

Protecting Sight #103: The rapid growth of the Chinese internet. Concussions, pupillary light reflex metrics, and Leaves of Grass.

Welcome to my daily learning journal. My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk – Gary Liu – The rapid growth of the Chinese internet — and where it’s headed. “The Chinese internet has grown at a staggering pace — it now has more users than the combined populations of the US, UK, Russia, Germany, France and Canada. Even with its imperfections, the lives of once-forgotten populations have been irrevocably elevated because of it, says South China Morning Post CEO Gary Liu. In a fascinating talk, Liu details how the tech industry in China has developed — from the innovative, like AI-optimized train travel, to the dystopian, like a social credit rating that both rewards and restricts citizens.” (ted.com).

Superlatives aside, this is a superb talk. I see a similar movement underway in India. I remember once reading that in the 1970s, the Indian government’s goal was to have at least one telephone in every village. Now, a villager may go from no phone access to an iPhone or Android.

2. Cataract Surgery – Uday Devgan MD – Cataract Quiz: many small opacities. Dr. Devgan writes, “Quiz time! You are doing what seemed like a routine cataract case and then you see many small opacities in the center of the red reflex. These are small and tend to move around a bit, close to the plane of the posterior capsule. What are these opacities and how do we handle them?”

macro photography of human eye

3. Journal – Pupil light reflex metrics and concussions:

  1. Utility of Pupillary Light Reflex Metrics as a Physiologic Biomarker for Adolescent Sport-Related Concussion Christina L. Master, MD; Olivia E. Podolak, MD; Kenneth J. Ciuffreda, PhD; et al. (JAMA Ophthalmology online September 2020)
  2. Audio Author Interview: The Utility of Pupillary Light Reflex Metrics as a Physiologic Biomarker for Adolescent Sport-Related Concussion
  3. Invited Commentary: Interpreting Multiple Outcomes of Pupillary Light Reflex in Sport-Related Concussion in Adolescents ; Wesley T. Beaulieu, PhD; Adam R. Glassman, MS

I look forward to seeing how pupillary light reflect metrics are used in concussion management in the future.

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4. Book Chapter – Walt Whitman – Leaves of GrassSparknotesWikipedia, and Gutenberg. Book 21 (Part 2).

5. “Harvard’s Chetty Finds Economic Carnage in Wealthiest ZIP Codes: The celebrated economist has built a data tool with a God’s-eye view of the pandemic’s damage—and soaring inequality.” (Bloomberg Businessweek 9/24/2020). Fascinating data aggregation.

Protecting Sight #102: The real story of Rosa Parks. The myopic rhexis, adrenal insufficiency, pseudotumor cerebri, Leaves of Grass, and the Knowledge Project.

Welcome to my daily learning journal. My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk – David Ikard: The real story of Rosa Parks — and why we need to confront myths about black history. “Black history taught in US schools is often watered-down, riddled with inaccuracies and stripped of its context and rich, full-bodied historical figures. Equipped with the real story of Rosa Parks, professor David Ikard highlights how making the realities of race more benign and digestible harms us all — and emphasizes the power and importance of historical accuracy.” (ted.com).

2. Cataract Surgery – Uday Devgan MD – measure the capsulorhexis in high myopia. Dr. Devgan writes, “In this large, myopic eye the white-to-white diameter is 12.6 mm and the pupil dilation is 8 mm. We use the capsulorhexis forceps, which have marks the 2.5 mm and 5 mm from the tip, to measure as we create the capsular opening. There are other methods as well such as using marks on the cornea or employing a femtosecond laser. Note that I do not have a financial interest in the forceps which bear my name. You can use a disposable steel keratome to engrave similar marks on your existing forceps.”

Case 1 of Episodic Pseudotumor Cerebri Syndrome, With a Beclomethasone Inhaler

3. Journal – Shah V, Hoyos-Martinez A, Horne VE. Association of Adrenal Insufficiency With Pediatric Pseudotumor Cerebri Syndrome. JAMA Ophthalmol. Published online September 17, 2020. doi:10.1001/jamaophthalmol.2020.3322

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4. Book Chapter – Walt Whitman – Leaves of GrassSparknotesWikipedia, and Gutenberg. Book 21 (Part I).

5. Podcast – Episode 92: Lisa Feldman Barrett: Balancing the Brain Budget — “Neuroscientist, psychologist and author, Lisa Feldman Barrett discusses the complexities of the brain, our emotions, improving ourselves and our relationship with others, making good decisions and giving yourself an existential break.”

A wonderful episode. Shane Parrish asks superbly insightful questions.

Protecting Sight #101: Adjustable liquid-filled eyeglasses. Low rigidity in high myopes, a corneal melt in CIN, and Leaves of Grass.

Welcome to my daily learning journal. My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk Joshua Silver: Adjustable liquid-filled eyeglasses. “Josh Silver delivers his brilliantly simple solution for correcting vision at the lowest cost possible — adjustable, liquid-filled lenses. At TEDGlobal 2009, he demos his affordable eyeglasses and reveals his global plan to distribute them to a billion people in need by 2020.” (ted.com).

Untreated refractive error (ie. the need for eyeglasses) is one of the most common causes of poor vision and blindness worldwide. This Ted Talk is from 2009 and Professor Silver had a bold goal for this year (2020). Hopefully one day the goal will be achieved … optimized vision for all worldwide.

2. Cataract Surgery – Richard Mackool MD – Episode 16: Intraoperative Aberrometry in a patient with low rigidity. Dr. Mackool writes, “This patient has a dense cataract, low ocular rigidity and unreliable preoperative biometry. The use of a high flow rate of 55 cc/min* to remove nuclear segments, wavefront aberrometry, and methods to prevent contact of the IOL with the endothelium during the late stages of the procedure are demonstrated.”

Great pearls. (Although Uday Devgan MD might cringe with that rhexis size! Dr. Mackool handles brilliantly).

Fig. 1

3. Journal – Corneal melt in conjunctival intraepithelial neoplasia. Warren N, Mercer R, Haddad J, et al. American Journal of Ophthalmology Case Reports, September 2020 (See also ONE Network Editors Choice post here.)

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4. Book Chapter – Walt Whitman – Leaves of GrassSparknotesWikipedia, and Gutenberg. Book 20.

Protecting Sight #100: There’s no such thing as not voting. A peaked pupil, the association of eyeglasses to COVID-19 risks, and Leaves of Grass. (100 Ted Talks, cataract surgeries, journal articles, and book chapters in 100 days!)

Welcome to my 100th daily learning journal! My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk – Eric Liu: There’s no such thing as not voting. “Many people like to talk about how important voting is, how it’s your civic duty and responsibility as an adult. Eric Liu agrees with all that, but he also thinks it’s time to bring joy back to the ballot box. The former political speechwriter details how he and his team are fostering the culture around voting in the 2016 US presidential election — and closes with a powerful analysis of why anyone eligible should show up on Election Day.” (ted.com).

I’ve known and admired Eric Liu since college. He was a freshman counselor when I was a college freshman. I enjoyed lunch with him when I visited Seattle a few years ago and marveled at his work on citizenship and advocacy. A most timely Ted Talk.

For Ted Talks, I recommend the Ted Talk iPad app to explore titles by new talks, trending talks, Tedcircle discussions, recommended talks, editors’ picks, etc. You can also Google the “Top 25 Ted Talks” for the most viewed ever. I much enjoy the diversity which trending and new talks include.

2. Cataract Surgery – Uday Devgan MD – Cataract Quiz: slight peak of pupil. Dr. Devgan writes, “This is a very subtle sign — look carefully at the picture. In the sub-incisional area, there is a slight peaking of the pupil. It seemed like a totally routine case up until this point, so what happened?”

I have featured Uday Devgan & CataractCoach.com more than any other cataract surgery website. Uday continues to move cataract surgery and ophthalmology forward, one pearl at a time. I love watching and learning from the submissions from talented colleagues worldwide.

3. Journal – Zeng W, Wang X, Li J, et al. Association of Daily Wear of Eyeglasses With Susceptibility to Coronavirus Disease 2019 InfectionJAMA Ophthalmol. Published online September 16, 2020. doi:10.1001/jamaophthalmol.2020.3906

Excellent and brief report.

JAMA Ophthalmology, Ophthalmology and AJO have many superb talks. I’ve been drawn to the JAMA Ophthalmology clinical challenges, which have excellent discussion sections and classic photos.

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4. Book Chapter – Walt Whitman – Leaves of GrassSparknotesWikipedia, and Gutenberg. Book 19.

Since starting my daily learning journal on June 14th, I’ve read / listened to:

  • Marcus Aurelius Meditations
  • Sun Tzu The Art of War
  • Jane Austen Pride & Prejudice
  • Herman Melville Moby Dick
  • Mark Twain The Adventures of Tom Sawyer
  • Mark Twain The Adventures of Huckleberry Finn
  • Henry David Thoreau Walden, and On The Duty of Civil Disobedience
  • Walt Whitman Leaves of Grass (in progress)
  • And a few others I started and then set aside for another day.

My goal is to read/listen to classic works which this pre-med student missed out on back in the day. Please send me suggestions in the comment section below! I love the free audio books on LoyalBooks.com and made available by Librivox. I listened to almost all of the titles above via the LoyalBooks podcast apps. The narrators are phenomenal.

Protecting Sight #99: Learn to read Chinese with ease. Penetrating the Great Wall of Chinese language. Staying calm during cataract surgery, chloroquine toxicity, and Leaves of Grass.

Welcome to my daily learning journal. My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk – ShaoLan – Learn to read Chinese … with ease! “For foreigners, learning to speak Chinese is a hard task. But learning to read the beautiful, often complex characters of the Chinese written language may be less difficult. ShaoLan walks through a simple lesson in recognizing the ideas behind the characters and their meaning — building from a few simple forms to more complex concepts. Call it Chineasy.” (ted.com).

Excellent 6 minute talk. Love the visual learning pearls.

2. Cataract Surgery – Uday Devgan MD – Recovering from posterior capsule rupture. Dr. Devgan writes, “In the video shown here, Dr. Kim from Wonju-si, Gangwon-do, South Korea does a beautiful job in recovering from a posterior capsule rupture. He is a very talented surgeon with a high degree of expertise and skill. He is also using a phaco machine with a venturi fluid pump, instead of a peristaltic pump. The primary difference between these two machines is how they build up vacuum, as explained in this video. In addition, the surgeon performs a pars plana anterior vitrectomy to clean up the prolapsed vitreous prior to implanting the IOL.”

Retinal Toxicity After Chloroquine Therapy of 10 mg/kg for 10 Months

3. Journal – Nuzbrokh Y, Jauregui R, Oh JK, Moazami G, Sparrow JR, Tsang SH. Presumed Chloroquine Retinopathy With Short-Term Therapy for Glioblastoma MultiformeJAMA Ophthalmol. Published online September 10, 2020. doi:10.1001/jamaophthalmol.2020.3251

Multimodal Imaging in Chloroquine Retinopathy

Excellent and brief report.

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4. Book Chapter – Walt Whitman – Leaves of GrassSparknotesWikipedia, and Gutenberg. Book 18.

Protecting Sight #98: The birth of Wikipedia. Rest in Peace Justice Ruth Bader Ginsburg. Dense cataracts, covid testing in tears, why moats matter, and my view on #manels. #RBG #HeForShe

Welcome to my daily learning journal. My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk – Jimmy Wales – The birth of Wikipedia. “Jimmy Wales recalls how he assembled “a ragtag band of volunteers,” gave them tools for collaborating and created Wikipedia, the self-organizing, self-correcting, never-finished online encyclopedia.” (ted.com).

I love Wikipedia. Nice history from Wikipedia’s co-founder & “benevolent dictator.”

2. Cataract Surgery – Uday Devgan MD Challenge: Monocular Dense Cataract. Dr. Devgan writes, “Operating on a monocular patient is always stressful since we know thatThis compilation video features the best of many prior videos regarding dense cataract techniques. The video has many clips which are shown at high speed in order to cover more material in the 10 minute timeframe. This is the same presentation that I would give at a large ophthalmology congress and now you can watch it now on your mobile device, at your leisure. Streaming on demand has taken over for television and movies, and it is now revolutionizing medical education.”

Like reading a great poem while listening to a symphony.

3. Journal – Evaluation of SARS-CoV-2 in Tears of Patients with Moderate to Severe COVID-19. Ritu Arora, MD et. al. Ophthalmology. Published:August 31, 2020 DOI: https://doi.org/10.1016/j.ophtha.2020.08.029PlumX Metrics

4. Book Chapter – Why Moats Matter: The Morningstar Approach to Stock Investing. Chapter 1. With thanks to author and hedge fund Guy Spier for sending this amazing book. Guy’s appearance on The Investors Podcast inspired me to attend the Berkshire Hathaway meeting in 2018 and 2019. Cancelled my 2020 hotel/flights due to COVID.

Guy Spier’s book on The Education of A Value Investor is filled with life lessons.

5. We Study Billionaires, hosted by Preston Pysh and Stig Brodersen, is the flagship podcast of The Investor’s Podcast Network, with more than 30 Million downloads.

  1. TIP314: THOUGHTS FROM RAY DALIO, ERIC SCHMIDT, PETER THIEL, & SAM ZELL ON THE CURRENT ECONOMY.
  2. TIP313: ED HARRISON FROM REAL VISION TALKS ABOUT CURRENT MARKET CONDITIONS

6. I posted a tweet about the #IIRSI program image above. My tweet is here which includes numerous responses. I have great respect for the all-star faculty. But I make no apology for the tweet itself. I think the profession needs to do better. We need to identify unconscious and unintentional biases which affect professional growth for diverse genders and communities.

5. Rest in Peace Justice Ruth Bader Ginsburg.

Protecting Sight #97: How to use sonar to navigate the world. A must-see Ted Talk for ophthalmology colleagues. Rest in Peace Justice Ruth Bader Ginsburg. #RBG

Welcome to my daily learning journal. My daily goal is to watch one Ted Talk and one cataract surgery. I also plan to read one journal article and read/listen to a book chapter, short story or significant work.

Here’s today’s list:

1. Ted Talk – Daniel Kish – How I use sonar to navigate the world. “Daniel Kish has been blind since he was 13 months old, but has learned to “see” using a form of echolocation. He clicks his tongue and sends out flashes of sound that bounce off surfaces in the environment and return to him, helping him to construct an understanding of the space around him. In a rousing talk, Kish shows how this works — and asks us all to let go of our fear of the dark unknown.” (ted.com).

This is a must-see for all ophthalmology colleagues. 13 minutes which includes a brief Q&A. Have a box of tissues handy. And prepare to be inspired.

2. Cataract Surgery – Uday Devgan MD Challenge: Monocular Dense Cataract. Dr. Devgan writes, “Operating on a monocular patient is always stressful since we know that the stakes are higher due to the patient having just this one eye with visual potential. It is also stressful for the patients, who often are so afraid of surgery that they delay procedures for years. That is the case here: the patient was so afraid of the potential risks of surgery that she waited for years until she presented with a dense white cataract with iris synechiae. Dr. Ali Al Beshri from Riyadh, Saudi Arabia does a great job helping this patient. He releases the synechiae and performs the double capsulorhexis technique to ensure a good outcome. The result is an outstanding outcome with a happy surgeon and an amazed patient.” Well done!

3. Journal – Duane A. Congenital Deficiency of Abduction, Associated With Impairment of Adduction, Retraction Movements, Contraction of the Palpebral Fissure and Oblique Movements of the EyeArch Ophthalmol. 1996;114(10):1255–1256. doi:10.1001/archopht.1996.01100140455017

The classic 1905 Duane’s Syndrome article!

Andrew Lee, MD with an excellent review of Duane’s Syndrome.
Dr. Connie Koklanis with an excellent review of Duane’s Syndrome.
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4. Book Chapter – Walt Whitman – Leaves of GrassSparknotesWikipedia, and Gutenberg. Books 16-17.

5. Rest in Peace Justice Ruth Bader Ginsburg. I have admired Justice Ginsburg since she stood with President Clinton in the White House Garden. A constant inspiration.