Yasmin Mali, MD

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,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Joshua Mali, MD, a vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, FL. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica.

	As we sit down together with our families and friends for Thanksgiving dinner this year, we thought reflecting on the great innovations in the field of ophthalmology since the turn of this new century seemed timely (a topic that is a natural by-product of the marriage between a retinal surgeon and a pediatric ophthalmologist!). We tried to be as objective as possible while evaluating all potential innovations by basing our judgments on three elements:

This seems obvious, but this basically describes the influence an innovation has on the field of ophthalmology overall.

Purely evaluates human ingenuity and the creative process in forming the innovation.

: This metric embodies qualities such as patient care/outcomes, physician decision-making influence, and disease modifying abilities.

	Telemedicine rounds out our top 5 and represents a new frontier of our field focusing on two main principles: prevention and early disease detection. Prevention of disease has the ability to not only improve overall patient health, but also to save our healthcare system financially in the long run. 

An ophthalmologist’s experience with telemedicine

	Early disease detection is critical in order to make our current therapies more effective by treating diseases at earlier stages. Technologies ranging from AMD home monitoring systems to nonmydriatic fundus photographs to screen diabetic retinopathy have significantly enhanced our efforts in this capacity and will continue to have advances for years to come.

	OCT is probably one of the most (if not the most) significant advances in ophthalmic imaging in our recent history. Incredibly, we are able to capture anatomical images from basically every part of the eye with OCT technology including the retina, optic nerve, and anterior segment.  

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	While initially conceived in 1991, it wasn’t until 2002 when time-domain OCT was introduced that this imaging modality truly started its journey to clinical utility.

 Later, with the advent of spectral domain OCT (2004-2007), widespread usage among ophthalmologists rose considerably and now is one of the most common ophthalmic imaging tests performed in the world. 

	While EHR may seem like an unusual choice to sneak into our top 5, just ask any ophthalmologist (or any physician for that matter) about the impact of EHR on their practice of medicine. No doubt their responses would be opinionated on both sides of the spectrum, to say the least. While EHR systems began as early as the 1960s, widespread adoption really took shape after the year 2000; currently, nearly 60% of all providers are utilizing EHR systems.

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	While initial financial expenses and practice logistics were burdensome with its adoption, EHR has had an overall positive effect by facilitating inter-practice communications, enhanced structural organization of medical charting, ease of patient medical records access, and improved integration of billing/coding metrics. 

Intraocular Lens (IOL) Implant Technology  

	We’ve come a long way from the days of Sir Harold Ridley implanting the first IOL in 1949.

 The vast array of technological advances in IOL technology is probably unmatched across all the fields of medicine.

	Lenses ranging from monofocal, multifocal, accommodating, toric, and even accommodating-disaccommodating (AD-IOLs) have forged a path of continual innovation, superior visual outcomes for patients, and even reducing-if not eliminating-dependence on glasses.

Anti-VEGF (vascular endothelial growth factor) medications         

	Hands down, the greatest innovation of our new century so far has to be anti-VEGF medications (Eylea, Lucentis, Avastin). These medications have had profound effects on patients with not only exudative age-related macular degeneration (wAMD) and diabetic macular edema (DME), but has demonstrated efficacy in retinopathy of prematurity (ROP) as well.

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	One would be hard pressed to find any other treatment since the turn of the century that has completely altered the prognostic course of such a prevalent condition like wAMD; a dramatic turn of events from essentially a few minimally effective treatments prior to the introduction of anti-VEGF to present day with medications that can preserve/improve vision significantly. The effects of this revolutionary treatment modality have already become generational.or example, some wAMD patients currently being treated with anti-VEGF medications have parents who lived in a time without the availability of this treatment. These patients continually acknowledge how lucky they are to live in a time like this and that’s why it made #1 on our list.

	There you have it, our top 5 innovations in ophthalmology of the 21

 century. Sure, your list might be different and there are other innovations that could have made the list, but this list represents significant advancements in the field of ophthalmology. So, when you are having Thanksgiving dinner this year, make sure to include an extra toast in honor of the great ophthalmological innovations of our time!

	1)      Apple DJ, Sims J. Harold Ridley and the invention of the intraocular lens. Surv Ophthalmol. 1996;40:279–292.

	2)      http://www.practicefusion.com/blog/ehr-adoption-rates

	3)      Zysk AM et al. Optical coherence tomography: a review of clinical development from bench to bedside. J Biomed Opt. 2007 Sep-Oct;12(5):051403.

Articles

As we sit down together with our families and friends for Thanksgiving dinner this year, we thought reflecting on the great innovations in the field of ophthalmology since the turn of this new century seemed timely (a topic that is a natural by-product of the marriage between a retinal surgeon and a pediatric ophthalmologist!).

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	After reflecting on this past year, I felt inspired to write an article on a topic that I hope will be interesting and helpful to a particular subset of people: professional/physician couples. To establish my credibility on the subject matter, it is essential for me to present our background. When my wife and I got married, I was in my final year of ophthalmology residency training at Albany Medical College and about to start my upcoming retina fellowship in Albany as well. 

	My wife was completing her medical internship and started ophthalmology residency at Albany Medical Center as I was just completing it. If you do the math, I would complete my two-year fellowship while she would still have one more year in residency training. At the end of fellowship, I was presented with an offer for my dream job as being the retinal specialist for The Eye Associates in Sarasota, Florida. 

	At first, I was not even going to consider a long-distance relationship for obvious reasons. However, after consultation and weighing the decision very carefully, I realized it was an offer I couldn’t refuse and it was an opportunity for my wife and I to conquer a challenge together as a team.

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	In the medical field, it is very common to see long distance relationships amongst healthcare professionals including medical students, residents, and fellows, who are often in different training programs across the country.

	The key is remembering that it will only be a temporary situation. Therefore, as we have successfully managed our long distance relationship this year, we thought we would share some tips that can be helpful to others.

	This seems like an obvious choice for #1 on our list and rightfully so. It is critical to try and compensate for the time you will not be together. This is also influenced by geographic location; shorter distances are more conducive to increased visits and time spent together in person. 

	This year, we were about a 3-hour plane ride apart. Of course if it were possible, we would visit each other every weekend. Practically, we determined that it was feasible to at least visit each other one weekend every 2 weeks. This was also augmented by holidays, vacations, and ophthalmology conferences. 

	Of course, this should be individualized to each couple’s situation. In addition, if one of you is starting a new job/employment, try to negotiate a more accommodating schedule or more vacation days during this long-distance time.         

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	Communication through multiple methods is extremely helpful in maintaining that personal contact while a thousand miles away from each other. Facetime/skype, email, and texts should be utilized to maintain as much contact as possible.  

	As a married couple living together, you take for granted that physical act of waking up next to each other and going to bed together, so it’s important to try and supplement that with your spouse with increased communication between each other.  

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	Coordinating call schedules, vacation dates, and social events have even higher stakes in long-distance relationships. It is helpful to ensure being on call at the same times if possible; this will help minimize unavailable visiting dates. 

	Make sure to schedule your vacation dates wisely in order to maximize the amount of time you can spend together. You may want to consider multiple shorter vacations in order to assist with maintaining your frequent visit plan. 

	Travel logistics for important social events like weddings and family related activities need to be planned well in advance. Additionally, make an extra effort to coordinate activities that you can do together (a recent example for us is writing this article together!).

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	We probably could have put this higher on the list but we think it almost goes without saying how important it is to consult with your spouse on important matters and work together to achieve compromise. 

	With long-distance relationships, it becomes even more vital and should be done in more frequency given the distance from each other. Always keep in mind that you are teammates for life.

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	To round off the top 5, I threw in a wild card with the “surprise visit”. I find surprises are an exciting way to keep it interesting and show how much you care about your soul mate.

	This year, I surprised Yasmin by taking her on a weekend getaway ski trip in Vermont (photo above), I didn’t tell her exactly when I was coming or what the plan was so it caught her by surprise and was a fun/romantic experience. 

	Overall, the long-distance relationship can seem like a challenging and overwhelming endeavor, but with the right preparation, confidence in each other, and dedication to your significant other, you can achieve anything. Remember, love conquers all!    

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In the medical field, it is very common to see long distance relationships amongst healthcare professionals including medical students, residents, and fellows who are often in different training programs across the country.

Author | Yasmin Mali, MD

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