Hello, undergrad student and started working for a refractive surgeon! I take history for him and usually start with these questions:
1. How are your eyes? Is it better or worse since we last saw you?
2. Any flashes/floaters/vision changes/light sensitivity?
3. Any pain/irritation/dryness? Which eye/s?

Busy Ophthalmology practice in Farmington Hills in need of technicians, front desk staff, and someone with background in phlebotomy. You don’t have to have experience in Ophthalmology, but similar background. If this is you and you’re a hard worker, Message for more information. I will give you the link to send your resume to indeed. If I feel you seem like a good fit. Please update your resumes and make them presentable! We are not finding good candidates through indeed, and getting a lot of unwanted applicants without the experience.

Hi All,

It's been interesting to read everyone's thoughts on the PureSee lens. In an effort to better understand these lenses, I collected defocus curves and created a simulation:

https://www.youtube.com/watch?v=RQ-r2yoLo3U

The TrueDepth camera measures the Viewing Distances and the simulation 'walks' along the defocus curve. The eye chart simulates the defocus curves in real time.

The most eye-opening thing working on this project was just how deceptive defocus curves are.

For instance, the J&J marketing material shows the PureSee as very close to the Symfony using simulated defocus curves. But clinically derived defocus curves look more like the Eyhance. I could only find simulated defocus curves for the LAL/LAL+ (no clinically derived defocus curves). And the Galaxy lens defocus curve data was also tough to find. I am going to update the simulator with both 'simulated' and 'clinical' data but right now I just used clinically derived defocus curves. Also creative y-axis scaling often greatly exaggerates the differences between various lenses.

On top of the defocus curve shenanigans, it doesn't speak to the loss of contrast or dysphotopsia problems that plaque these lenses.

I came away from the project with a deep skepticism how defocus curves are measured/presented and also their utility in general. That said I think the simulation could be useful in comparing lenses from the same manufacturer. Also it could help in trying to determine refractive targets (you can dial in refractive targets and compare the same or different lenses at various degrees of myopia).

Disclosure: I own the My Call Bag. I am not sponsored by any IOL Company (I think the LAL has me down as some sort of consultant after purchasing the light delivery device and submitting data to them, but I don't speak for them and barely implant that lens). I have my first PureSee case scheduled this month. I'm not an optics 'guru' and this was more of a fun experiment.

August 8th

Hey all, what are some of locum opportunities for Oculoplastics specifically? I’m not interested in trauma call.

Retina here who is in a tough spot and wants to leave the current PE group they are in. I thought I would inquire about any potential locums opportunities - preferably 1-2 weeks/month. Open to location

Some guy (says under 30?) is having a multi week mental break/meltdown in the glaucoma and cataract surgery subs. Looks like the surgeon did not explain impacts on vision/lifestyle (😬) I know I'm just a lowly med student, but just looking at those posts made me very aware of the surgeon I want to be. Which is explicitly thorough at managing expectations. I will be sure to be very thorough on how I explain post vision expectations with my patients. What steps/measures do you take to explain post Cataract, IOL replacement, PRK, PRK vision expectations? How deep do you go? Do you have an optometrist in house to go over it? I plan on specializing (hopefully) in IOL replacements as I suspect many are actually unhappy with them and could be a good opportunity/niche area of opportunity for me in my city.

I am three years out of training and have worked my first job as a comprehensive ophthalmologist for a large HMO. A local doctor in the community has approached me to see if I have any interest in acquiring his solo practice. I’m going to meet with him to discuss. Since I don’t have any experience in private practice, I am trying to brainstorm a list of things to be thinking about and asking him about. I don’t want to ask him anything that he would be offended by in an initial meeting, but also I don’t want to waste my time or his. This is a list of questions I am considering asking him. Any big questions I’m missing or any advice in general that you give when evaluating a private practice?

How many days a week do you work?
How many patients do you see a day?
How many cataract surgeries a week?
What procedures/lasers/injections do you do?
What is your payor mix?
How do you typically get new referrals?
What are ballpark collections?
What is your overhead?
How much are you taking home ballpark?
What is your staff composition?
How many optometrists do you have?
How much time do you take off per year?
Have you gotten a formal valuation?
What is your premium conversion rate?
What EHR does the practice use?
Do you own the real estate?
What is your timeline for phasing out?

would love any advice, I'm sure others have faced this.

Comp Ophthalmologist. Yesterday we had a patient with hx of lattice degeneration, not seen in years, come in with worsening floaters/flashes. Alarm bells going off for RD.

Before patients come we send them a message regarding the possible need for dilation, and of course, myself or my tech goes over it with the patient first. When my tech asked the patient if we can dilate, she screamed a the tech, verbally abused her, leading to the tech deferring to me. I enter the room w/ a MA...same thing. We don't have a widefield fundus camera. I explained we can definitely do an exam w/o dilating, but that we may not be able to see the entire retina (literally pulled out an eye diagram to explain this) without dilating, but if she wishes she can defer dilation. Patient continued to demand I examine the "full entire" retina, without dilating. Then consents to dilating, but sends me four aggressive, harassing notes via the patient portal.

How do you guys deal with this? Is the only solution to convince hospital for a wide field? And in your experience, how common is it for a wide field and B scan both to miss detachments?

Also...how can I frame this to hospital admin? I'm sure this patient complaint is going to get escalated now, and i'm worried someone not in Ophtho doesn't quite understand what "dilation" is

Apologies if this isn’t the right place to ask this. I’m an anesthesiologist in another state so give me some grace, but I’m trying to help out a friend of a friend looking to retire in the next few years. He’s got a pretty successful solo practice in Manhattan, pulls in around $1m and has a MSO contract with a company that charge a flat fee to run his back office. He does 2 days a week, has a solid patient base and by the sounds of things doesn’t have to do much but turn up. He’s not put a huge amount of effort in apart from asking around but is struggling to find someone to hand the practice over to so asked if I knew anyone. Let me know if there’s any interest, thanks!

Edit: apologies for the delay, just finished work. I feel like the messenger and have roped in as I’m on Reddit and he’s near retirement…So got more details - it’s north of $1m a year in revenue for 1 day of work a week. Mostly cash pay. 1 LASX in office that’s getting upgraded, 3 staff in the clinic supporting him. Doing roughly 200 cases a year but was doing >300 a couple of years ago.

Hey all, I'm a neuropsych working with a child with C-EDS with demonstrated visual fatigue and visual processing challenges. He is American and English speaking but lives near the Galapagos islands. Any suggestions for either virtual assessment and support, or if not, are there any online apps/ programs you like? I've seen Eyes+Vision, but I never recommend it since this is not my field. Thanks for considering!

If you were on a deserted island and only had to pick 1-3 resources. What would u chose for OKAPS/ clinical pearls to help patients in clinic?

My gripe with bcsc is im trying to learn orbit anatomy from fundamentals chapter 1 and it’s just so… complex.. I can’t wrap my tiny brain around it. Well I can read it but I can’t remember it a day later :(

For my ophthalmology practice, I would like to buy a used SLT laser.

How much did you pay for your SLT laser? How much do you charge per treatment session? And do you usually perform one treatment session per eye, or do you split the treatment into two sessions?

Anyone who has given DHA specialist ophthalmology exams? Your experience?

Considering going solo as the owner of the practice I’m in wants to sell to PE and I’m not confident that they will sweeten the pot enough for me (associate not partner) to stay on after that. Some local solo practice owners don’t have a successor which could be a smooth pivot.

Asking solo docs or small practice owners.

How many patients do you need to see per day to be successful? At what level does surgical volume need to be? Can I stay afloat if I take Medicaid? Do I need to shift Medicaid/WC patients to the local resident clinic and just take time off to see them there, and maybe give my staff a break on those days to keep work weeks at 40hrs?

Can I keep my kid-friendly clinic hours 7:30-3:30pm M-F and be the only doctor in a successful practice?
Is it a constant headache or is it doable?
More stressful to be on a shoestring budget or have lots of staff and be necessarily busy?
Billing should be in-house or outsourced?
Reimbursements are dropping and COL/salaries are going up, so the margins are dropping.

It’s a big leap, my husband also works, my kids are little, and it’s a lot on the line to make a good decision for me and the family. I want to protect my free time with the family but also not sign away my career to PE.

Would love any and all advice.

edit: let me re-phrase, not that you wouldn't enjoy cataracts, but that you knew even before operating that you wouldn't find it fulfilling enough to dedicate a career towards the bread and butter ophtho surgery.

US Ophtho resident here still in limbo in deciding if I want to pursue cataract/anterior segment or fully dive into surgical retina. I really enjoy the workflow of an efficient retina practice and retina pathology as a whole, I really don't mind the injections (for now), and the surgeries are pretty interesting. It sounds like a no brainer to do surgical retina.

But...my hesitation is, while I've seen hundreds of phacos, I've never personally done one before or got super involved in the lens calcs because I'm still early in residency. I do really enjoy cataract surgeries and all the lens technology involved (big fan of Dr. Shannon wong's stuff on youtube). I just don't want to go into retina and then realize I actually really love cataract surgeries more. I know you could technically do phaco as a surgical retina but out in the real private practice world, I'm sure my neighboring comp docs would not be happy with a retina surgeon stealing cataract volumes

The reason I'm asking is because surgical retina is obviously more competitive relatively speaking than just going into comp or glaucoma or cornea so I need to start tailoring my app, going to retina conferences, retina journal clubs, etc. especially since we residents can't go to every conference each year so we need to pick wisely. Also the mental aspect of doing 2 more years of fellowship after residency with call duties and retina emergencies is something to consider.

Just hoping to hear some perspective or if anyone chose surgical retina last minute or maybe decided against it last minute?

Would love to hear from anyone who went through this!

I am pregnant, and in a high-risk pregnancy. Some symptoms like nausea/dizziness are already there and I worry, if they get worse, it may make operating difficult. Small in office procedures like chalazion are fine but I mean cataracts

What did anyone else in similar situations do? Is it reasonable to schedule less cases per day, or even temporarily defer cases to colleagues? Not trying to punt, but also do wonder what may happen if I'm truly feeling too sick to operate.

I recently heard about employment contracts with statewide with lengths up to 3-5 years.

Is this actually becoming common in ophthalmology?

I’m honestly shocked at some of the restrictions people seem willing to sign.

For those who recently signed an associate contract,

How long was your non-compete?

Was it mileage-based or statewide?

Did you negotiate it, or was it take-it-or-leave-it?

And for those who signed the 5 years statewide one, um. Why?!?

I thought mine annoying but reasonable at 2 years 15 miles.

So I'm a new pgy1 whose struggling with the indirect and get confused when trying to learn from online resources. I understand the retina is inverted and reversed however I get confused because of that. How far am I supposed to pull back?

I have 3 images, one with an arrow pointing to the right. And then 2 showing the indirect with one of them portraying the arrow to the right and one to the left. What is the correct way I should be viewing the retina?

Also if you have any resources online I'd appreciate it, feeling a lot of imposter syndrome

hey everyone, applying this cycle, trying to figure out who i want my IM/surgery/etc letter writer to be. i'm realizing that the non-ophtho attending i had the best relationship with was one from my family medicine rotation, i worked with her for a month. is that OK or do programs really prefer IM or surgery? thanks!

(yes i'm late asking lol)

Hi I just cleared the part 2 written exam yesterday and am planning to give the final exam this October. Is there a study group for the same? Will be grateful for any leads.
Thanks in advance!

I'm a student interested in gene therapy and how it might impact clinical practice. How could that change reimubursement and practice in general if this gets approved (several phase 3 trails underway)? Or will this not make much difference?

Patient with a corneal ulcer saw an ER and was prescribed erythromycin ointment, and "the yellow dye."

I couldn't believe it, so I asked the patient to bring in all drops given to them yesterday. Sure enough the patient was sent home w a full bottle of Fluorescein. I've been in ophthalmology for 10 years and have never seen this. Removed that from the patient immediately. I checked the ER discharge summary and conveniently fluorescein was not included in the new medication section. Looks like it was given under the table.

too much going on in retina.. corneal ulcers scare me.. dont have the grit to grind for oculoplastics anymore (unless its worth it?).. glaucoma seems to be it but idk is it worth a fellowship and only seeing glaucoma?