The new "No OD vs. OMD rhetoric!" thread

[Visionary]

Are you tired of reading about ODs' and OMDs' mutual disdain for each other? Greater than 300 of the most recent posts on this forum are related to it!

Are you tired of the inflammatory, typically poorly-constructed arguments on this issue? The quality of rhetoric seems to spiral downward not unlike yesterday's lunch!

Are you tired of this whole fruitless endeavor? None of us can honestly think we will convince the other side we're right! And, that being the case, we must just like hearing ourselves talk, eh?

I propose this new thread: one that is completely free of OD vs. OMD rhetoric! If you love ophthalmology, and would like to show your feelings (please do retain some self-control, as this is a public site), post here on the "No OD vs. OMD rhetoric" thread!

*Disclaimer: This is not at all intended to trivialize the OD vs. OMD issue or the strength of conviction on either side, I'm just sick of it appearing in the majority of posts!!!

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[Andrew_Doan]

I propose this new thread: one that is completely free of OD vs. OMD rhetoric! If you love ophthalmology, and would like to show your feelings (please do retain some self-control, as this is a public site), post here on the "No OD vs. OMD rhetoric" thread!

Although I love debating, I love ophthalmology more.

In fact, I love it so much that I'm at the hospital on Saturday taking care of two extremely ill patients. One of my patients is a poorly controlled diabetic with a HA1C of 13%, endogenous endophthalmitis, and hypertension (BP 200/110). I've had to manage her diabetes and hypertension while she is admitted on the retina service.

To end on a positive note, I performed a scleral buckle procedure on a patient with a macular off retinal detachment with hand motion vision. I saw him yesterday, and he is now 20/100! I was shocked to see how quickly he gained vision from an almost complete retinal detachment. He was happy, and I was relieved.

 

[GlaucomaMD]

Andrew,

Congratulations on the excellent outcomes...

Remember though, early excitements can later turn to disappointments...

Retina has been known to re-detach...

Ophthalmic surgery is very humbling - just when you think you "got it down," it has a way of putting you back in your place...
That is partly why it's so much FUN!

I must say I love ophthalmology as well (especially glaucoma!). Can't imagine what else I would be doing. Just make sure you secure occupation-specific disability insurance before they stop offering 'em!

 

[Mirror Form]

Just make sure you secure occupation-specific disability insurance before they stop offering 'em!

Are they planning to stop offering it soon???

 

[Andrew_Doan]

Ophthalmic surgery is very humbling - just when you think you "got it down," it has a way of putting you back in your place...
That is partly why it's so much FUN!

I hear ya. I just finished my glaucoma rotation last month. Talk about humbling.

Post-op outcomes: pressure high, pressure low, and then suprachoroidal hemorrhage.

 

[mdkurt]

After seeing one of my post-op trabs yesterday (yes, Saturday) and biting my nails all morning, it's good to know that hypotony and choroidals happen in Iowa City, too. Still, you won't find me doing anything else.

 

[Richard_Hom]

The "eye field" is most rewarding and highly recommend it to anyone whether they strive for ophthlamology, optometry or opticianry.

Just a thought about patients. My patient population is 95% indigent and can both be rewarding and frustrating.

1. 59-year old woman who has extensive metastatic breast cancer has decided to withdraw all medications and just wanted a refraction to read better in her last 3 months of life. She just also wanted to talk.

2. A 75 -year old male with 20 years of diabetes hadn't been brought in by his children for an eye examination in the last 10 years and now has extensive PDR in one eye and neovascular glaucoma and PDR in the other eye. The eye is NLP now.

Richard_Hom

 

[cpw]

I've seen more diabetic retinopathy in two weeks at the VA than in two years at the UH clinic... I my externship site.

 

[Andrew_Doan]

I've seen more diabetic retinopathy in two weeks at the VA than in two years at the UH clinic... I my externship site.

The VA has tons of pathology.

 

[Andrew_Doan]

Here's an interesting case of pseudoexfoliation with spontaneous zonular dehiscence 5 years after cataract surgery. I took this with my Canon S230 at the slit lamp.

 

[Richard_Hom]

This 43 year old male presents from the Emergency Department with a 4 month history poor vision in each eye and 20years of diabetes. This is his first ever eye examination. His relevant labs at this visit are finger stick RBS is 480. He is on no medications of any kind.

His best vision is HM 6 ft. in each eye. IOP's are 17mm OU.

See photo attachments, OU.

 

[cpw]

This 43 year old male presents from the Emergency Department with a 4 month history poor vision in each eye and 20years of diabetes. This is his first ever eye examination. His relevant labs at this visit are finger stick RBS is 480. He is on no medications of any kind.

His best vision is HM 6 ft. in each eye. IOP's are 17mm OU.

See photo attachments, OU.

Holy PDR batman !!


Poor guy..... first eye exam.. YIKES!

 

[Richard_Hom]

This male patient with a 15 year history of diabetes was seen over last year and was repeatedly referred to a retinologist for evaluation and treatment. Each time the patient failed. He returned to this clinic for "better" glasses. His best vision is 20/100 each eye. Noteworthy is the change of the right eye in 3 months.

The moral is that diabetic retinopathies can change "rapidly" (at least in the eye field).

 

[Richard_Hom]

Of course, you could also get this walking into your office from the ER.

 

[Andrew_Doan]

Of course, you could also get this walking into your office from the ER.

That's impressive. What was the diagnosis? Malignant hypertension? Hypocoaguable state? CNS mass?

 

[Richard_Hom]

That's impressive. What was the diagnosis? Malignant hypertension? Hypocoaguable state? CNS mass?

Parasitic neuroretinitis. Neurologist started on Oral Decadron.

Richard_Hom

 

[Andrew_Doan]

Parasitic neuroretinitis. Neurologist started on Oral Decadron.

Richard_Hom

Interesting. What was the clinical outcome?

Was there a macular star figure?

 

[Richard_Hom]

Interesting. What was the clinical outcome?

Was there a macular star figure?

No macular star seen when everything was quieted. The patient after a 60 day course of steroid has reduced disc edema but still has several flame shaped hemorrhages in either eye in the papillo macular bundle.

Headaches and diplopia have subsided.

Richard_Hom

 

[cpw]

Parasitic neuroretinitis. Neurologist started on Oral Decadron.

Richard_Hom

That's an amazing picture Dr Hom !! the only neuroretinitis I've seen was secondary to cat scratch. she had a beautiful star at her 2 week follow up but alas I couldn't convince her to let me dilate her so i could photograph it. but, she recovered very quickly after a round of Cipro. She even searched me out a few months later to get her new reading Rx. She's going to be a rounds case for me in the spring. I'll have copies of the pics then I can post for ya andrew !! She was a great ODEMS case.

 

[Andrew_Doan]

She's going to be a rounds case for me in the spring. I'll have copies of the pics then I can post for ya andrew !! She was a great ODEMS case.

Thanks!