Protecting Sight #45: 39th POTUS Jimmy Carter on the mistreatment of women and human rights abuses worldwide. International cataract surgeons share phaco pearls.

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 – 39th US President Jimmy Carter – Why I believe the mistreatment of women is the number one human rights abuse . “With his signature resolve, former US President Jimmy Carter dives into three unexpected reasons why the mistreatment of women and girls continues in so many manifestations in so many parts of the world, both developed and developing. The final reason he gives? ‘In general, men don’t give a damn.’ ” (ted.com)

A compelling Ted talk by the 39th President of the United States. 16 minutes and a lifetime of wisdom.

2A. Cataract Surgery – Uday Devgan MD – Dense Cataract Vertical Chop. Guest surgeons Dr. RK Tadanki (Guntur, India) and Dr. Sunil Kumar (Ranchi, India). I watch Uday’s cases often and especially on the morning of surgery. Today was no different.

2B. Cataract Surgery – Ike Ahmed MD – Pediatric Posterior Capsulorhexis. Ike shares his talents with us “mere mortals” (Uday’s words). I’ve seen Ike narrate this case and Uday’s pearls are excellent as well. #IkeNeedsAHaircut

3A. Journal – EyeNet July 2020 – Journal Highlights. EyeNet is one of the most widely read ophthalmic journals. The article highlights in this section are superb.

4. Book Chapter – Mark Twain – The Adventures of Tom Sawyer. Listened to Chapters 7-10 via LoyalBooks.com Apple Podcast (free). See also Sparknotes (narration) and Gutenberg (book text).

The narration on the free podcast is excellent. Highly recommend.

See Protecting Sight Daily Learning posts here.

Please send me feedback. Would appreciate suggestions of Ted Talks, cataract videos, and journal articles to learn from and share.

Protecting Sight #44: The New Yorker’s Comma Queen. Cataract surgery, iStents, and The Adventures of Tom Sawyer.

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 – Mary Norris: The nit-picking glory of The New Yorker’s Comma Queen. ” ‘Copy editing for The New Yorker is like playing shortstop for a Major League Baseball team — every little movement gets picked over by the critics,’ says Mary Norris, who has played the position for more than thirty years. In that time, she’s gotten a reputation for sternness and for being a ‘comma maniac,’ but this is unfounded, she says. Above all, her work is aimed at one thing: making authors look good. Explore The New Yorker’s distinctive style with the person who knows it best in this charming talk.” (ted.com)

A favorite pursuit among young Yale Daily News reporters was to read copy before each edition was published. I still marvel over commas — with much amusement, I must say — and delight with the proper use of dashes, semi-colons, and the occasional exclamation point. (!)

This was a Ted trending talk. Super fun. 10 minutes.

2. Cataract Surgery – Richard J. Mackool, MD – Episode 6: Phacoaspiration of a nuclear cataract in a 78 year old patient. Dr. Mackool writes, “Utilizing high vacuum, removal of a 2+ nuclear cataract is accomplished without ultrasound.” Excellent. 9 minutes.

Figure thumbnail gr1

3A. Journal – Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract: Two-Year Results. Thomas W. Samuelson, Steven R. Sarkisian Jr., David M. Lubeck, Michael C. Stiles, Yi-Jing Duh, Eeke A. Romo, Jane Ellen Giamporcaro, Dana M. Hornbeak, L. Jay Katz for the iStent inject Study Group. Ophthalmology, June 2019, p811–821.

Figure thumbnail gr1

3B. Journal – Phthiriasis Palpebrarum Treated with Oral Ivermectin. Justin H. Dredge, Timothy W. Winter, Adel E. Alset. Ophthalmology, June 2019, p791.

Figure thumbnail gr1

3C. Journal – Isolated Uveal Amyloidoma in the Absence of Systemic Amyloidosis. Guy S. Negretti, Caroline Thaung, Mandeep S. Sagoo. Ophthalmology, June 2019, p828.

4. Book Chapter – Mark Twain – The Adventures of Tom Sawyer. Listened to Chapters 5-6 via LoyalBooks.com Apple Podcast (free). See also Sparknotes (narration) and Gutenberg (book text).

See Protecting Sight Daily Learning posts here.

Please send me feedback. Would appreciate suggestions of Ted Talks, cataract videos, and journal articles to learn from and share.

Protecting Sight #43: A new way to study the brain’s invisible secrets. From Moby Dick to The Adventures of Tom Sawyer.

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 – Ed Boyden – A new way to study the brain’s invisible secrets. “Neuroengineer Ed Boyden wants to know how the tiny biomolecules in our brains generate emotions, thoughts and feelings — and he wants to find the molecular changes that lead to disorders like epilepsy and Alzheimer’s. Rather than magnify these invisible structures with a microscope, he wondered: What if we physically enlarge them and make them easier to see? Learn how the same polymers used to make baby diapers swell could be a key to better understanding our brains.” (ted.com)

This was a Ted trending talk. Great innovative concepts. Well worth a watch. 13 minutes.

2A. Cataract Surgery – Uday Devgan MD Spiral Capsulorhexis Technique (Guest surgeon Dr. Ashraf Armia). “After needle decompression of the cataract, using a spiral technique for the capsulorhexis has a distinct advantage: if there is any pressure on the capsule, the capsule tissue can immediately be brought centrally to terminate the capsulorhexis and prevent radial extension. This video features expert surgeon Dr Ashraf Armia from Egypt and he demonstrates his technique for the spiral capsulorhexis. This helps to prevent the dreaded Argentinian Flag Sign and gives the surgeon a high level of control.”

2B. Cataract Surgery – Dr. Ashraf Armia – PEAR shaped capsulorhexis (YouTube). Excellent technique.

Fundus autofluorescence (A) demonstrating multiple, discrete hyperautofluorescent lesions throughout the posterior pole, concentrated along the superior arcades; spectral-domain optical coherence tomography (B) shows small, localized subretinal fluid pockets at the site of these lesions.

3A. Journal – JAMA Ophthalmology Clinical Challenge – Patel SN, Kim SJ. Sudden Onset of Multiple Green Spots in the Eyes of a Woman With Breast Cancer. JAMA Ophthalmol. 2020;138(4):412–413. doi:10.1001/jamaophthalmol.2019.5288

A, Fundus photograph of the left eye demonstrates a central maculopathy with focal gray discolored lesions and yellow-orange pigmentation. B, Scanning laser ophthalmoscopy and spectral-domain optical coherence tomography (SD-OCT) of the same eye reveal ellipsoid zone disruption and vertical hyperreflective bands. Similar findings were present in the fellow eye.

3B. Journal – JAMA Ophthalmology Clinical Challenge – Zhu I, Mieler WF, Francis AW. A Mysterious Central Scotoma in a Teenage Male Patient. JAMA Ophthalmol. 2020;138(4):414–415. doi:10.1001/jamaophthalmol.2019.5383

Orbital noncontrast imaging studies. Noncontrast computed tomography (CT) (A) and magnetic resonance imaging (B), images of the orbit. Computed tomography demonstrates inflammatory changes of the right medial orbital wall (arrowhead). Magnetic resonance imaging demonstrates inflammatory changes at the right orbital apex (arrowhead). Both images demonstrate nasosinal inflammation.

3C. Journal – JAMA Ophthalmology Clinical Challenge – Geyman LS, Pham CM, Aakalu VK. Acute-Onset Visual Acuity Loss in a Man With Advanced Diabetes Mellitus. JAMA Ophthalmol. 2020;138(4):416–417. doi:10.1001/jamaophthalmol.2019.5388

4. Book Chapter – Mark Twain – The Adventures of Tom Sawyer. Listened to Chapters 1-4 via LoyalBooks.com Apple Podcast (free). See also Sparknotes (narration) and Gutenberg (book text).

See Protecting Sight Daily Learning posts here.

Please send me feedback. Would appreciate suggestions of Ted Talks, cataract videos, and journal articles to learn from and share.

Protecting Sight #42: Being young and making an impact. The BBC, Harold Bloom and Melville’s Shakespearean prose. Long live Moby Dick.

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:

1A. Ted Talk – Natalie Warne – Being young and making an impact (April 2011) “At 18, Natalie Warne’s work with the Invisible Children movement made her a hero for young activists. She uses her inspiring story to remind us that no one is too young to change the world.” (ted.com)

This was a Ted trending talk. Love the concept of the anonymous extraordinaire. Also, though not mentioned directly, this reminds me of the concept of the Serving Leader.

2B. Ted Talk – Chip Kidd – Why books are here to stay. Good visuals. 3-minute Ted Talk.

2. Cataract Surgery – Uday Devgan MD – Review: if the bag shallows during cortex removal. Watch Uday everyday and you’ll continue to become a better cataract surgeon. A pearl a day! 7 minutes & a twist.

3A. Journal – JAMA Ophthalmology Clinical Challenge – Garcia ML, Starr MR, Smith WM. Middle-aged Woman With Optic Neuritis and a Rapidly Progressing Retinal Vaso-occlusive Disease. 2020;138(7):797–798.

3B. Journal – JAMA Ophthalmology Clinical Challenge – Venkateswaran N, Tonk RS, Berrocal A. Corneal Edema in a Gardener. Published online July 23, 2020. doi:10.1001/jamaophthalmol.2020.1325

4. Book Chapter – Herman Melville – Moby Dick. Listened to Chapters 133-Epilogue via LoyalBooks.com. See also Sparknotes (narration) and Gutenberg (book text).

I finally finished Moby Dick! A most enjoyable novel. This wasn’t a book I could pick up and just read. Life has many distractions and the text is dense. I needed the audio version. A big shout out to LoyalBooks and their podcast version with narration by Stewart Mills. He’s an extraordinary narrator.

Would suggest reviewing the Sparknotes or other book guide which draw out the chapter highlights and thematic messages.

harpoon
©SCRAN/University of Aberdeen, Harpoon

After listening to the book today, I listened to and recommend two discussions of the book:

  1. BBC Radio (Podcast, December 2017) – “Melvyn Bragg and guests discuss Herman Melville’s (1819-1891) epic novel, published in London in 1851, the story of Captain Ahab’s pursuit of a great white sperm whale that had bitten off his leg. He risks his own life and that of his crew on the Pequod, single-mindedly seeking his revenge, his story narrated by Ishmael who was taking part in a whaling expedition for the first time.” This is excellent and a British take on the classic American novel!
  2. Harold Bloom’s Moby-Dick – Open Source (November 2011). The reporter states, “Harold Bloom is giving us a one-man performance of a one-act play. He invited us months ago to his class at Yale on Herman Melville’s Moby-Dick, and finally here it is and here we are. Because this is Harold Bloom on stage, himself the “living labyrinth” of literature, his jazz-like solo improvisation is endlessly allusive …”

Yale English professor Harold Bloom holds court with his students to discuss Moby Dick. One of my great regrets is not taking more English classes while at Yale — I was an Ethics, Politics and Economics major & pre-med.

The pre-med college experience — complete with labs and problem sets — left little time to enjoy great works of fiction. When I read Hamlet a few years ago, I Googled and tried to process Yale professor Maynard Mack’s classic essay on Shakespeare & Hamlet. Much as I tried to do with John Nash’s original article which led to a Nobel Prize and the movie Beautiful Mind.

See Protecting Sight Daily Learning posts here.

Please send me feedback. Would appreciate suggestions of Ted Talks, cataract videos, and journal articles to learn from and share.

Protecting Sight #41: The art of the Metaphor. Congratulations to Michael F. Chiang, MD, National Eye Institute Director-Elect! Savoring the last chapters of Moby Dick.

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 – James Geary – Metaphorically speaking (Dec 2009). “Aphorism enthusiast and author James Geary waxes on a fascinating fixture of human language: the metaphor. Friend of scribes from Aristotle to Elvis, metaphor can subtly influence the decisions we make, Geary says.” (ted.com)

I listened to this talk twice today. Fascinating. As Elvis would sing, “I’m all shook up.”

2. Cataract Surgery – Uday Devgan MD – Challenging Uveitic Cataract. Great case and especially the process to assess a glaucoma tube’s status.

Congratulations to Michael F. Chiang, MD, newly appointed Director of the National Eye Institute. Pictured with David Chang, MD at the Chinese American Ophthalmology Society dinner.

3A. Journal article – Michael F. Chiang MD. How Does the Standard of Care Evolve? Anti-Vascular Endothelial Growth Factor Agents in Retinopathy of Prematurity Treatment as an Example. Ophthalmology. 2018;125(10):1485-1487. doi:10.1016/j.ophtha.2018.04.018.

I remember learning in the first days of medical school that half of what we were taught (and memorized) would no longer be true just a few years later. Great article.

t-Distributed Stochastic Neighbor Embedding Visualization of Features Extracted From an Intermediate Layer of a Trained Convolutional Neural Network for Plus Disease Diagnosis in Retinopathy of Prematurity
“This visualization demonstrates that the convolutional neural network is able to automatically generate features that roughly separate the 3 diagnoses and that they appear to run along a continuum of disease severity.” JAMA Ophthalmol. 2018;136(7):803–810.

3B. Brown JM, Campbell JP, Beers A, et al. and Chiang MF. Automated Diagnosis of Plus Disease in Retinopathy of Prematurity Using Deep Convolutional Neural Networks. JAMA Ophthalmol. 2018;136(7):803–810. doi:10.1001/jamaophthalmol.2018.1934

Congratulations to Michael F. Chiang, MD on his appointment to become Director of the National Eye Institute. Michael and I were residents in Baltimore together two decades ago! Both articles above are excellent and just a sampling of the Director-Elect’s work on moving ophthalmology forward.

4. Book Chapter – Herman Melville – Moby Dick. Listened to Chapters 128-132 via LoyalBooks.com. See also Sparknotes (narration) and Gutenberg (book text).

What is it, what nameless, inscrutable, unearthly thing is it; what cozening, hidden lord and master, and cruel, remorseless emperor commands me; that against all natural lovings and longings, I so keep pushing, and crowding, and jamming myself on all the time; recklessly making me ready to do what in my own proper, natural heart, I durst not so much as dare? Is Ahab, Ahab?

Ahab (speaking to himself), Chapter 132

Once I finish Moby Dick – savoring the last few chapters – I plan to find and enjoy 1-2 college level lectures. Usually I look to YouTube, Coursera, or Open Yale Courses. Please send me your favorite lectures!

5. #NoRubberBullets & #NotOneMoreEye Campaign – I reposted my blog on eye safety with rubber bullets & tear gas yesterday. The blog post is here. A shout-out also to Esther Choo, MD MPH @choo_ek who posted the tweet above. Her tweets often go viral and have greatly helped the mission of protecting sight. #TearGasEyeSafety

See Protecting Sight Daily Learning posts here.

Please send me feedback. Would appreciate suggestions of Ted Talks, cataract videos, and journal articles to learn from and share.

Protecting Sight #40: How AI could extend the mind. A submarine phaco chop in search of Moby Dick. #NoRubberBullets #NotOneMoreEye #TearGasEyeSafety

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 – Arnav Kapur – How AI could become an extension of your mind (May 2019) “Try talking to yourself without opening your mouth, by simply saying words internally. What if you could search the internet like that — and get an answer back? In the first live public demo of his new technology, TED Fellow Arnav Kapur introduces AlterEgo: a wearable AI device with the potential to let you silently talk to and get information from a computer system, like a voice inside your head. Learn more about how the device works and the far-reaching implications of this new kind of human-computer interaction.” (ted.com)

TED Fellow Arnav Kapur invents wearable AI devices that augment human cognition and give voice to those who have lost their ability to speak. A remarkable talk (9 minutes) which introduces technology to help millions worldwide.

2A. Cataract Surgery – Uday Devgan MD – Submarine chop (Dr. Pradip Mohanta). Dr. Devgan writes, “For a dense cataract, performing phaco chop is challenging because the central lens nucleus is so hard that the chop does not always propagate all the way through. Our guest surgeon, Dr Pradip Mohanta from West Bengal, India has a great technique to facilitate phaco chop in these brunescent cataracts: the submarine chop.”

2B. Dr. Neto Rosatelli – Spiral Rhexis and Mohanta’s Submarine Chop. This video clip appeared in the YouTube screen after I watched Dr. Devgan’s clip. Excellent.

3. Journal article – Deluged by Data – “Keeping up with and implementing the latest evidence poses myriad challenges for clinicians. This month’s feature takes a look at how physicians, trial investigators, and organizations can speed the adoption of evidence-based medicine to ensure that patients receive the best current care.” (EyeNet December 2019).

This is a good article. I especially enjoyed the “Five Recent Studies Worth Attention” on page 47. Have already featured the glaucoma pick on SLT vs. drops in the LiGHT Study.

4. Book Chapter – Herman Melville – Moby Dick. Listened to Chapters 124-127 via LoyalBooks.com. See also Sparknotes (narration) and Gutenberg (book text).

Can it be that in some spiritual sense the coffin is, after all, but an immortality-preserver! I’ll think of that. But no. So far gone am I in the dark side of earth, that its other side, the theoretic bright one, seems but uncertain twilight to me.

Ahab (speaking to himself), Chapter 127

5. #NoRubberBullets & #NotOneMoreEye Campaign – I reposted my blog on eye safety with rubber bullets & tear gas. The blog post is here. A shout-out also to Esther Choo, MD MPH @choo_ek who posted the tweet above. Her tweets often go viral and have greatly helped the mission of protecting sight. #TearGasEyeSafety

See Protecting Sight Daily Learning posts here.

Please send me feedback. Would appreciate suggestions of Ted Talks, cataract videos, and journal articles to learn from and share.

Tear gases and rubber bullets can cause permanent eye damage, eye injury, loss of vision, and blindness. In cases of chemical injury and eye trauma, protect the eyes and seek medical attention immediately. #Portland #TearGasEyeSafety #NoRubberBullets

There are numerous reports in the last few days and weeks of individuals sustaining eye injury from tear gases and rubber bullets. A CNN report states, “Portland mayor tear gassed after speaking with protesters on presence of federal agents.”

This image has an empty alt attribute; its file name is img_7348.jpg

I’d like to summarize review papers for ophthalmologists and health care colleagues. I’d also like to offer some initial management options. Protect the eye and seek medical attention immediately.

Tear gases

Kim, Payal, and Daly wrote an excellent review article, “Effects of tear gases on the eye,” (Survey of Ophthalmology, July-August 2016, Volume 61, Issue 4, Pages 434–442). Tear gases come in numerous forms, and the ocular injuries can be caused by the chemical and explosive effects.

Photo by Koshu Kunii on Unsplash

Kim et al state, “The effects on eyes include conjunctival injection, complete
corneal epithelial defects, pseudopterygium, corneal neovascularization, persistent conjunctivalization, corneal opacities, and reduced visual acuity. Current management, based on limited human studies, emphasizes decontamination and symptomatic treatment.” (Survey, page 434)

Pepper Spray injury to the cornea (Epstein RJ and Majmudar PA, Ophthalmology Oct. 2001, p. 1712)

Schep, Slaughter, and McBride state, “The eyes and respiratory systems are the primary target organs, with onset of ocular and respiratory tract irritation occurring within 20–60 s(econds). The ocular symptoms include pain, blepharospasm, photophobia, conjunctivitis, diffuse conjunctival and scleral injection, periorbital oedema, eyelid erythema and lacrimation.”

Hyphema is blood in the anterior chamber of the eye which can lead to significant eye injury and sequelae (Photo: Bryan Thiel, Moran CORE)

Schep and colleagues also address serious eye injuries in their paper. They state, “They (tear gases) do not typically cause irreversible eye effects, but more severe ocular injuries have been reported, including hyphema, uveitis, necrotising keratitis, coagulative necrosis, symblepharon, secondary glaucoma, cataracts and traumatic optic neuropathy and loss of sight.” (Schep LJ, Slaughter RJ, McBride DI. “Riot control agents: the tear gases CN, CS and OC—a medical review.” BMJ Military Health 2015;161:94-99.)

US Navy Seabees in full mission-oriented protective posture gear training with smoke grenades and tear gas. Public domain image. Photograph credit: Photo by Chief Mass Communication Specialist Michael B. Watkins, US Navy.

Eye protection is the best initial option to hopefully avoid exposure to tear gases and rubber bullets but they do NOT give 100% protection. If exposed to tear gas, an individual should:

  1. Remove themselves from the contaminated area as quickly and safely as possible.
  2. Seek fresh air.
  3. Seek higher ground (aerosolized tear gases are heavier than air).
  4. Blink frequently (to promote tearing).
  5. Do not rub eyes (may spread crystals within ocular surfaces).
  6. Remove contact lenses.
  7. Flush the eyes with copious clean water.
  8. Seek emergency ophthalmic evaluation.
  9. Ashley Brissette MD, a NYC cornea specialist offers great advice in a tweet here.

Rubber Bullets

Figure 2
Rubber bullet adjacent to ruptured globe, having penetrated the eyebrow and traversed the frontal sinus. From Lavy, T., Asleh, S. Ocular rubber bullet injuries. Eye 17, 821–824 (2003).

For rubber bullets, the risk for globe injury, orbital fractures, and permanent vision loss is increased. As colleagues have stated, “rubber bullets” may offer a false sense of security and may lead to blindness. Lavy and Asieh conclude, “The term ‘rubber bullet’ is misleading. ‘Rubber bullets’ cause a wide variety of ocular and periocular injuries. Orbital fractures are common. The tissues of the orbit are easily penetrated. If the globe is hit, it is rarely salvageable.” (Lavy, T., Asleh, S. Ocular rubber bullet injuries. Eye 17821–824 (2003). https://doi.org/10.1038/sj.eye.6700447 )

Instagram: is.visualart 11/19/2019

There are numerous reports of the devastating effects which rubber bullets, pellet guns, and projectiles can have on the eyes. The NYTimes profiles Dr. Natarajan Sundaram and his heroic efforts to protect sight after the protests in Kashmir, India here. (“An Epidemic of ‘Dead Eyes’ in Kashmir as India Uses Pellet Guns on Protesters” 2016). More recently, see an article from Chile: “A Bullet to the Eye Is the Price of Protesting in Chile” November 19, 2019. (link). Eye injuries are becoming increasingly common worldwide.

Temporary eyeshield made from styrofoam cup. Anton Helman MD. https://emergencymedicinecases.com/ocular-trauma/

As with potential tear gas exposure, eye protection is the best initial option to hopefully avoid injury from rubber bullets & projectiles but they do NOT give 100% protection. If exposed to a rubber bullet or projectile injury, an individual should protect the eye immediately. The eye may have an “open injury” (ruptured globe) and the intraocular contents are fragile and must be preserved. This is a medical emergency.

The Mass Eye & Ear, Harvard Medical School “Benchmark Protocols for Managing Eye Trauma” states, “The annual incidence of open-globe injuries worldwide is estimated to be 203,000 cases. Overall, males comprise approximately 80 percent of open-globe injuries. Males age 10 to 30 are at greatest risk. The chance of blunt globe rupture also increases after some types of ocular surgical procedures, including: large incision cataract removal, cornea transplant, glaucoma filtering, or refractive surgery.” (Eye Insights Issue 01: Ocular Trauma)

If injury occurs, remember the military phrase SHIELD AND SHIP. In transit to the emergency room:

  1. Do not touch the eye.
  2. Do not rub the eye.
  3. Stay upright.
  4. SHIELD: Place a hard shield around eye. Even a temporary eyeshield, such as paper cup or styrofoam cup, may work in an emergency.
  5. SHIP: Seek emergency room and ophthalmology consultation immediately.

Tear gases and rubber bullets can cause permanent eye damage, eye injury, discomfort, pain, loss of vision, and blindness. In cases of chemical injury and eye trauma, protect the eyes and seek medical attention immediately.

Amee Azad, MD, MSEpi student Stanford Med @ameeazad
& Ryan Brewster MD student Stanford Med @_ryanbrewster_

Additional resources since this blog posted:

  1. Interviewed by Reporter Evan Koslof (WUSA 9 in Washington DC) on the risks of ophthalmic injury with contact lens use and tear gas exposure (June 3, 2020)
  2. Nation’s Ophthalmologists Condemn Use of Tear Gas and Rubber Bullets. American Academy of Ophthalmology (June 3, 2020)
  3. Statement on Rubber Bullets for Crowd Dispersion. American Academy of Ophthalmology (June 4, 2020)
  4. “Rubber bullets are touted as a ‘safe alternative.’ My patient’s wound tells a different story” (Opinions). Dr. Lilun Li, Washington Post (June 4, 2020)
  5. “A guide to the less-lethal weapons that law enforcement uses against protesters.” By Alyssa Fowers ,Aaron Steckelberg andBonnie Berkowitz, Washington Post June 5
  6. Steve Gieser, MD, MPH, a Chicago ophthalmologist and glaucoma specialist, has posted poignant clinical vignettes of individuals affected by tear gas, rubber bullets, and other projectiles. Instagram
  7. The Department of Ophthalmology at the University of California San Francisco, in conjunction with the American Academy of Ophthalmology, is collecting information regarding ocular injuries surrounding civil protests. To add a case to this registry, please use the Google Form here.
#NoRubberBullets vignettes by Steve Gieser, MD, MPH on Instagram

(Media: Journalists covering eye health news who are in need of information, expert and/or patient interviews should contact the American Academy of Ophthalmology’s public relations department at media@aao.org or call the media line at 415.561.8534.)

#NoRubberBullets #NotOneMoreEye #SaveTheEye

Protecting Sight #39: India’s invisible innovation. A white cataract is akin to the white whale!

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 – Nirmalya Kumar – India’s invisible innovation. “Can India become a global hub for innovation? Nirmalya Kumar thinks it already has. He details four types of ‘invisible innovation’ coming out of India and explains why companies that used to just outsource manufacturing jobs are starting to move top management positions overseas, too.” (ted.com)

This 2012 Ted Talk is a fabulous and thought-provoking presentation. Many of Kumar’s observations have proven correct and just look at the CEOs of Google, Microsoft, and many other innovating companies.

2A. Cataract Surgery – Uday Devgan MD – White cataract needle decompression – Great case with the white cataract (akin to Moby Dick, the white whale!)

2B. I was delighted to be a panelist on the Prism Eye Round‘s Intraoperative Cataract Complications (July 22 YouTube). Fascinating cases which celebrate lifelong learning and atomic habits.

3. Journal article / cutting edge concepts (via webinar) Oracles of the Eye – One of the hidden benefits of COVID has been the creation of numerous webinars with international faculty. All of these talks were on the cutting edge. (Live webinar today, hopefully they will post an archived link in days ahead).

Ike Ahmed MD of course made a special appearance during an actual case in the OR! He performed an IOL exchange, MIGS insertion, RD repair with silicone oil, pupil cerclage, and blepharoplasty on a single patient. All while simultaneously presenting his presentation on Intraocular IOP sensors.

Dr. Neuhann, the first speaker, described using the anterior capsule from a laser capsulorrhexis to protect the endothelium during cataract and other anterior segment procedures. This is especially helpful in eyes which have compromised corneas. Love this innovation!

Moby-Dick FE title page.jpg
Title page, First edition, 1851 (Wikipedia)

4. Book Chapter – Herman Melville – Moby Dick. Listened to Chapters 115-123 via LoyalBooks.com. See also Sparknotes (narration) and Gutenberg (book text).

Oh, thou dark Hindoo half of nature, who of drowned bones hast builded thy separate throne somewhere in the heart of these unverdured seas; thou art an infidel, thou queen, and too truly speakest to me in the wide-slaughtering Typhoon, and the hushed burial of its after calm. Nor has this thy whale sunwards turned his dying head, and then gone round again, without a lesson to me.”

Chapter 116
See Protecting Sight Daily Learning posts here.

Please send me feedback. Would appreciate suggestions of Ted Talks, cataract videos, and journal articles to learn from and share.

Protecting Sight #38: Hunting for ancient ruins & lost civilizations with satellite technology. Let Ahab beware of Ahab.

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:

1A. Ted Talk – Sarah Parcak – Help discover ancient ruins — before it’s too late. “Sarah Parcak uses satellites orbiting hundreds of miles above Earth to uncover hidden ancient treasures buried beneath our feet. There’s a lot to discover; in the Egyptian Delta alone, Parcak estimates we’ve excavated less than a thousandth of one percent of what’s out there. Now, with the 2016 TED Prize and an infectious enthusiasm for archaeology, she’s developed an online platform called GlobalXplorer that enables anyone with an internet connection to discover unknown sites and protect what remains of our shared human inheritance.” (February 2016 talk, via ted.com)

1B. Sarah Parcak – Hunting for Peru’s lost civilizations — with satellites “Around the world, hundreds of thousands of lost ancient sites lie buried and hidden from view. Satellite archaeologist Sarah Parcak is determined to find them before looters do. With the 2016 TED Prize, Parcak is building an online citizen-science tool called GlobalXplorer that will train an army of volunteer explorers to find and protect the world’s hidden heritage. In this talk, she offers a preview of the first place they’ll look: Peru — the home of Machu Picchu, the Nazca lines and other archaeological wonders waiting to be discovered.” (ted.com)

I was drawn to Sarah Parcak’s Ted Talk when I stumbled upon this 2nd talk on Machu Picchu and Hiram Bingham (Yale 1898).

I collect Yale-related historical documents as a hobby. Many years ago, I came across a manuscript for a Dr. George F. Eaton (Yale 1894), who accompanied Bingham on his 1912 Yale Peruvian expedition (JStor). The manuscript was too rich for my blood — though I did alert a friend who worked in the Yale President’s office of the auction — and I’m constantly on the look-out for Bingham related items (See my Yale collections here.)

2A. Cataract Surgery – Richard J. Mackool, MD – Shallow Anterior Chamber and Severe Corneal Endothelial Dystrophy. “This patient exhibits severe corneal gutatta with an endothelial cell count of 368 cells/sq mm, and an extremely shallow anterior chamber. I first perform a pars plana vitrectomy to deepen the anterior chamber followed by cataract surgery using techniques intended to protect the already compromised endothelium. Because of the patient’s anatomy, I again choose to use the Trendelenburg position to obtain better access to the eye. I think you will really enjoy this case!” Excellent case by Dr. Mackool.

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3A. Journal article – Cost-Effectiveness of Preoperative OCT in Cataract Evaluation for Multifocal Intraocular Lens. Ella H. Leung, Allister Gibbons, Douglas D. Koch. Ophthalmology July 2020, p859–865.

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3B. Pictures & Perspectives – Infiltrative Choroidopathy Revealing Leukemia. Edward Gigon, Anthony Gigon, Ariane Malclès. Ophthalmology July 2020, page 873.

Moby-Dick FE title page.jpg
Title page, First edition, 1851 (Wikipedia)

4. Book Chapter – Herman Melville – Moby Dick. Listened to Chapters 109-114 via LoyalBooks.com. See also Sparknotes (narration) and Gutenberg (book text).

Chapter 109, Starbuck states, “But let Ahab beware of Ahab; beware of thyself, old man.”

See Protecting Sight Daily Learning posts here.

Please send me feedback. Would appreciate suggestions of Ted Talks, cataract videos, and journal articles to learn from and share.

Protecting Sight #37: Confidence is the necessary spark before everything that follows. Glaucoma patients see the LiGHT with SLT.

Welcome to day #37 of 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 – Brittany Packnett – How to build your confidence — and spark it in others. ” ‘Confidence is the necessary spark before everything that follows,’ says educator and activist Brittany Packnett. In an inspiring talk, she shares three ways to crack the code of confidence — and her dream for a world where revolutionary confidence helps turn our most ambitious dreams into reality.” (ted.com)

This was a Ted Talk recommendation (via email). If you watch Ted Talks on ted.com, you can click on “Transcript” to see the text. If you click on the text (on a desktop), a video clip for that portion of the talk appears.

Packnett’s pearls are wonderful and I’ve sent along to my nieces and nephews to watch.

2A. Cataract Surgery – Uday Devgan MD – Complete Cataract Case: a very special case. Unedited cases are among my favorites.

3A. Journal – Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Gus Gazzard et. al on behalf of the LiGHT Trial Study Group. Lancet 2019; 393: 1505–16. April 13, 2019.

I saw Malik Kahook MD’s twitter post today and decided to revisit this Lancet article. Would recommend the original article and both of Dr. Kahook’s resources below.

3B. Selective Laser Trabeculoplasty (KEOGT site)

3C. LiGHT Study: 1 Slide in 5 Minutes  (Malik Y. Kahook MD) (Youtube)

Moby-Dick FE title page.jpg
Title page, First edition, 1851 (Wikipedia)

4. Book Chapter – Herman Melville – Moby Dick. Listened to Chapters 105-108 via LoyalBooks.com. See also Sparknotes (narration) and Gutenberg (book text).

See Protecting Sight Daily Learning posts here.

Please send me feedback. Would appreciate suggestions of Ted Talks, cataract videos, and journal articles to learn from and share.

5. (BONUS) I discovered Shane Parrish’s blog, The Knowledge Project, a few years ago. My own blog posts are inspired by his weekly newsletter (Brain Food). I highly recommend the clip below on breaking bad habits. For me, a “bad habit” was watching Sopranos, Seinfeld, and Everybody Loves Raymond video clips on YouTube! (Check out Farnam Street here).