Over the years, we’ve all heard the adage, “Change is the only constant in life.” Well, most people don’t like change. Change can be intimidating, such as when we start a new position. Change can be frustrating—when we see regular cuts to Medicare reimbursement or the expansion of Medicare replacement plans, for example. However, change also can be liberating, as many retina doctors experience when they open an independent clinic. Change can be exhilarating, as we have seen when we provide patients with novel treatment options. Change can also be disappointing, as we have seen with certain treatment modalities.
As with much in life, the way a person approaches change depends on their station in life and perspective. Socrates said, “The secret of change is to focus all of your energy not on fighting the old, but on building the new.” With this mantra at heart, let’s continue to learn together and modify change to our advantage for the benefit of our patients’ vision.
In this month’s issue of New Retinal Physician, Dr. Abbas Haider and his colleague Jake Breazeale present a case in which indocyanine green (ICG) dye retained after complex cataract surgery subsequently led to vision loss. Interestingly, their patient presented the following day with inflammation, which could have been infectious (endophthalmitis) or non-infectious (toxic anterior segment syndrome, or TASS) in nature. As many of us have experienced, ICG dye powder is mixed with dextrose 5% in sterile water to increase its specific gravity, thereby providing a better stain of the internal limiting membrane. This step is subject to human error, as incorrect reconstitution may result in a higher-than-normal concentration. This increased dose, as well as longer duration, can result in more severe injury to the neurosensory retina.
Speaking of retinal toxicities, the next article features a comprehensive review of how certain systemic medications can cause retinal damage. Dr. M. Stephanie Jardeleza encourages readers to carefully review patient medications, as early detection is essential in preventing or limiting vision loss that is often irreversible. As retina specialists, we should never underestimate our fundamental medical skills.
Dr. David J. Ramsey, Dr. Ayman Elnahry, and their medical student, Ashwin Verghese, present a case report highlighting the importance of a thorough history, detailed review of systems, and a little help from genetic data registries. They describe and discuss a case of maternally inherited diabetes and deafness (MIDD), a mitochondrial syndrome that can present with decreased vision secondary to pattern retinal dystrophy.
It’s easy to dismiss a patient who has good vision but is complaining of redness/irritation as having an anterior segment issue. However, Dr. Sayena Jabbehdari and Dr. Sarwar Zahid present a case in which the patient’s irritated eye was saved by preventing potential endophthalmitis stemming from a loose subconjunctival Gore-Tex suture. Remember, the retinal examination begins with the slit-lamp!
Retina practice consultant Elizabeth Cifers reviews iterative aspects of operating a retina clinic in this issue’s practice management section. Specifically, Elizabeth provides insight on regularly evaluating and revising practice operations. As someone who founded a solo retina practice, I agree with Elizabeth that a never-ending cycle of improvement leads to success! Human capital is the most important investment we can make, so create an environment of continual learning and make your staff visionary partners in the process.
If you are an early career retina specialist interested in contributing to New Retinal Physician, please feel free to contact me directly. We plan to partner with our industry colleagues to host some social events during the American Academy of Ophthalmology’s 2023 meeting this month. Mitul and I look forward to seeing you in San Francisco for more camaraderie and mutual growth! NRP
— Hemang K. Pandya, MD, FACS
President, American Retina Forum
Co-Chief Medical Editor, New Retinal Physician
