Ravi’s Primer for the Advocacy Ambassador! Optimize Your Experience at the American Academy of Ophthalmology Mid-Year Forum 2019 #MYF2019 #WhyIAdvocate #ProtectingSight

I finished ophthalmology residency in 2001.  Since 2002, I’ve attended every American Academy of Ophthalmology Mid-Year Forum (left early circa 2007 for a friend’s premiere at the NY Metropolitan Opera.  I also missed two days in 2015 when my practice partner served as president-elect of our state society).  I’ve attended as a member of the Young Ophthalmology (YO) committee, Leadership Development Program (LDP), American Academy of Ophthalmic Executives (AAOE) and as a representative to outside organizations (AMA Ophthalmology Section Council).  I’ve also enjoyed the privilege of speaking at numerous Mid-Year Forum educational sessions.

The Academy’s Mid-Year Forum (#AAOMYF) originally included state and speciality society leaders, Academy volunteers & committee members, representatives to outside organizations, international leaders and the Academy’s board of trustees.  Since 2004, the Academy has welcomed residents and fellows to serve as Academy Advocacy Ambassadors.  The program was started by members of my Leadership Development Program (LDP) VI class (Jen & Beth!) and has evolved into one of the Academy’s growth areas of leadership development & YO engagement (“YO” = Young Ophthalmologist, coined circa 2000).

To make the most of the Mid-Year Forum, I offer the following suggestions to Advocacy Ambassadors:

Wednesday night – Meet mentors, colleagues and residents from your state.  During the dinner briefing, you’ll learn about the key issues which ophthalmology faces at the federal level.  Try to identify three talking points which will help when you meet Members of Congress and their staff.

18198773_10211171262530172_5026314955878171340_n

Thursday – Capitol Hill Visits – You’ll travel to Capitol Hill and meet Congressional offices on both the House and Senate side.  Have your running shoes on!  You will want to speak with your mentors and fellow residents who will be attending.  Do not be disappointed if you do not meet directly with your Member of Congress.  Legislative Assistants (LAs) and Congressional staff are well versed in health care issues and in fact are wonderful liaisons with Congressional offices on key issues.  Your perspective as a young ophthalmologist is critical to the ophthalmology efforts to protect sight.  If you offer to follow-up on an issue, write down names, emails and follow-up!  If the Congressional office requests more information beyond the “leave behind” packets which the Academy has prepared, alert Academy staff on the post-meeting forms.

Thursday-Saturday Mid-Year Forum – attend as many events as you can and meet colleagues from your state and subspecialty.  The Surgical Scope Fund (SSF) and OPHTHPAC host receptions with modest contribution levels ($50 for Advocacy Ambassadors, $500 for other attendees).  These are optimal opportunities to meet colleagues who volunteer hundreds of hours outside of their clinical practices to move medicine forward.  If you have a specific interest (“Hey, I want to write an article for EyeWiki & EyeNet” or “I’d love to learn more about international ophthalmology”), feel free to reach out to connect with key leaders.

 

The Academy’s Mid-Year Forum is the premiere meeting to learn about health care policy, challenges and solutions for ophthalmology.  The pearls you learn now will serve you well once you finish residency & fellowship.  I’ve formed lifelong friendships and interacted with colleagues worldwide in a shared mission of #ProtectingSight & #EmpoweringLives.

See you soon!

Ravi

PS. 1. Bring your business cards!

2. Please engage in social media early & often!  Every post helps your patients, legislators and colleagues keep up-to-date with your travels on behalf of the #ProtectingSight journey. #AAO2019 #MYF2019 #WhyIAdvocate. You can find me on Twitter (@RaviDGoel) and Instagram (@rdgoel).

3. Bonus pearl: If you curate the perfect post (photo and caption), you may well be rewarded with a retweet/repost by the Academy or legislator.

Frank Norris’ The Octopus – A newly discovered manuscript leaf at Yale’s Beinecke Library

I recently donated a collection of documents related to American editor, literary critic and author Frederic Taber Cooper (1864-1937) to Yale’s Beinecke Library.  Cooper (Harvard AB and Columbia LLB, AM, PhD), was an associate professor of Latin and Sanskrit at New York University (1895-1902). He was also an editor of The New York Commercial Advertiser (1898-1904), The New York Globe, and The Forum (1907-1909). His NY Times obituary states, “It was while Dr. Cooper was editor of The Forum that it began to take a leading position in literature and changed from a quarterly to a monthly publication.”

Cooper profiles Frank Norris among fourteen distinguished writers in Some American Story Tellers (1911). In the preface, Cooper writes, “The late Frank Norris once wrote that in every child a story teller was born, but that the vast majority died soon after birth.”  Cooper features Norris as a novelist among a group who possess “the gift that makes them next of kin to the minstrel and troubadour, to the ancient fabulist, and to the forgotten spinner of the world’s first nursery tales, – the gift of holding the attention by the spell of the spoken word.” 

During the collection’s appraisal process, the appraiser discovered an unsigned document which he described as “Believed Frank Norris” manuscript related to his work, The Octopus.  He writes, “A highly important literary discovery: fascinating manuscript working draft from Norris’ epic The Octopus: A California Story, from Cooper’s files. Oversize sheet 10-1/4 x 15-3/4, with corrections also in Norris’ hand. Norris died the year after publication, at just 32, from a ruptured appendix. A major work in the annals of Western Americana and turn-of-century literature, here dealing with American free trade, and iron and steel tariffs!”

IMG_2006

The Beinecke Library displayed three Frederic Taber Cooper items during my 25th reunion weekend. The label states, “an uncredited manuscript that may be a draft fragment of Frank Norris’s acclaimed 1901 novel The Octopus.” 

IMG_0106

The display also included “surly” letters between Frederic Taber Cooper and then-future Pulitzer prize winner Conrad Richter.  

After the donation, I hired an independent researcher, Juliet Demeter, to photograph The Octopus related items at the UC Berkeley Bancroft Library (Frank Norris Collection of Papers and Related Materials).  

I am most excited to share the images below.  The Frank Norris manuscript leaf at the Beinecke Library appears authentic when compared to the known manuscript leaves at the Bancroft Library.

IMG_4779

Infact, based on the Bancroft descriptions (leaf numbers 190, 213, 7), the document I donated to the Beinecke Library may well be leaf number 117.  (See the number notations in red ink in the upper right hand corner.)

Below is an image of a known manuscript fragment, which has a representative Bancroft Library stamp and leaf number “190” in upper right corner (Gift of Dr. Frank Norris, 1969).

photo aug 23, 12 39 09 pm

Bancroft Library manuscript leaves 190 and 213 alongside Beinecke Library leaf 117.

The Bancroft Library collection includes negatives of The Octopus manuscript fragments from the Bohemian Club (San Francisco) and New York Public Library (leaf numbers not identified).  

photo-aug-23-12-41-08-pm

I hope to get color images of the Bohemian Club and New York Public Library manuscript fragments for comparison in this most extraordinary inventory. (Also, Frank Norris was a member of the Bohemian!)  

image.png

In addition, I exchanged emails with leaders of the Frank Norris Society.  Frank Norris Society President Eric Link replied, “This is potentially a very exciting discovery, indeed.”

I hope that Frank Norris scholars will study & share insights into this fragment leaf.

Relevant links:

  1. Ravi D. Goel Collection of Frederic Taber Cooper. Yale Collection of American Literature, Beinecke Rare Book and Manuscript Library. 
  2. Frank Norris collection of papers and related materials, BANC MSS C-H 80, The Bancroft Library, University of California, Berkeley.
  3. Finding aids for my collections at the Yale Library and Amherst College Library.

IMG_0116

Night Vision, including Driving with Glare and Halos– A most common complaint for my cataract patients

Patients are increasingly presenting to my office with difficulty with night vision, including glare and halos with nighttime driving.  I was delighted to post an article on the American Academy of Ophthalmology EyeSmart patient education site, which can be found here.

I’ve also included the article’s text below.

Night Vision

Written By: Ravi D Goel MD
Reviewed By: Ravi D Goel MD
Edited By: Dan T. Gudgel
Dec. 19, 2018

Night vision is the ability to see in low light conditions. There are a few main differences between daytime vision and night vision:

  • The pupils become larger and the eye lets in more light when it’s dark outside.
  • A different, more sensitive kind of cell in the eye — rod cells — collects the light for night vision.
  • Night vision is mostly or completely in black and white. Color vision is poor in very low light conditions.

What to Do About Night Vision Problems

If you notice that your night vision is getting worse, you should see an ophthalmologist for a full exam. Decreasing night vision can be a sign of serious eye conditions, a temporary side-effect of other conditions or a natural part of aging.

There are no home treatments or exercises that can improve night vision. Prompt medical treatment of any underlying conditions will preserve as much vision as possible. Your doctor can help figure out what’s best for you.

How Do We See In the Dark?

In darkness, the iris opens wider, making the pupil larger. This dilation lets more light into the eye, so more light reaches the retina.

The retina, the light-sensitive tissue at the back of the eye, is covered in two kinds of photoreceptor cells: rods and cones. The cone cells give us the color vision that we have in brighter light. Rod cells are much more sensitive in low light, but only give black and white vision.

In dark conditions, most of the rods in the retina are turned on, but only a few cones are working. That’s why, when it’s dark, vision is all or mostly in black and white. Cones begin to turn on and contribute some color vision when the amount of light approximates what you’d see on a starry night.

If the rods stop working due to disease or injury, a person can lose night vision and won’t be able to see at all in the dark.

What Problems Do People Have with Night Vision?

Some of the most common problems people have seeing at night are:

Trouble seeing at night can increase the risk of falling and can make it hard to drive safely.

As the pupil gets bigger in the dark, some people become more nearsighted than they are in bright light. This night myopia can make distant objects appear fuzzy. This condition may be a sign of a need for glasses or a change to your glasses’ or contacts’ lens power.

Some of the diseases and conditions that can affect night vision are:

  • Cataracts. Trouble seeing or driving at night can be one of the first symptoms of a cataract. Cataracts can make vision blurry or dim and can increase glare, halos or streaks from headlights and streetlights.
  • Glaucoma. Glaucoma first attacks peripheral vision before harming central vision. Both daytime and nighttime vision are affected as parts of the retina stop working.
  • Macular degeneration. As the retina changes from macular degeneration, distortion and blind spots can appear in both daytime and nighttime vision.
  • Retinal diseases including retinitis pigmentosa. Diseases that directly affect the retina often harm low-light vision first because there are far more rod cells in the retina. Rod cells also cluster more around the edge of the retina, where damage may start.
  • Vitamin A deficiency. Night blindness (nyctalopia) is one of the first signs of vitamin A deficiency. Vitamin A deficiency reduces the production of rhodopsin, the pigment that your rods need to see in low light.
  • Congenital night blindness. Several genetic conditions can reduce or block night vision.
  • Refractive error. If you need glasses or contacts, or need a new prescription, your night vision will be blurry just like your daytime vision.
  • Refractive surgery (Lasik, PRK, etc.). Changes in the shape of the cornea can affect how light is bent and cause more glare or halos around lights at night.

How is Night Vision Tested?

To assess night vision, your ophthalmologist may ask you questions, look at your eyes and test your vision. One common test is the Pelli-Robson Contrast Sensitivity Chart. It is like the Snellen eye test letter chart, but with letters in different shades of grey. This test measures how well you can see the contrast between white paper and light grey shapes.

Ravi D. Goel M.D. is a cataract surgeon & comprehensive ophthalmologist at Regional Eye Associates in Cherry Hill, NJ.  He is also a clinical instructor at Wills Eye Hospital.  His patient-friendly YouTube cataract surgery educational videos are here.

A message from an uncle to his nieces as they start college

14379731_10209084698407373_7786964761452359039_o

I remember the days you were both born and less than three months apart. You brought great joy to my brothers, sisters-in-law and our extended families. Now you are both entering college and I wanted to give you some advice. Having no children of my own, and hoping to one day have children, I thought it best to record some of my feelings.

I’ve had the joy of being a doting chacha (uncle). For many years I could watch you grow, attend birthday parties, participate in activities and then pass you back to your parents.  Uncles enjoy the best parts of parenting without the responsibilities. You have both grown up to become wonderful young adults.

Still in your teenage years and ready to take on the world. Having spent my own childhood obsessed with college admissions and watching your journeys I offer you the following advice:

  1. The college experience is a privilege not a right. With online resources, college-level courses, podcasts and blogs, you could achieve a world-class education for free online. Appreciate that a university community enhances the learning experience.
  2. Learn as much as you can in the next four years. Both from your professors and classmates.  You will be surrounded by mentors.  
  3. Universities have vast resources available to you. Take advantage of them. Libraries are places to study and explore. The book you find in the stacks will have resources adjoining ready to be discovered. Google Books & Wikipedia are nice starts but originality comes from researching primary sources. 
  4. Remember that borrowed & purchased books should not simply collect dust. Books are meant to be opened, read, and enjoyed. You may not read every book in the curriculum and you will be fascinated that your classmates “read that book in high school.” Learn at your own pace and seek help when you don’t understand concepts.
  5. More than 25 years after graduating college, one of my biggest regrets is that I did not go to professor office hours often enough. You’ll be surrounded by world-class faculty and graduate students who have the skills to teach you outside the lecture hall.  Honor and respect them. Seek out your teachers for help. They are not there to complete your coursework. Rather, come prepared with questions and ask them to guide you in the journey of learning.
  6. Learn gratitude.  Write to teachers, counselors and mentors to thank them for helping you along your journey.  A text message doesn’t count.  Put pen to paper.
  7. Be careful not to judge yourself against your peers. You are now surrounded by many more classmates who have natural abilities which you do not have.
  8. Remember that success depends on those who have grit.  Success and failure are both part of success. You cannot be successful in life unless you fail on occasion. The mark of success is being able to give your best effort, be knocked down, and still stand up and fight again. (Read Teddy Roosevelt’s In The Arena and watch my high school classmate Angela Lee Duckworth’s TED Talk before the first day of class.)
Love Naomi Osaka’s leadership, humility & grit!

9. Surround yourself with classmates that inspire you. Find ways to avoid those who do not inspire you or take away from your learning & growth experiences.

10. Limit social media.  Every post you make will be reviewed by graduate school admissions officers and human resource departments.  Turn your phone into airplane mode, set an alarm for 30-60 minutes and then study uninterrupted. (I learned this from Shane Parrish’s wonderful Farnam Street blog & The Knowledge Project podcast.)

In four years I hope to be at your graduation. I hope that you will look upon these next few years as a learning experience. I hope that you will utilize the unlimited resources that are available to you.

If you need help, assistance, or an ear to listen to, I’m here for you. Your parents, siblings and extended families are here for you. You are surrounded by those who want you to succeed in life. Do not waste these next four years on stress, the loss of learning opportunities, nor regret.

Love,

Ravi Chacha

11221958_1651430721803726_8355309697890453408_n

Troy Aikman needs to ignore Dr. Twitter and see an #ophthalmologist. #ProtectingSight #EmpoweringLives #ophthalmology

I graduated from college in May 1993 and went straight to my state medical school.  My student loan debt was $100k+ after 4 years (I missed out on the NYU College of Medicine’s remarkable tuition free initiative earlier this week). When I saw Troy Aikman’s tweet earlier today asking for a Twitter ophthalmology consult, I Googled the former Dallas Cowboys QB’s name and learned he signed an 8-year, $50 million deal the same week I had taken my anatomy final! (link)

D5799E1D-8620-414C-85C0-42C90DE2A008

I love Twitter and have embraced the American Academy of Ophthalmology’s hashtags #ProtectingSight & #EmpoweringLives. I also follow many ophthalmology colleagues, eye hospitals and ophthalmology related organizations.

I have the privilege of being an on-call phone consultant when colleagues have difficulty finding an ophthalmologist in their local communities (including the Great State of Texas!).  One friend who was then-president of the American Medical Association called me with a curbside question while managing patients in his ER. (Emergency Medicine colleagues know how to get the information they need to help patients with efficiency!) Ophthalmology is a visual specialty, and the patient history and clinical findings dictate management.

The American Academy of Ophthalmology has a detailed Preferred Practice Pattern for conjunctivitis management (link). A patient friendly guide is here. (“Pink eye,” or “red eye” are among the many descriptions for this acute or chronic condition.)

Acute conjunctivitis is a common ailment which affects upto 6 million people in the US yearly. Viral conjunctivitis is the most common cause, followed by bacterial conjunctivitis. The cost of antibiotics therapy for bacterial conjunctivitis alone is estimated to be $377 million to $857 million per year (Azari AA in JAMA 2013; 310(16): 1721-1730. doi:10.1001/jama.2013.280318 ). In addition, allergic conjunctivitis affects 15-40% of the population.

For Mr. Aikman (whom I have not examined) and patients with similar symptoms, I recommend ophthalmology consultation. Specialists consider the zebras of rare conditions when they hear the horse hoofbeats of common infections. In the absence of immediate ophthalmology availability I recommend:

1. Maintain contagious precautions – Wash your hands and your workplace frequently. Do not shake hands and avoid door knobs. Literally walk with your hands in your pockets. Take time off work and keep kids out of school as you may cause others to become infected.

2. Discontinue contact lenses (if you wear them) – With any pink eye or conjunctivitis, stop wearing contact lenses and throw away the current case and contact lens solutions.

3. Seek medical (preferably ophthalmology) consultation immediately – As the American Academy of Ophthalmology Preferred Practice Pattern alludes, there are numerous vision threatening conditions which need to be assessed in a timely fashion and treated immediately. Azari offers a helpful algorithm for clinicians and patients to approach suspected acute conjunctivitis:

The AAO Preferred Practice Pattern has a helpful high yield summary paragraph:

“The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic adenoviral conjunctivitis, primarily by educating the patient and family about proper hygiene. Infected individuals should be counseled to wash hands frequently with soap and water (as opposed to sanitizer only) and use separate towels, and to avoid close contact with others during the period of contagion. Avoiding contact with others is especially important for individuals in professions with high potential for transmission, such as health care workers and child care providers. While the exact length of the period of infectivity is variable, many consider 7 days from the onset of symptoms as the contagious period, because the recovery of virus from infected cases drops off after 7 days of infection.43 However, other studies have suggested that patients should be considered potentially contagious for at least 10 to 14 days.44,45″

Good luck to Mr. Aikman.  With his public stature, I hope this potentially contagious conjunctivitis can be limited from spreading to colleagues and fans.

And #FlyEaglesFly!

—-

Ravi D. Goel M.D. is a cataract surgeon & comprehensive ophthalmologist at Regional Eye Associates in Cherry Hill, NJ.  He is also a clinical instructor at Wills Eye Hospital.  His patient-friendly YouTube cataract surgery educational videos are here.

Ravi’s Primer to Optimize the Advocacy Ambassador Experience at the American Academy of Ophthalmology Mid-Year Forum 2018 #MYF2018

I finished ophthalmology residency in 2001.  Since 2002, I’ve attended every American Academy of Ophthalmology Mid-Year Forum (left early circa 2007 for a friend’s premiere at the NY Metropolitan Opera.  I also missed two days in 2015 when my practice partner served as president-elect of our state society).  I’ve attended as a member of the Young Ophthalmology (YO) committee, Leadership Development Program (LDP), American Academy of Ophthalmic Executives (AAOE) and as a representative to outside organizations (AMA Ophthalmology Section Council).  I’ve also enjoyed the privilege of speaking at numerous Mid-Year Forum educational sessions.

The Academy’s Mid-Year Forum (#AAOMYF) originally included state and speciality society leaders, Academy volunteers & committee members, representatives to outside organizations, international leaders and the Academy’s board of trustees.  Since 2004, the Academy has welcomed residents and fellows to serve as Academy Advocacy Ambassadors.  The program was started by members of my Leadership Development Program (LDP) VI class (Jen & Beth!) and has evolved into one of the Academy’s growth areas of leadership development & YO engagement (“YO” = Young Ophthalmologist, coined circa 2000).

To make the most of the Mid-Year Forum, I offer the following suggestions to Advocacy Ambassadors:

Wednesday night – Meet mentors, colleagues and residents from your state.  During the dinner briefing, you’ll learn about the key issues which ophthalmology faces at the federal level.  Try to identify three talking points which will help when you meet Members of Congress and their staff.

18198773_10211171262530172_5026314955878171340_n

Thursday – Capitol Hill Visits – You’ll travel to Capitol Hill and meet Congressional offices on both the House and Senate side.  Have your running shoes on!  You will want to speak with your mentors and fellow residents who will be attending.  Do not be disappointed if you do not meet directly with your Member of Congress.  Legislative Assistants (LAs) and Congressional staff are well versed in health care issues and in fact are wonderful liaisons with Congressional offices on key issues.  Your perspective as a young ophthalmologist is critical to the ophthalmology efforts to protect sight.  If you offer to follow-up on an issue, write down names, emails and follow-up!  If the Congressional office requests more information beyond the “leave behind” packets which the Academy has prepared, alert Academy staff on the post-meeting forms.

Thursday-Saturday Mid-Year Forum – attend as many events as you can and meet colleagues from your state and subspecialty.  The Surgical Scope Fund (SSF) and OPHTHPAC host receptions with modest contribution levels ($50 for Advocacy Ambassadors, $500 for other attendees).  These are optimal opportunities to meet colleagues who volunteer hundreds of hours outside of their clinical practices to move medicine forward.  If you have a specific interest (“Hey, I want to write an article for EyeWiki & EyeNet” or “I’d love to learn more about international ophthalmology”), feel free to reach out to connect with key leaders.

The Academy’s Mid-Year Forum is the premiere meeting to learn about health care policy, challenges and solutions for ophthalmology.  The pearls you learn now will serve you well once you finish residency & fellowship.  I’ve formed lifelong friendships and interacted with colleagues worldwide in a shared mission of #ProtectingSight & #EmpoweringLives.

See you soon!

Ravi

PS. 1. Bring your business cards!

2. Tweet early & often: #AAO2018 #MYF2018 @RaviDGoel

Erin Burnett needs #ophthalmology consultation for #ViralConjunctivitis #PinkEye #CNN

The text came from a college classmate who is also an Emergency Medicine physician. She and I caught up over the weekend when I asked her to donate to our college class’ upcoming 25th reunion gift. She declined and cited a wonderful endowed scholarship she had recently created in her mother’s memory for under-represented medical students who are “first in their family” to pursue advanced degrees.

I also have the privilege of being one of my classmate’s on-call phone consultants when she has difficulty finding an ophthalmologist in her local community. (Another friend who was then-president of the American Medical Association once called me with a curbside question while managing patients in his ER. Emergency Medicine colleagues know how to get the information they need to help patients with efficiency!) Ophthalmology is a visual specialty, and the patient history and clinical findings dictate management.

My classmate texted, “Do you watch CNN? Poor Erin Burnett trying to hide a terrible r conjunctivitis or something…. please tweet her to take a day off!!! Poor girl is sick w adenovirus or rhinovirus ! Give her second a chance!!! She looks crazy!!!”

I immediately tuned to CNN, “The Most Trusted Name in News,” which I turn to daily along with NPR, ABC World News Tonight, the NY Times, and the Oldest College Daily.

The CNN segment included Ms. Burnett interviewing the expert on the recent UFO project. The numerous cameras kept going in and out with minimal time allotted to the anchor asking questions. A most unusual and adaptive technique. I turned to my iPad and took a quick screenshot of Ms. Burnett at the end of the segment.At low resolution, a viewer can appreciate the anchor’s “pink eye” with upper eyelid ptosis (secondary drooping of the right upper eyelid from inflammation) and conjunctival redness. On higher resolution, the findings are confirmed.

She likely also had light sensitivity, though it was difficult to assess with CNN strategic video angles.

The American Academy of Ophthalmology has a detailed Preferred Practice Pattern for conjunctivitis management (link). A patient friendly guide is here.

Acute conjunctivitis is a common ailment which affects upto 6 million people in the US yearly. Viral conjunctivitis is the most common cause, followed by bacterial conjunctivitis. The cost of antibiotics therapy for bacterial conjunctivitis alone is estimated to be $377 million to $857 million per year (Azari AA in JAMA 2013; 310(16): 1721-1730. doi:10.1001/jama.2013.280318 ). In addition, allergic conjunctivitis affects 15-40% of the population.

For Ms. Burnett (whom I have not examined) and patients with similar symptoms I recommend ophthalmology consultation (a bias and specialists consider the zebras of rare conditions when they hear the horse hoofbeats of common infections). In the absence of immediate ophthalmology availability I recommend:

1. Maintain contagious precautions – Wash your hands and your workplace frequently. Do not shake hands and avoid door knobs. Literally walk with your hands in your pockets. Take time off work and keep kids out of school as you may cause others to become infected.

2. Discontinue contact lens (if you wear them) – With any pink eye or conjunctivitis, stop wearing contact lens and throw away the current case and contact lens solutions.

3. Seek medical (preferably ophthalmology) consultation immediately – As the American Academy of Ophthalmology Preferred Practice Pattern alludes, there are numerous vision threatening conditions which need to be assessed in a timely fashion and treated immediately. Azari offers a helpful algorithm for clinicians and patients to approach suspected acute conjunctivitis:

The AAO Preferred Practice Pattern has a helpful high yield summary paragraph:

“The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic adenoviral conjunctivitis, primarily by educating the patient and family about proper hygiene. Infected individuals should be counseled to wash hands frequently with soap and water (as opposed to sanitizer only) and use separate towels, and to avoid close contact with others during the period of contagion. Avoiding contact with others is especially important for individuals in professions with high potential for transmission, such as health care workers and child care providers. While the exact length of the period of infectivity is variable, many consider 7 days from the onset of symptoms as the contagious period, because the recovery of virus from infected cases drops off after 7 days of infection.43 However, other studies have suggested that patients should be considered potentially contagious for at least 10 to 14 days.44,45″

Good luck to Ms. Burnett and the CNN team! (I hope this potentially contagious conjunctivitis can be limited from spreading to colleagues).

—-

Ravi D. Goel M.D. is a cataract surgeon & comprehensive ophthalmologist at Regional Eye Associates in Cherry Hill, NJ.  He is also a clinical instructor at Wills Eye Hospital.  His patient-friendly YouTube cataract surgery educational videos are here.

Ravi’s Quick Guide to Credit Report Protection post Equifax data breach

I returned from vacation to learn that my personal information may have been hacked via Equifax, one of the three biggest credit reporting agencies. I’ve infrequently reviewed the “free credit reports” available via the three companies, which a prudent consumer would rotate and obtain every four months (once learned I had a 20 year old Macy’s account still active). I’d usually get a report from all three companies at the same time and every couple of years.

The Equifax data hack, which could have affected 140 million+ consumers, is a wake up call to us all.

Here’s my quick pearl list to protect your credit report and personal identity post-Equifax:

1. Read Ron Lieber’s “Equifax’s Instructions Are Confusing. Here’s What to Do Now.” (NY Times). This is the most straight-forward summary I’ve seen. Based on this, I will NOT sign up for the free Equifax service post-hack, which strips away legal rights for arbitration.

2. I created a security freeze on on my credit reports with the three big credit report agencies (and a 4th one below). Each state has various costs to freeze, temporarily unfreeze, or permanently unfreeze your credit. I live in a state which is FREE to freeze and costs $5 to “lift” (temporarily unfreeze). I’ve seen the costs vary even for my state via the agencies online links. (Transunion is most web friendly) If you are a consumer advocate, now is the time to lobby your state legislators to address these fees and especially if they are higher than other states.

Here’s a quick run-down of how I initiated credit report security freezes this morning:

A. Equifax – relatively easy to do. You need your current information. Created immediate 10 digit PIN you need to unfreeze (I took a screenshot and wrote down).

B. Experian – relatively easy to do. They will ask you about old account details (5 multiple choice questions, “What is the last 4 digits of a phone number (or a primary checking account) … Which is a street number of an old address?” ) Creates 10 digit PIN.

C. Transunion – straightforward. Need to create an account and then select freeze (You may need to create an account, log out, then log back in). You then get to pick your own 6 digit PIN.

D. Innovis – straightforward but they will send you a letter once you sign up.

3. Obtain a free credit report every four months at annualcreditreport.com. Here, you simply set up a mobile phone / desktop calendar alert every 4 months to obtain a credit report from Equifax (September 1), Experian (January 1 ), TransUnion (May 1). Do this on the same day you change the air filter in your heating system (Air filters should actually be changed every 3 months!). In any event, a calendar alert should be a good reminder to review your credit report for FREE (federal law) every few months.

My NEW calendar Alerts:

I will add more links as this story evolves. Please like, share and comment below!

Ravi’s Quick Guide to Ophthalmology MIPS Reporting 2017

Dear Ophthalmology Colleagues,

I’ve started to read the MIPS Manual: A Primer and Reference from the EyeNet Supplement (August 2017).

My practice plans to use the IRIS Registry web portal for MIPS reporting. The IRIS Registry dashboard eases confusion. The EyeNet Supplement (August 2017), Page 10, states that EHR vendors may also submit for all three performance categories. IRIS Registry (also free for AAO members) is a better fit for my practice this year.

There are 3 MIPS performance category baskets:
1. Quality – IRIS Registry does the calculation and suggests which measures to submit (with green flags!).
2. ACI  (Advancing Care Information) – Practices need to select measures to submit.
3. IA – (Improvement Activities) – Practices need to select measures to submit.

Here’s my plan to achieve maximum benefit from the 2017 MIPS cycle:

  1. Watch the Academy’s 2-minute video “How to Avoid a 2019 MIPS Penalty”by George Williams, MD, Academy Secretary for Federal Affairs.  The page includes instructions to report a single quality measure before December 31, 2017 to avoid 2019 penalties.  My practice uses IRIS Registry AND I still plan to submit some claims-based quality measures.
  2. Review the AMA’s “MIPS Action Plan – 10 Keys Steps for 2017” (Opens as PDF)  The AMA web portal for MIPS Action Plan is here.  (It pays to be an AMA Member!)
  3. Review the Academy’s EyeNet Supplement (August 2017).  Have a highlighter ready and circle measures you can meet easily.  The supplement is initially overwhelming so plan ahead.
  4. If you participate in IRIS Registry, login into IRIS Registry portal and click MIPS in the left hand column (easier from desktop vs. tablet). This is where the rubber hits the road.  I had my greatest ANXIETY RELIEF when I logged into IRIS Registry and reviewed the MIPS information.  The 3 performance category baskets are outlined and I could more easily understand (with EyeNet graphics) which measures to submit. (See below)
  5. Develop a September action plan so that you can meet the measures needed to report successfully.  If you plan on going for more than the minimum (#1 above) then you’ll need to develop a plan in September and start no later than October 2.
  6. I will continue to add and edit pearls in the weeks ahead. If you send me a pearl (in the comment section below or via @RaviDGoel), I will add with credit in this blog.

—–

My IRIS Registry Dashboard currently looks like this:

1. Quality – We need to submit 6 of 15 measures which the IRIS Registry is extracting from our EMR. Some measures have green flags, some red flags and some gray flags. I plan to monitor this so that we can submit for the full year if we have at least 6 measures with green flags.

2. ACI -Advancing Care Information – Here are the measures which IRIS Registry has for ACI. I will plan to master the mandatory measures and then use the EyeNet Supplement to see which other measures we need to submit to maximize our score.

3. IA – (Improvement Activities) – Here also, I will work with my team to identify the best measures to meet the IA component. IRIS Registry is a big help.

The IRIS Registry Dashboard will allow you to keep score along the journey.

Happy Labor Day weekend!

Please revisit this page for additional pearls and suggestions for measures which are more easily achievable with EMR.

Ravi

Ravi D. Goel M.D. is a cataract surgeon & comprehensive ophthalmologist at Regional Eye Associates in Cherry Hill, NJ.  He is also a clinical instructor at Wills Eye Hospital.  His patient-friendly YouTube cataract surgery educational videos are here.

Ravi D Goel collection on Henry Roe Cloud (Yale BA 1910, MA 1914): Yale’s First Native American graduate

Henry Roe Cloud was the first known Native American to graduate from Yale College (BA 1910, MA 1914), a campus celebrity and member of the Elihu Club. Roe Cloud, a Ho-Chunk Native American, has a remarkable history as described in Joel Pfister’s The Yale Indian: Henry Roe Cloud (2009). 

Item 02 YaleBA1910

1910 Yale Degree. Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

There is an extensive collection of “Roe Family Papers” at the Yale Library which includes letters between Henry Roe Cloud and his adoptive mother, Mary Roe.  Joel Pfister states, “Again, it must not be forgotten that Roe Cloud wrote many of his letters to a white woman whom he admired and whom he wanted to admire him, and thus may have excised or modified some of what he could have told her about his daily life.”  

Item 04A YaleComposite

Yale Class of 1910 (Henry Roe Cloud seated in first row). Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

Item 04B YaleComposite

Henry Roe Cloud, Yale Class of 1910. Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

Pfister also writes, “It is important to keep three things in mind when taking stock of the Roe family archive and its focus.  First, there is no Roe Cloud archive per se at Yale … he did not give Yale reams of his private letters.  Many of these, no doubt, would have been sent to and received from family members and Indian friends (Roe Cloud was often on the road, especially in the 1920s and 1930s).” 

I first learned about Henry Roe Cloud after stumbling across an Elihu Club silver tray from a leading auction house.  Elihu is one of Yale’s senior societies (aka secret societies).  Some of the senior societies used to send a group gift when one of their graduates (before the early 1970s, all men) were married.

ElihuClub

Elihu Club Silver Tray (Delegation of 1910 Wedding Gift to Kent Sarver Clow).

The silver-plated Gorham presentation tray was from the Elihu Club Delegation of 1910. The auction house’s archivist graciously included the names and significant research about the members of the delegation.  In addition to Yale’s 1st Native American student (engraved “HR Cloud“), the delegation also includes the co-author of the Whiffenpoof Song (Meade Minnigerode).  Frank Thayer Nelson won a silver medal for pole vaulting at the 1912 summer Olympics.  Hildreth Benner was reported an usher at Teddy Roosevelt Jr.’s wedding.  (TR lore: the ushers walked in their khaki uniforms and the 26th President of the United States (Teddy Sr) stood up and bowed).  Charles Carroll Glover Jr. is credited with the layout of the main boulevards in Washington DC. A jovial lot for sure.

(Regarding the archivist’s notations: the New York Times (May 29, 1910) reported on Theodore Roosevelt Jr. wedding. Alas, Hildreth Benner was a groomsman in the Bowen-Stevens wedding (Column 3) and not TR Jr.’s nuptials (Column 1-2, in which TR Jr.’s groomsmen are reported to be mostly Harvard classmates). Both appeared under the three column headline “Society Home and Abroad” which may explain auction house error. In addition, the Washington boulevard credit belongs to Glover Sr. and not Elihu man Glover Jr.).

Item 08 AuburnTheological

Henry Roe Cloud at Auburn Theological Seminary. Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

Yale’s second oldest senior society, Scroll & Key, gives beautiful silver bowls to a member of its “College Street crowd”, etched with members names, bridal couple, date and the society’s symbol with “CSP/CCJ.” Secret society “neutral” Lyman Bagg (Yale grad but not a secret society member) reports in Four Years at Yale of the Keys’ motto as, “Collegium Sanctum Pontificum / Collegium Conservat Jupiter.”

img_0895

CSP/CCJ. Scroll & Key wedding bowl (1912 Delegation) Yale University Art Gallery

A former Keys member told me that “CCJ” is the more venerated motto.  Delegation  leaders, known as Z’s (Zanoni (1842 novel) or Zeus?) take members along a journey well described in Gurney’s 1992 Keys’ history True Fellowship in All Its Glory.  (The phrase “true fellowship in all its glory” also appears in an 1889 Yale class decennial report in which one of the three authors (WL Armstrong) is a Keys member.  Love Google Books.)

The Yale Art Gallery owns a Scroll & Key wedding bowl — donated by Philip Skinner Platt, B.A. 1912 and gorgeous in its own right.

ag-obj-10023-001-pub-med

Scroll & Key wedding bowl (1912 Delegation) Yale University Art Gallery

I was also interested in Roe Cloud because I once owned another item with a Yale – Native American connection.  My Yale collection includes a 1719 letter by Joseph Willard (1714).  Willard was named one of Yale’s 30 most prominent graduates at Yale’s 300th Anniversary by the Yale Alumni Magazine in 2001 (one per decade which includes Princeton founder Jonathan Dickinson, Noah Webster of Webster Dictionary, US Presidents George HW Bush, WH Taft, and Bill Clinton among many).  Willard was skinned by Indians in 1723 and this is the only letter I’ve been able to locate by him anywhere. (And thus more rare than Declaration of Independence Signer Button Gwinnett 50+ known signatures in existence, though my appraiser would likely not see the relevance of my argument).

1719JosephWillard1714FrontPage

Josiah Willard (Yale 1714). Ravi D Goel collection on Yale, Yale Manuscripts & Archives.

A year after purchasing the Elihu Club tray, I purchased the Henry Roe Cloud papers from one of his direct descendants.  In November 2014, the items were donated to the Yale University Library, Manuscripts and Archives and are part of the Ravi D Goel Collection on Henry Roe Cloud.  I timed the gift to mark the 2014 centennial of Henry Roe Cloud’s graduation from the 1914 Yale Masters program.

Item 11 YaleMasters1914

Yale Master Degree (1914) Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives. (*** Note, the degree corrects erroneous dates elsewhere)

The finding aid summarizes the collection’s provenance: “The Ravi D. Goel Collection on Henry Roe Cloud was originally the possession of Cloud’s daughter, Marion Roe Cloud Hughes. After the death of Marion Roe Cloud Hughes and her husband, Edward Hughes, their grandson Shahn Hughes inherited the materials. They were then sold to Dr. Ravi D. Goel with the understanding that they would be donated to Manuscripts and Archives at Yale University.”

Item 01 MountHermon1906

Mount Hermon School diploma (1906). Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

The collection includes Roe Cloud diplomas from 1906 Mount Hermon School, Yale 1910 BA, 1912 Auburn Theological Seminary, and 1914 Yale MA.  Almost all of the letters were addressed to his fourth and youngest daughter, Marion Roe Cloud Hughes. The candor is extraordinary and defines Henry Roe Cloud’s view on Native American issues through the 1930s.

Item 10 AuburnDiploma

Auburn Theological Seminary Degree (1912). Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

Item 07 AuburnTheological

Henry Roe Cloud at Auburn Theological Seminary. Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

Item 07 AuburnTheological.JPG

Collection highlights include Roe Cloud’s candid thoughts on many Indian tribes, leading figures and the state of US-Indian affairs.  A detailed April 1937 letter addresses Cloud’s views on the Crees, Joseph Dussome, Baptiste Samatt, and Rocky Boy Superintendent Earl Wooldridge.

Item 13A IndianDress

Henry Roe Cloud in Indian Dress (marked “Silver Bay – June 1916”). Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

In a February 14, 1938 letter, Cloud writes about a reunion with his Yale 1910 classmate and then Chinese Ambassador to the United States Wang Zhengting.  He states in a most breathtaking letter, “In the next room stood the Ambassador and a long line of Chinese – the receiving line.  I stepped up with my heart in my throat, when the Ambassador said, ‘Henry Cloud, how stout you are!  What have you been eating?’  I replied ‘Wild Turkey and Buffalo meat.’  The dainty sweet pretty daughter standing next to him on the receiving line said sweetly ‘And butter, perhaps.'”  Roe Cloud goes through receiving line “feeling fatter than ever.” (See also Yale Manuscripts and Archives April 2015 blog, “Party Diplomacy: The Ravi D. Goel Collection on Henry Roe Cloud.”)

In a January 12, 1939 letter, he writes of the opportunity to see his Yale classmate and US Senator Robert Taft on his upcoming visit to Washington, DC.  U.S. Senator Taft was Skull & Bones 1910 and was at Yale while his father William Howard Taft (Skull & Bones 1878) served as 27th US President (and Yale Corporation trustee!).  The younger Taft was instrumental in the young Roe Cloud meeting President Taft.  Roe Cloud represented as head of a Winnebago delegation at the White House meeting. (See Pfister, The Yale Indian, page 44).  (Both Robert A. Taft (philosophical oration stand) and Henry Roe Cloud (first dispute) are mentioned in the 1910 NY Times article on Yale Commencement honorees.)

My collection also includes the original manuscript of his most famous 1915 essay, “From Wigwam to Pulpit: A Red Man’s Own Story of His Progress from Dark to Light.

Page 01

“From Wigwam to Pulpit” (1915 Manuscript). Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

The original From Wigwam to Pulpit manuscript is a more genuine read in Cloud’s own words versus the edited version that appears in The Missionary Review of the World (1915). This is one of the cornerstone gems of this collection, and mesmerizing in every word as he describes his childhood, Indian life, and conversion to Christianity. This 11-page manuscript autobiography is 97-98% complete with only 2-3 sentences and the post-script missing.  The NY Times honors Roe Cloud’s essay as his 1950 obituary begins, “Dr. Henry Roe Cloud, a Yale graduate of 1910, who was born in a wigwam on the banks of the Missouri River, died on Thursday of a heart attack in Siletz, Ore.”

Yale is in the process of digitizing many of these documents for access globally.  The Native American Cultural Center at Yale hosts a Henry Roe Cloud conference.  The Yale Group for the Study of Native America (YGSNA) also supports the Henry Roe Cloud Dissertation Writing Fellowship in American Indian and Indigenous Studies.

The Henry Roe Cloud collection is referenced in Kipling collector, Yale Library Development Council vice-chair, and Skull & Bones Trustee David Richards ’67 upcoming book, “Skulls & Keys: The Hidden History of Yale’s Secret Societies.” Richards is reported in a June 19, 2000 NY Times article as the outgoing senior who tapped 43rd U.S. President George W. Bush ’68 for Skull & Bones (no Bones wedding trays that I’ve been able to find, though Scroll & Key alum Alexandra Robbins reveals intriguing wedding rituals in her book Secrets of the Tomb).

IMG_2178.JPG

David Richards’ extraordinarily well written and researched 800 page book will soon become the starting point for future generations interested in Yale history.  I was delighted to review early drafts.  He mentions Henry Roe Cloud’s 1910 Elihu Club photo.

FullSizeRender (1)

David Richards, Skulls & Keys. HR Cloud details.

Here’s what I believe is the Elihu Club Delegation of 1910 photo:

Item 06 ElihuClub

Elihu Club Delegation of 1910. Ravi D Goel collection on Henry Roe Cloud, Yale Manuscripts & Archives.

I include a 2014 YouTube video of an excited overview I created during the process of documenting the collection for my appraiser (he’s “Bob” in the narrative):

 

I hope that these items will help spark more research and understanding of Yale and Native American history.

The documents may have increased interest with the August 9, 2017 Yale Alumni Magazine Daily Snap entitled “Disarmament.”

dailysnap0809_861x1299_0_0_460 (1)

Yale Alumni Magazine “Daily Snap” August 9, 2017.

See also :

1. Yale Daily News (August 22, 2017), “Yale to remove offensive stonework from library entrance.”

2. Artnet (August 21, 2017): Yale University Altered a Campus Sculpture Depicting Violence Against a Native American