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CRU 2023: Charting the path to optimal eye emergency care


Steven A. Greenstein, MD, emphasizes the importance of identifying and assessing eye emergencies, highlighting the need to determine when to escalate care from primary to subspecialty settings. He discusses various types of anterior segment emergencies, while stressing the significance of maintaining a calm demeanor in these critical situations.

Steven A. Greenstein, MD, who is part of the faculty for the 2023 CRU Eye Symposium, caught up with Sheryl Stevenson, Eye Care Group Editorial Director, to talk about the meeting.

CRU is an acronym that stands for "Current, Relevant, Useful," and the second annual symposium will be held November 10-12, 2023, at the Silverado Resort in Napa Valley, California. S. Barry Eiden, OD, FAAO, FSLS; Stephanie Woo, OD, FAAO, FSLS; and John D. Gelles, OD, FAAO, FIAOMC, FCLSA, FSLS, FBCLA, are the co-chairs of the meeting, with honorary ambassador Vance Thompson, MD, FACS.

If you are interested in attending the CRU meeting, click here to register.


Editor's note: This transcript has been edited for clarity.

Sheryl Stevenson: We are joined today by Dr. Steven Greenstein, who is among the faculty at this year's second annual CRU Eye Symposium. Welcome to you. We're so delighted to have you and learn more about your presentation regarding eye emergencies and traumatic brain injury. Can you tell us about that?

Steven A. Greenstein, MD: First of all, I'm really looking forward to coming to CRU again this year. It's such an amazing venue—really an amazing group of lecturers and educators who all get together to kind of talk about a very diverse amount of very diverse topics—with a little bit of wine as well. So that's always a fun combination!

This lecture is a little bit different. We normally talk a lot about irregular corneas and surgical management of irregular corneas. So I'm excited to be expanding the repertoire a little bit.

We all know that eye emergencies come up every day. No matter what practice or type of practice you run, whether it be general primary care to the most subspecialized practice, we're always surprised sometimes by what might come through the door. And it's really important to be able to first identify what's going on, to be able to assess how emerging each situation and each case is, and of course when we need to elevate the level of care—whether that be between primary care and subspecialty care, between optometry and ophthalmology, and sometimes between subspecialty private practice and tertiary care settings where certain emergencies and traumatic injuries are best handled. So I'm really kind of looking forward to going through the gamut of the types of emergencies that we see, the management of those emergencies, and it should be a fun lecture with hopefully, some interactive questions as well.

Stevenson: How would you classify the various eye emergencies that may occur? Are there different classifications or certain things that you would look for?

Greenstein: The first is really the level of emergency. Is this something that can be handled and needs to be handled immediately? Is this something that needs to be triaged, but can be managed in the current setting that it's in? I think it's first just the level of emergency, which sometimes is also if you're not seeing some of these things on a regular basis or seeing the outcomes of some of these things on a regular basis, it's going to be very hard to assess, because you don't always appreciate how quickly something has to be fixed or repaired. That alone can be a comforting factor for certain things and for other things make you feel like you need to get that patient to the next level of care faster.

Certainly, there are also different type of emergencies based on where they're occurring in the eye, which is going to lead you to where sort of the next place the patient needs to go or the type of treatment that a patient needs. We'll go through a lot of different things that you need to assess.

Stevenson: Can you walk us through some of the various eye injuries that someone as yourself may encounter whether it's a patient with an eye stroke or an injury, obviously, that needs immediate repair. What are some of the cases that you may see?

Greenstein: We're anterior segment specialists. We're a cornea subspecialty practice so we definitely see primarily anterior segment emergencies here. That can be anything from a corneal abrasion, which can be treated clearly in the office, to corneal infections and ulcers which can be treated also in the office but some need even higher levels of care; traumatic injuries like ruptured globes, traumatic cataracts, dislocated lenses, things like that, ruptured globes, we repair in tertiary care settings, but a lot of the lens repairs now can be done in our outpatient surgery centers. That's more on the anterior segment side. That's my specialty but like I say, you never know what can walk through the door. Retinal issues spanning from retinal tears and detachments all the way to CRAOs [central retinal artery occlusions] and CRVOs [central retinal vein occlusions] and things like that we'll be reviewing as well.

Stevenson: I imagine awareness is just so important among the role of the clinician, technician, and everyone throughout the whole process. What are some key pearls that you may have in that area?

Greenstein: The key pearl is actually sort of being able to remain somewhat calm in these settings because usually the patient is very, very stressed by their emergency situation. Usually something has happened to them all of a sudden and so it's a very, very stressful situation for them. We know it's a very stressful situation for the doctor as well, particularly if it's something that you don't see on a regular basis, something that you don't manage on a regular basis. There's a lot of stress in the room. There's a lot of stress even on your staff that is just kind of used to the routine and now this breaks the routine.

The important thing is being able to maintain a level of calm in the room, both for the patient and for yourself, and that kind of allows you to think through the process. Part of maintaining that level of calm comes from this sort of review of these types of emergencies. When you're not seeing them all the time, the opportunity to review them, go over them and kind of feel like well, I can get this patient to the next level of care or manage some of these things on your own. That really makes it a much more...you feel more confident taking care of these situations, which does bring a level of calm in the room, and it will be very, very important and calming to your patient who may not always have the best outcome when they have to go through these things, but you still need to be able to manage them through it nonetheless.

Stevenson: Thank you for that overview. Is there anything else that you'd like to add that we haven't touched upon?

Greenstein: Like I said, last year, this was an unbelievable meeting. It far surpassed even anything I could have imagined, and I imagined a lot going to such a beautiful location like Napa [Valley]. Really, the education was second to none. It was a very, very impressive group of lectures in a comprehensive way that is not seen in most other meetings around. I'm really looking forward to attending again this year.

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