Eye diseases caused by sunglasses: None, obviously

Eye diseases caused by the sun: 🧵

https://twitter.com/masculinepath04/status/1816075905665511782

Pterygium

This is all nonsense. I’m so tired of people thinking they can exercise themselves to “healthy vision.” Let’s take a look at these exercises…🧵

https://twitter.com/kuijsters_tim/status/1787796031301648582

Saccades are generated in the brain. There are voluntary and involuntary saccades. As long as you have a functional frontal lobe and midbrain you will have normal saccades your entire life without any practice whatsoever.

I’m not sure what he’s trying to accomplish with his exercise here. With a fully developed brain there is no way he is strengthening his frontal eye fields or superior colliculus. If he is trying to strengthen his eye muscles to give himself better saccades (I assume this is the case since all of his content is about strength and mobility) just going about your daily life generating thousands of saccades every day should suffice. You can’t bulk up your extraocular muscles. That’s called thyroid eye disease.

This is a common argument I hear from the pro private equity crowd. I’m trying to reconcile this argument with the business model of PE. Somebody help me. As far as I know, the only ways to generate profit is by cutting costs and/or increasing revenue. (Thread) Medical practices generate revenue by seeing patients, so one option for increasing profit would be telling physicians to work more days, see more patients, bill higher codes, push cash services, all of which I would consider, “interfering with patient care.”

PE thread:

One of the challenges with fighting private equity in medicine is the lack of data. We need to look at costs, outcomes, burnout, etc pre/post PE acquisition. We all know pushing medicine further into for profit territory is bad, but we need data to show how bad it is Of course, PE will never let it happen. In the era of “evidence based medicine” we have this massive intervention (PE acquisitions) happening everywhere with no ability to study its effects on patient care bc it will almost certainly make PE look really bad

This is the selling point of private equity. We have the cash to grow your practice and give you more negotiating power with insurance companies, which is better for doctors and patients. Everybody wins, right?

https://twitter.com/wiley2020/status/1625576788662312960

Until you remember the goal of PE is to increase profitability as quickly as possible, so once the deal is signed, they begin reducing costs. It’s a hard transition, but the practice is full of excellent docs who can still make it work with fewer technicians & 1-ply toilet paper

Couple things about vision insurance. It’s mostly used for glasses/contacts and routine exams for people with perfectly healthy eyes. Also, it’s dumb. Why would the most important disability accommodation in human history not be covered by medical insurance? Makes no sense… But if you have a medical ophthalmic diagnosis, then you don’t need vision insurance for routine eye exams. Everybody over 65 has cataracts. That is a medical diagnosis. You can get a routine eye exam covered by Medicare.

Man next to me on this flight has done nothing but stare at the map on the screen in front of him. That’s it. 5 hours watching a tiny clip art airplane move across the country. Guys I’m not being critical. I’m impressed. No way I could just exist undistracted with my own thoughts.

I get asked a lot about how to use humor in medicine without getting yourself into trouble. Let me show you an example… First, watch this video

So it appears my health insurance saga has come to a somewhat dissatisfying ending. There’s a lot to unpack. I’ll do my best... As many of you know, I received multiple surprise medical bills associated with my emergency hospitalization for a cardiac arrest. Several doctors (who I never met btw due to my lack of consciousness) were out of network and therefore, not covered by Cigna

It’s Election Day, so let’s talk about why our eyes get puffy when we cry We have 3 kinds of tears: basal tears (always there), reflex tears (noxious stimuli), emotional tears (democracy collapsing).

Emotional tears come from the lacrimal gland, the big ass gland in your upper eyelid, pictured here by Netter

Roughly 100% of people on the west coast are dealing with burning eyes from wildfire smoke, so here are a few eye care tips... First, invest in some artificial tears. No redness relievers. If you use visine, you might as well just waft smoke directly into your face while screaming “why is this not helping?!”

https://twitter.com/dglaucomflecken/status/1291102018434510850

Let’s talk about floppy iris syndrome. That’s right, in a specialty with complicated words like “phthisis” and “glaucomflecken,” we have a thing called floppy iris syndrome.

It’s time for the ophthalmology/urology crossover you never thought you needed and probably still don’t. Alpha 1 blockers like tamsulosin relax smooth muscle in the urinary system. Unfortunately, they also relax the iris dilator muscle, despite repeated requests by ophthalmologists that they please not do that

Call night 1/7: 2 pages

5:30pm - Rx clarification from pharmacy

5am - ED, patient punched in the face, swollen eyelids but no orbital fracture, vision 20/30, follow up in clinic this morning

Difficulty rating (from 1-5 eyeballs): 👁 Call night 2/7: 2 pages

5:48pm - Patient with a scratchy eye 1 day after eye surgery. Reassurance provided.

8:30pm - Thought I heard a page, but it was just the clothes dryer beeping

Difficulty rating: 👁

Today, I met the people who saved my life.

I’ve been tweeting about my cardiac arrest since I woke up in the ICU and re-downloaded twitter (@LGlaucomflecken deleted it for my own safety and concluded that if I could figure out how to get it back, I was safe to tweet again) Now almost 3 months, hundreds of tweets and 1 electric bra later, I was finally able to meet the EMTs, firefighters, and call operators who responded that night and hear about their experience

I get asked about blue light blocking glasses more than anything else. It’s a topic I am deeply uninterested in, so here’s a thread about blue blocking (BB) glasses so that maybe I will never be asked about them again. Advertisements for BB glasses focus on 3 selling pts:

#1 improve sleep: This is the only potential benefit. Blue light can screw up melatonin levels, so buying these to help you sleep is defensible, OR just don’t stare at your phone before bed. Lmao I’m kidding that’s impossible

Alright I’m gonna try to explain astigmatism, because this is an extreme example of what you might see at night if you have it.

https://twitter.com/quitlarri/status/1279202481449373696

Astigmatism is all about the cornea. You can have astigmatism in the lens as well, but I want you to read this thread so let’s keep it simple

Ok here’s what everybody wants right now, a 9 tweet eyeball education thread:

I saw a patient who came to the ED with sudden painless vision loss. 20/20 in her good eye, could only see hand motion in her not so good eye, so SEVERE vision loss Thinking the patient had a central retinal artery occlusion (extremely reasonable thought), they started a stroke workup. A CT was done, neuro consult, and they discussed the likelihood of a stroke with the patient. They stopped short of giving tPA and called me.

For all the protestors, pepper spray is oil based. If you get sprayed DO NOT rub your eyes. Immediately blink as much as you can to wash out some of the oil with your own tears. Then, wash your eyes with baby shampoo and rinse copiously with water. Be safe. Obviously, remove contacts immediately if you get sprayed. Some kind of safety glasses or goggles would be great if you have them (protect against tear gas as well)

Boy did I have a wild last few days. Monday night I had a cardiac arrest while sleeping. My wife noticed I was breathing funny, checked my pulse, didn’t have one and started compressions. EMT arrived and shocked me. I spent the next 3 days with some kind of weird brain fog. I was in an ICU, but in my mind there was a big screen tv and nice plush leather recliners. I remember wondering why they were making me wear an open back gown and not letting me watch the big tv. It didn’t seem fair

There’s a lot of talk about *potentially* using hydroxychloroquine to treat COVID. This is the most relevant I’ve been in weeks, so here’s a thread which addresses HCQ associated retinal toxicity... Personally, I love HCQ consults. They make me feel smart because a rheumatologist is asking me for help, but keep in mind the risk of retinal tox is low, so low in fact that routine screening is not recommended until a patient has been on it for 5 yrs, unless pt has certain RFs

It's possible in the coming days that specialists may be called upon to help out our critical care colleagues, so I thought I'd share a few tips for my fellow ophthalmologists on how to manage a ventilator. Hope this helps... 1. First, you need to learn the ICU lingo. Vent is short for ventilator. You may also hear words like, "tube," "code," and "what the fuck are you doing don't touch that."