Fishman Blog

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Why is manual expression at the slit lamp important? January 9, 2021 Question: Why is manual expression at the slit lamp important? [vc_row][vc_column][vc_video link="https://youtu.be/ZuTFatYcaM8"][/vc_column][/vc_row] While automated expression devices are efficient and provide consistent results, manual expression as shown here provides incredibly helpful information about the qualitative features of the meibum. Here, we see surprising contents of a meibomian gland. It is multi-layered[...] Read More
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Plasma rich in growth factors fibrin membrane (mPRGF) January 3, 2021 Fishman comments: Dr. Fishman offers Plasma rich in growth factors (PRGF) autologous serum eye drops in his practice. PRGF is a form of autologous serum tear eye drop that can be used to treat severe dry eye and other ocular surface diseases. During the preparation of PRGF, a fibrin membrane[...] Read More
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Diagnostic ability of maximum blink interval together with Japanese version of Ocular Surface Disease Index score for dry eye disease December 29, 2020 Fishman comment: Blink analysis is a simple yet under appreciated technique that helps dry eye diagnosis and treatment. This paper illustrates the utility of blink analysis. Authors: Kunihiko Hirosawa1,2, Takenori Inomata1,2,3,4,5*, Jaemyoung Sung1, Masahiro Nakamura2,6, Yuichi Okumura1,2,4, Akie Midorikawa‐Inomata5, Maria Miura1,2, Kenta Fujio1,2, Yasutsugu Akasaki1,2, Keiichi Fujimoto1,2, Jun Zhu1,7, Atsuko[...] Read More
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Potential Role and Significance of Ocular Demodicosis in Patients with Concomitant Refractory Herpetic Keratitis December 26, 2020 Fishman comment: Interesting association with HSV keratitis and Demodex and by treating for Demodex, clinical improvement was observed. Purpose: To evaluate the role of Demodex infestation of the eyelids in patients with recurrent herpetic keratitis. Patients and Methods: This is a retrospective and noncomparative case series. Twenty-seven patients with ocular[...] Read More
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Gland of Zeis Expression December 23, 2020 Gland of Zeis expression The Rodney Dangerfield of glands ... “they don’t get no respect!” The #glands of #Zeis are the much less “respected” glands in the eyelid but have important function providing lubricant to the eyelash and lid margin. These sebaceous glands are located on the margin of the[...] Read More
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High-Speed Video Blink Analysis December 13, 2020 High speed blink and ocular analysis . We are exploring some exciting new research directions at FishmanVision. Stay tuned… Read More
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Punctal plug follies December 5, 2020 Extruded silicone punctal plug. Punctal plugs are generally well tolerated but occasionally the body will form reactive tissue and push them out as was the case here. It is important to have punctal plugs monitored . #Dry eye #plugs #mgd #Ophthalmology #Cornea #Blepharitis #eye disease Read More
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Intestinal microbiome: a new target for chalaziosis treatment in children? November 27, 2020 What is Known: • The intestinal microbiome plays a crucial role in several inflammatory diseases of the eye and is considered a therapeutic target. • Probiotics play a role in the prevention and treatment of different conditions in children. What is New: • In children probiotic supplementation is safe and[...] Read More
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A fishy floater November 18, 2020   [wpvideo zNkLjO4e hd="true" loop="true"]   A fishy floater seen at FishmanVision. Check out DrFishman's podcast EyeChat with Dr. Harv on floaters #floater #pvd #vitreous separation #retina #vision Read More
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Lesser known findings of Map Dot Fingerprint Dystrophy: Vision loss and painless tearing November 6, 2020 https://youtu.be/XG0_ZGilZso     Map dot fingerprint dystrophy (MDFD), also known as epithelial basement membrane dystrophy, is an incredibly common but frequently overlooked cause of a range of problems in the eye. The goal of this blog is not to reiterate what we already know about basement membrane dystrophy but to[...] Read More
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Dynamic oil analysis October 22, 2020 Manual expression of meibomian glands Manual expression of meibomian glands is not just an important therapeutic option for #mgd, but it is a critical diagnostic component of a dry eye exam. Manual expression is a dynamic assessment of oil color, turbidity, and viscosity. This dynamic assessment is not seen in[...] Read More
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Trichiasis masquerading as dry eye disease October 20, 2020 Trichiasis masquerading as dry eye disease What is it? Trichiasis is a condition where eyelashes (one or many) are misdirected onto the cornea or conjunctiva. The mechanism of injury is from friction and the constant rubbing over months and years can cause severe corneal abrasions, infections (ulcers) and can result[...] Read More
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Iris flocculi October 15, 2020 Iris flocculi is a benign condition but can be associated with familial TAAD (Thoracic aortic aneurysm and dissection). Patients with these findings should be seen by a cardiologist especially if there is a family history of early cardiac event. #ophthalmology #iris #systemicdisease Read More
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Asteroid Hyalosis October 1, 2020 asteroid hyalosis Spectacular video of asteroid hyalosis. The asteroid bodies are made up of hydroxylapatite which consists of calcium and phosphates or phospholipids. It is remarkable that it rarely affects the patient’s vision but it can make examination challenging. From an ocular standpoint , asteroid hyalosis is relatively benign but[...] Read More
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Recurrent corneal erosion: a comprehensive review by Miller et.al. September 30, 2020 Fishman Comments: Recurrent cornea erosions (RCE) can be a tough condition to treat. One particularly frustrating cause is LASIK or PRK. I see a number of patients who have been diagnosed with "dry eye" and/or neuropathic pain syndrome after refractive surgery. However, a careful examination of the cornea in many[...] Read More
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Dynamic OCT of a Floater September 18, 2020 Dynamic OCT of a floater. At FishmanVision, Dr. Fishman will often personally perform the testing (giving his techs a much needed break). The OCT doesn’t record the “taking” of the test , but as shown here , watching the test in progress can be very revealing and super helpful to[...] Read More
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Periocular BoTox on Tear Film Homeostasis September 16, 2020 Fishman comments: The effect of Botox on ocular surface disease is seriously under appreciated. While the cosmetic benefit of Botox is widely known, Botox use was actually "invented" by an Ophthalmologist (Dr. Alan Scott) to treat strabismus (eye muscle misalignment) in kids. BoTox does have some other less well known[...] Read More
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4 dead Demodex September 12, 2020 The below video snippet is an example of dead Demodex mites on a lash. We see no leg movement on video microscopy and presume mite death.  Demodex mites are parasites with a length ranging from 200-400 microns (1) . One study suggests that six or more Demodex mites per 16 lashes[...] Read More
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Lash Plucking August 29, 2020 Epilation. Sometimes it’s the small things in life that can really make a difference in the patient’s life. However don’t forget to consider eyelid carcinoma in any misdirected lash. #squamouscellcarcinoma #basalcellcarcinoma #trichiasis #sebaceouscellcarcinoma #rosacea #dryeyes #ipl #blepharitis #demodex #mgd #meibomianglanddysfunction Read More
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Dry eye and Menopause August 29, 2020 Prevalence of ocular surface disease symptoms in peri- and postmenopausal women Garcia-Alfaro, Pascual MD; Bergamaschi, Luciana MD; Marcos, Celia MD, PhD; Garcia, Sandra BSc; Rodríguez, Ignacio MScAuthor Information Menopause: September 2020 - Volume 27 - Issue 9 - p 993-998 Conclusions: Sixty-four percent of the pre- and postmenopausal women studied[...] Read More
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Meibomian Gland Incision August 25, 2020 An obstructed meibomian gland that becomes acutely inflamed is called an internal hordeolum. It is typically the result of infectious inflammation and the organism most commonly involved is Staphylococcus. Antibiotic therapy is thus the typical first step along with relief of the obstruction which can be achieved by using warm[...] Read More
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Live View of a Retinal Hole August 22, 2020 Shown here in this video snippet is an operculated hole in the periphery of the retina. Clearly seen is the operculum floating above the pigmented edge of the hole (a lattice spot). This hole occurred in response to a posterior vitreous separation pulling on the retina. Retinal hole Holes can[...] Read More
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Glaucoma and dry eye August 13, 2020 Patients with dry eye disease need to be screened for glaucoma. It is not uncommon for steroids to be used in dry eye disease and is often used in a "pulsed" type fashion. As a result, while the pressure may be measured as "normal" in the office, the intra-ocular pressure[...] Read More
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Multifocal lenses and dry eye August 13, 2020 Multifocal intraocular lenses are particularly sensitive to small irregularities on the corneal surface. Dry eye disease in its many different manifestations can alter the ocular surface and significantly degrade the image quality for the patient. Read More
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“Review. Neuropathic Pain and Dry Eye” by Dr. Anat Galor August 4, 2020 Fishman comments: Dr. Galor continues to be one the TOP academic physician/ researchers in the area of dry eye and neuropathic pain. This article from 2017 by Dr. Galor et al. does a terrific job of summarizing the mechanisms, treatments and challenges of neuropathic pain and dry eye and how[...] Read More
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Conjunctivochalasis Displacing Tears July 29, 2020 Shown here is a segment of video showing conjunctivochalasis. Conjunctivochalasis (CC) as described by EyeWiki is "redundant, nonedematous conjunctiva that causes a wide variety of symptoms ranging from completely asymptomatic, to worsening of an unstable tear film, and when severe, a real mechanical disruption of tear flow."  As a part[...] Read More
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Can Gut Microbiota Affect Dry Eye Syndrome? by Moon et al. December 16, 2020 [vc_row][vc_column][vc_video link="https://www.youtube.com/watch?v=qEVGr8luZg8"][vc_column_text] "Can Gut Microbiota Affect Dry Eye Syndrome?" by Moon et al.  Fishman comments: The microbiome of the gut is proving to be a very exciting new frontier in medicine in general, and in ophthalmology in particular. This paper is an excellent review highlighting how the microbiome of the gut can affect[...] Read More
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Effect of IRT5 probiotics on dry eye in the experimental dry eye mouse model December 4, 2020 Effect of IRT5 probiotics on dry eye in the experimental dry eye mouse model Jayoon Moon, Jin Suk Ryu, Jun Yeop Kim, Sin-Hyeog Im, Mee Kum Kim Abstract Objective To investigate the clinical effects of IRT5 probiotics in the environmental dry eye model. Methods Eight week old male C57BL/6 mice[...] Read More