Ophthalmology

This week, I have been on a one-week ophthalmology rotation, working with the resident (Curt) on COS, or the comprehensive ophthalmology service. It has been awesome. Curt is amazing-- super nice, brilliant, and a phenomenal teacher. My intention in doing this rotation was to get more comfortable with the funduscopic exam and with common eye conditions. I've definitely accomplished that (as well as learned how to spell "ophthalmology"-- there's one more "H" than I knew about and a silent "L")! Doing these specialty rotations now is great because the residents recognize that you've already made your career choice. So, rather than sitting there, listening while they try to convince me to go into ophtho (like Amy, my classmate who matched here [very competitive] at Mayo!), I'm just learning things that would be "good to know as a family doc," getting tons of exposure to common things like dry eye and meibomian gland dysfunction, as well as a lot of other varied ophthalmologic conditions, which have included such things as:

• corneal ulcers and abrasions
• chalazions
• conjunctivitis (pinkeye)
• subconjunctival hemorrhage
• herpes simplex and Staph marginal keratitis
• preseptal cellulitis
• glaucomatous discs
• diabetic retinopathy with flame and dot-blot hemorrhages, exudates, macular edema, and vitreous hemorrhage, treated with PRP (pan-retinal photocoagulation)
• posterior vitreous detachment ("floaters and flashing lights")
• retinal detachment
• retinal nevus (mole)
• remnant pupillary membrane
• uveitis
• pinguecula (conjunctival growth due to sun exposure)
• internuclear ophthalmoplegia (inability to completely move one eye medially or towards the nose)
• pigment dispersion syndrome (risk factor for glaucoma)
• benign episodic anisocoria (intermittent pupil asymmetry)
• post-cataract surgery posterior capsule membrane opacity (treated with YAG laser capsulotomy)
• diplopia (double vision) with congenital IV (nerve) palsy
• pseudopapilledema (swelling or fullness of the optic discs)
• conjunctival melanosis (pigmentation around the limbus, found in darker-skinned people)
• macular degeneration with drusen
• trochleitis (~tendonitis of one of the tendons of the eye muscles!)
• hypertensive changes (arterio-venous nicking, Drance hemorrhage)
• spontaneous periorbital hemorrhage secondary to coagulopathy
• dacrocystitis

These ophthalmologists are very good and very thorough, but I think a week of it is enough for me. I've found that they really like using these big words (lagophthalmos, pseudophakia, etc...) as well as abbreviations (BRVO [branch retinal vein occlusion], GCA [giant cell arteritis], RD [retinal detachment], etc...). And they always want to take one more "quick peek here." I feel bad for the patients with all of the bright lights being shined in their eyes again and again! But I've learned a ton, and the patients are very patient.

I've been meaning to get my own eyes checked for a while, as Mayo has something like $1000 (per year?) in a dental/vision account to reimburse you for dental and eye care. But, as I haven't needed glasses or contacts, this money is just sitting there... My fear is getting to residency and needing glasses i.e. the first week of intern year, which would just kill me because I didn't "make use" of the Mayo insurance. I also really love some people's frames and think that, if I could get myself some glasses, I might add a few years to my appearance and gain credibility with patients who ask me, "How old are you?!" So Curt did refraction on my eyes the other day.

It turns out that I have a slight degree of myopia (nearsightedness), i.e. - 0.25 in each eye-- which is not really that significant. I do have a small astigmatism in my right eye. News to me. But this qualifies me for some frames! Curt says it's okay if I don't wear them all the time, i.e. I'd be able to accommodate okay if I went "out dancing or to the beach, glasses-less." Ha ha. Like I do either of those things. In any case, I may go this weekend to see if I can get some stylin' frames. Call me (maybe, sometimes) four-eyes from now on...