Eyeworld Daily News

16 | EYEWORLD DAILY NEWS | MAY 17, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING by Liz Hillman Editorial Co-Director "C OVID crashed my life"—if this is how you feel, take a deep breath. A symposium co-run by the ASCRS Young Eye Surgeons (YES) Clinical Committee and Vanguard Ophthalmology Soci- ety gave attendees info on how to "survive and revive." Topics ranged from prac- tice/job-finding considerations to surgery/patient care to pre- dictions for a new normal. Manjool Shah, MD, Ann Arbor, Michigan, tackled the topic of keeping surgical skills sharp from home during a time of reduced volume. "Even in these uncertain times," Dr. Shah began, "it's important for us to come to- gether, learn from one another, and continue to grow and develop." He drew from sports coach- ing literature for how benched players keep themselves ready to play with "mental represen- tations," "anticipation game," and specific, hands-on tasks. Surgical skills start in our heads, not in our hands, Dr. Shah said, adding that "our best tool is watching game tape." He recommended watching video of your rou- tine cataract cases—and don't fast forward. Watch actively, take notes, draw diagrams, and imagine where you would make incisions, etc., Dr. Shah said, adding that you should rewind and rewatch key portions of the tape. While watching, he said to be criti- cal of yourself, perceiving the "why" behind every action and inaction. He advised finding YES symposium drills down into impact of COVID-19 pandemic continued on page 18 6 and 12 months afterward. Overall, IOP was reduced 23%, and baseline IOP and corneal hysteresis accounted for 64% of the variance of IOP lowering of the procedure, Dr. Radcliffe noted. Viewing the angle with gonioscopy is also a criti- cal component of glaucoma exams. There is, of course, gonioscopy at the slit lamp with a gonioprism, but Dr. Radcliffe also mentioned vir- tual gonioscopy with anterior segment OCT and ultrasound biomicroscopy. In his sum- mary, Dr. Radcliffe described gonioscopy as a "priceless" glaucoma diagnostic technique that should be performed at baseline on all patients and periodically afterward. Central corneal thickness, he contin- ued, is the current standard for IOP interpretation and glaucoma development and progression risk, and corneal hysteresis likely allows for better assessment of glaucoma development, progression, and risk. Jody Piltz-Seymour, MD, Philadelphia, Pennsylvania, gave a "practical approach" to optic nerve analysis in her pre- sentation. Optic disc imaging has revolutionized glaucoma care, Dr. Piltz-Seymour said, and the most important "de- vice" for interpreting these images is none other than the ophthalmologist's brain. A normal optic nerve is vertically oval with an intact rim interiorly and superiorly; it follows the ISNT rule. In assessing the optic disc think SHIP—size, hemorrhage, ISNT evaluation of the optic nerve rim, and parapapillary atrophy. When evaluating images for progression, look for hem- orrhages, progressive rim thinning, widening notch, wid- ening nerve fiber layer defects, vessel shifts, increasing ß-peri- papillary atrophy, and pallor, Dr. Piltz-Seymour presented. Dr. Piltz-Seymour's pearls for optic disc imaging evalua- tion included: • The more you look, the more you will see. • Have a system for observa- tion. • Take the time to look for optic disc hemorrhages. • Magnification improves ob- servation. • Look for true contour chang- es. • Compare to normal. • Compare to contralateral eye. Brian Francis, MD, Los Angeles, California, gave an overview of how OCT can be complementary to other indicators of glaucomatous optic nerve damage and in following glaucoma suspects and mild-to-moderate glauco- ma patients. It is important, Dr. Francis noted in his presen- tation, to make sure the scans are of sufficient quality. He em- phasized that this information must be taken in context with the clinical exam and visual field testing. Editors' note: Drs. Radcliffe and Francis have financial interests with various ophthalmic companies. Drs. Shukla and Piltz-Seymour have no financial interests related to their presentations. continued from page 12 Dr. Shah shows a video of Nicole Fram, MD, practicing a technique on SimulEYE. Source: Manjool Shah, MD, screenshot from presentation one actionable change to fun- damentals that you could apply when back in the OR. After watching straightfor- ward cases, Dr. Shah said to view more complicated case videos. While watching, he said to use the power of the video to go forward and backward to figure out where the complica- tion started.

• Cover