Fishman Blog

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Flow Control Punctal Cautery: A Novel Approach to Occlusion September 19, 2021 To cauterize or not to cauterize, that is the question. The big concern with punctal cautery as mentioned in a previous blog (“to plug or not to plug that is the question”) is that cautery is considered an irreversible and permanent solution. Moreover, cautery is thought of as an “all-or-none”[...] Read More
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Explosive Meibomian Gland Expression August 11, 2021 Explosive Meibomian Gland ExpressionFor those patients with meibomian gland disease, the expression of meibomian glands on a regular basis is an important part of maintaining a healthy ocular surface.  In this video snippet, Dr. Fishman shows an "explosive" manual expression of a gland in a patient with MGD. Dramatic indeed,[...] Read More
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Impacted Foreign Body in Meibomian Gland July 21, 2021 Impacted Foreign Body in Meibomian Gland  The meibomian glands are specialized sebaceous glands that secret lipids (1). What is in this special gland? Oils, salts, water, proteins, DNA/RNA and its own microbiome all show up (2-3) - but not an eyelash! https://youtu.be/cvwZaRRYB0A   In the above video snippet, Dr. Fishman shows a[...] Read More
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EyePrint Scleral Lens using Impression Molds July 16, 2021 Data Driven Scleral Lens Design FishmanVision is super delighted to now offer Eyeprint scleral lenses. What is so special about EyePrint scleral lenses? They are truly data driven scleral lens designs. In other words, no fitting sets, no endless iterations, no guesswork.  How are such precise scleral lenses made?  [...] Read More
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The Shrinkage: Radiofrequency to treat Epiphora June 7, 2021 Conjunctivochalasis (CCH) is a big issue in ocular surface disease (aka dry eye) and often a frequent cause of epiphora. The video snippet shown below is a case where the patient was experiencing significant epiphora from both conjunctivochalasis and benign eyelid cysts that were displacing the tear meniscus onto the[...] Read More
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Mystery eyelid lesion: cilium incarnatum externum June 7, 2021 Mystery eyelid lesion! https://youtu.be/8LcR6eN8Udk This subcutaneous eyelid elevation was caused by a misdirected eyelash - also know as “cilium incarnatum externum.” This particular patient was referred in by her dermatologist to rule out a possible cancer on the eyelid. It was a big relief for the patient to learn that[...] Read More
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Dry Eye Mimicry: Salzmann’s nodule April 17, 2021 Dry Eye Mimicry This video snippet showing a patient with Salzmann's nodular degeneration in the cornea. Often patients with these corneal nodules will report that they have dry eyes, but the discomfort is from the thinned epithelium over the nodule becoming inflamed with epithelial breakdown also possible. These patients can[...] Read More
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How to Abort a Chalazion? March 23, 2021 Styes (also known as hordeolums) are painful pimples of the eyelid margin and dreaded by many! Styes can evolve or co-exist with a chalazion, a very uncomfortable swelling of the eyelid and cosmetically unacceptable. This blog post shows a video of Dr. Fishman using a Maskin probe to avert a chalazion.[...] Read More
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Eye Exam Superpowers: Finding Systemic Disease February 15, 2021 One of our greatest "superpowers" is the ability to make connections between findings on the eye exam and systemic disease. Prevalent diseases such as diabetes, hypertension, and thyroid disorder are readily found on our ophthalmic exams. However, we can often detect uncommon and rare genetic diseases. Such is the case in[...] Read More
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How to detect cardiac irregularities during the eye exam! February 5, 2021 Ocular Pulse!   https://youtu.be/Xinprnle2do Shown is the ocular pulse as seen by Dr. Fishman (www.fishmanvision.com) as he measures eye pressure using the Goldmann tonometer. As the heart beats, the pulsating blood pressure wave can be seen as pulsations in the tonometer mires. Cardiovascular activity can be detected by measuring various[...] Read More
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What does Uveitis look like at the slit lamp ? January 28, 2021 Anterior Uveitis imaging at the slit lamp The below video shows what we, as ophthalmologists, see when looking at uveitis through the slit lamp. By angling the slit lamp beam, we can actually can see fine particulates in the anterior chamber. Look carefully for these tiny dots floating around (it[...] Read More
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Phonto Slit Lamp Imaging January 27, 2021 Advanced Slit Lamp Imaging https://youtu.be/x4ZnaK8lLVk   Imaging at the slit is particularly helpful not only for the clinician to go back and "review the films," but, also to educate the patient about what we actually see on their eye. In this video, Dr. Fishman is using the Phonto Slit Lamp[...] Read More
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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
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Rosacea and the Microbiome: A Systematic Review | SpringerLink November 13, 2020 Rosacea, a chronic inflammatory skin disease characterized by recurrent episodes of facial flushing, erythema, pustules, and telangiectasia, largely affect — Read on link.springer.com/article/10.1007/s13555-020-00460-1 Read More
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A Genomic Approach to Investigating Ocular Surface Microorganisms: Monitoring Core Microbiota on Eyelid Margin with a Dot hybridization Assay November 11, 2020 A sound ocular surface microbiota has been recognized as a part of ocular surface health following a growing body of evidence from next-generation sequencing technique and metagenomic analysis. However, even from the perspective of contemporary precision medicine, it is difficult to directly apply these new technologies to clinical practice. Therefore,[...] Read More
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Derm Findings in Complex Regional Pain Syndrome August 31, 2020 Title: "Dermatological Findings in Early Detection of Complex Regional Pain Syndrome" JAMA Dermatology June 2014 Volume 150, Number 6 Authors: Rameez Kabani, BSc; Alain Brassard, MD, FRCPC Fishman comments: This is an extremely complex condition and the question for dry eye specialists is whether some of the eyelid and eye[...] Read More
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Dry eye & Glaucoma July 29, 2020 synechiae after angle closure glaucoma This is a short video snippet of synechiae after angle closure glaucoma. Glaucoma patients often suffer from several mechanisms of DryEye. Iatrogenic causes of dry eye are too often the culprit and prostaglandins (Latanoprost, etc) are one of the greatest offenders. Through their role in[...] Read More
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Subconjunctival hemorrhage July 26, 2020 Impressive case of subconjunctival hemorrhage. An under appreciated cause of subconj hemorrhage is conjunctivochalasis. Other causes of subconj hemorrhage include micro trauma from dry Eye disease , inadvertent eye rubbing and a multitude of systemic diseases , oral medicines and supplements. Fortunately, most causes are benign , but in the[...] Read More
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Remove that “pea” from my eye! July 17, 2020 Concretions are tiny little "micro pea" sized deposits in the conjunctiva of the eyes. More precisely (from the EyeWiki), they are "degenerating epithelial cells and proteinaceous secretions [and lipids (oils)] from conjunctival glands. This cellular debris becomes trapped and can undergo calcification."  It is an often underappreciated source of discomfort[...] Read More
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Corneal Verticillata July 13, 2020 Slit lamp video of a patient with corneal verticillata also know as vortex keratopathy, whorl keratopathy, or Fleischer vortex.  Corneal verticillata are these whorl like opacities in the cornea. As shown in the below video, they appear dramatic, but generally cause no decrease in vision or glare to the patient.[...] Read More
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Blue Sclera July 13, 2020 The below video snippet is a case of blue sclera. Blue sclera isn't really blue but can be from either thinning of the sclera which causes a bluish hue on examination or pigmentation deposits that can also appear to give a bluish hue to the sclera.   [embed]https://youtu.be/mxsAb0dmPEg[/embed]   Blue[...] Read More
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Electrovestibulography (EVestG) for Post-concussion syndrome (PCS) July 12, 2020 Fishman comment:  Post-concussion syndrome (PCS) is a very debilitating condition in which individuals suffer from symptoms including "headaches, dizziness, fatigue, irritability, reduced concentration, sleep disturbance, memory loss, sensitivity to noise or light, double or blurred vision, nausea, anxiety and depression." Electrovestibulography (EVestG) is an objective diagnostic tool for PCS. It is an[...] Read More
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Platelet-rich Plasma (PRP) may reduce pain by an Endocannabinoid-Related Mechanism July 8, 2020 Fishman Comment: I have been very impressed with the use of serum tears in the treatment of neuropathic corneal pain. At FishmanVision, we use a subset of serum tears called Plasma Rich in Growth Factors (PRGF). PRGF is itself a subset of PRP. Compared to other modalities, patients appear to[...] Read More
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Tape Stripping: A Novel Noninvasive Method Using RNA Sequences for Diagnosing Ocular Surface Diseases of the Eye and Eyelid June 17, 2020 Fishman comment: This is our recent work on a new method for measuring the mRNA on the ocular surface. The implications for this research range from microbiome analysis to point of care testing for infectious diseases. Abstract: Harvey Fishman MD PHD, Jonathan Mansbridge, Vera Morhenn; Tape Stripping: A Novel Noninvasive[...] Read More
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Heavy eye syndrome versus sagging eye syndrome in high myopia June 9, 2020 Fishman comment: When a patient presents with double vision, the immediate reaction is to rule out serious neurologic causes such as stroke (CVA), brain tumor, giant cell arteritis, infection, cancer, and myasthenia gravis amongst others. However, it turns out that a leading cause of double vision in older adults is[...] Read More
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Association of Dietary Fatty Acid Intake With Glaucoma in the United States June 7, 2020 Ye Elaine Wang, MD1; Victoria L. Tseng, MD, PhD1; Fei Yu, PhD1,2; et al. Joseph Caprioli, MD1; Anne L. Coleman, MD, PhD1,3 JAMA Ophthalmol. 2018;136(2):141-147. doi:10.1001/jamaophthalmol.2017.5702 Key PointsQuestion  Does an association exist between daily dietary intake of polyunsaturated fatty acids, especially ω-3 fatty acids, and the risk of glaucoma in the US[...] Read More
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Relationships Between Short-Term Exposure to an Indoor Environment and Dry Eye (DE) Symptoms May 10, 2020 Air composition influences Dry Eye (DE) symptoms as demonstrated by studies that have linked the outdoor environment to DE. However, there is insufficient data on the effect of short-term exposure to indoor environments on DE symptoms. We conducted a prospective experimental research, in which an older building served as an[...] Read More
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Palpebral and facial skin infestation by Demodex folliculorum – Contact Lens and Anterior Eye May 10, 2020 Purpose To evaluate facial Demodex densities in participants with varying severities of blepharitis secondary to Demodex folliculorumassessed by the highest number of cylindrical dandruff on one lid. Methods This double masked cross-sectional study included 58 participants [19 control, 21 mild/moderate and 18 severe Demodex blepharitis] who underwent a standardized skin-surface[...] Read More
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Development of Feasible Methods to Image the Eyelid Margin May 10, 2020 Purpose: To develop a feasible method to image eyelid margin structures using in vivo confocal microscopy (IVCM) for use in clinical research. Second, to assess the association between IVCM and meibography images. Methods: IVCM was performed on the central upper eyelid margin of 13 healthy participants (31 ± 5 years).[...] Read More
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The Ocular Surface and the Coronavirus Disease 2019: Does a Dual ‘Ocular Route’ Exist? May 10, 2020 Coronavirus disease 2019 (COVID-19) is an important health problem that was defined as a pandemic by the World Health Organization on 11 March 2020. Although great concern has been expressed about COVID-19 infection acquired through ocular transmission, its underlying mechanism has not currently been clarified. In the current work, we[...] Read More
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Reflectance confocal microscopy enabling full viewing of Demodex sp. – Ribeiro – – International Journal of Dermatology – Wiley Online Library May 10, 2020 Reflectance confocal microscopy enabling full viewing of Demodex sp. - below image from...   — Read on onlinelibrary.wiley.com/doi/abs/10.1111/ijd.14911 Read More
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Development of an inactivated vaccine candidate for SARS-CoV-2 | Science May 9, 2020 Abstract The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) has resulted in an unprecedented public health crisis. There are currently no SARS-CoV-2-specific treatments or vaccines available due to the novelty of the virus. Hence, rapid development of effective vaccines against SARS-CoV-2 are urgently needed.[...] Read More
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Micro piezo drug delivery for Neurotransmitter-Based Retinal Prosthesis: Blast from the past 2003 April 27, 2020 Blast from the past... "Towards a Neurotransmitter-Based Retinal Prosthesis Using an Inkjet Print-head". Biomedical Microdevices 5:3, 195- 199, 2003. HA Fishman and co-workers. This work shows one of the earliest examples (2003 publication from my lab) of drug delivery using micro piezo technology from an ink- jet printer head. Abstract. Electronic chips[...] Read More
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Successful TeleMedicine in EyeCare: a Meticulous History April 9, 2020 by Dr. Harvey A. Fishman, MD PhD Co-founder, EyeCareLive The most frequent question that EyeCare doctors, both ophthalmologists and optometrists, have about telemedicine is, “what conditions be accurately diagnosed and treated in a remote exam using a mobile device or a webcam?” The telemedicine platform often intimidates MDs and ODs[...] Read More
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A PRACTICAL GUIDE TO TELEMEDICINE IN EYECARE by Dr. Harvey A. Fishman, MD PhD March 14, 2020 Click here for the e-book! Tele-ophthalmology and telemedicine have been a passion of mine for the past 25 years. As a medical student at Stanford in the 90's, I was one of the first beta users of the then famous palm pilot app, ePoctrates. At Stanford Medical School, I tried[...] Read More
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Highlights from Dr. Galor’s article, “What can photophobia tell us about dry eye?” March 7, 2020 [vc_row][vc_column][vc_column_text]Dr. Fishman's comments: Light sensitivity is a very important symptom that occurs in a variety of ocular diseases including dry eye disease. Dr. Galor has done truly pioneering work in this area and has written many papers on this topic. At FishmanVision, Dr. Fishman is also been conducting research in[...] Read More
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Hordeolum Expression & Curettage March 2, 2020 [vc_row][vc_column][vc_column_text] [embed]https://youtu.be/oDc3vhvbuKI[/embed] This video shows a nice example of treating a hordeolum (also known as a stye) by first pre-treating the eyelid with a Mibo heating pad, then gentle expression, and finishing with curettage of the gland with a corneal spud. Hordeolums aka "styes" are infections of the glands in[...] Read More
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The disparity between the dry eye “DREAM” study results and real world clinical experience: Is the gut microbiome the missing link ? February 29, 2020 Dr. Fishman's comments on latest DREAM study publication: Why is there is a huge disparity between the clinical experience of most well-known dry eye and corneal specialists and the results that are emerging from the DREAM study? To cut to the chase, the study lumped together all of the many[...] Read More
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Death by Ipl February 26, 2020 [vc_row][vc_column][vc_column_text] [/vc_column_text][vc_column_text]Fishman comments: Our paper is the first to show direct evidence of "Demodex Death by IPL" using live video microscopy.   Honored to collaborate on this important work with Dr. Periman (aka @dryeyemaster) and Dr. Shah (@sfgotox). Click the below download button for the full PDF of the paper.  [...] Read More
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Regional Comparison of Goblet Cell Number and Area in Exposed and Covered Dry Eyes and Their Correlation with Tear MUC5AC February 23, 2020 Fishman comments: Another brilliant article by Dr. Pflugfelder and co-workers. Here, they show a correlation between tear MUC5AC concentration and GC area and suggests tear MUC5AC mucin can be used as a disease-relevant biomarker for conjunctiva GC health. Authors: Khimani, K.S., Go, J.A., De Souza, R.G. et al. Sci Rep[...] Read More
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Heart-Shaped Meibomian Gland February 23, 2020 [vc_row][vc_column][vc_column_text] Human anatomy often delights us with unexpected structures. This is a heart shaped meibomian gland in the upper eyelid of a patient. The meibomian glands are holocrine type exocrine glands. Estimates vary but there are ~20 to 30 meibomian glands on the lower lid and ~40 to 50 on the[...] Read More
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MicroRNA Profiling in Benign and Malignant Conjunctival Melanocytic Lesions February 19, 2020 Fishman comments: The article says it best... "Conjunctival melanoma is a rare tumor with an incidence of 0.2 to 0.8 cases per 1 million people, although the incidence is increasing." "In daily practice, it can be very difficult to distinguish a benign from a malignant melanocytic lesion based on only[...] Read More
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Female mouse tears contain an anti-aggression pheromone February 17, 2020 Fishman comments: Super interesting article on the effects of female mouse tear fluid on male behavior. The authors found that female tears contain a factor that strongly inhibits inter-male aggression. Cavaliere, R.M., Silvotti, L., Percudani, R. et al. Female mouse tears contain an anti-aggression pheromone. Sci Rep 10, 2510 (2020). https://doi.org/10.1038/s41598-020-59293-9[...] Read More
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Mmp-9 positive : Chalazion February 6, 2020 Matrix metalloproteinases (MMPs) are a group of enzymes that in concert are responsible for the degradation of most extracellular matrix proteins during organogenesis, growth and normal tissue turnover. Presence of MMP-9 in the tear film indicates an inflammatory process. The MMP-9 detector shown below is a nice way to track[...] Read More
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Death by IPL January 29, 2020 Fishman comments: Our paper is the first to show direct evidence of "Demodex Death by IPL" using live video microscopy.   Honored to collaborate on this important work with Dr. Periman (aka @dryeyemaster) and Dr. Shah (@sfgotox). Photobiomodul Photomed Laser Surg. 2020 Jan 27. doi: 10.1089/photob.2019.4737. [Epub ahead of print] Real-Time[...] Read More
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Dietary restriction increases protective gut bacteria to rescue lethal methotrexate-induced intestinal toxicity January 27, 2020 Fishman comments: Methotrexate is a commonly used drug to treat various ocular autoimmune conditions including  uveitis and scleritis. Unfortunately, GI side effects are a problem. This is a nice paper exploring the possibility of reducing GI toxicity by  increasing the protective intestinal microbiota. Hopefully, we will continue to understand the[...] Read More
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How I approach the “Hey Doc, these glasses don’t work” – Part I , optics January 25, 2020 This is a very common comment that eye care professionals hear from their patients and thus an excellent opportunity to unpack many important issues in ophthalmology and optometry. I am going to break this into several blog posts and part (I) will start with optics. Future blog posts will focus[...] Read More
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To plug or not to plug, that is the question January 24, 2020 The American Academy of Ophthalmology (AAO) publishes guidelines called preferred practice patterns (PPP). In the staged management of dry eye disease as per the PPP, punctal occlusion (plugs) for dry eye disease has been a level II (step 2) option for many years. It has been an excellent solution for[...] Read More
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Comparative portrayal of ocular surface microbe with and without dry eye January 23, 2020 Fishman comments: From an analytical chemistry standpoint, the ocular microbiome is an extremely complex environment to measure. This work is interesting and adds to our understanding of the impact of the ocular microbiome and dry eye disease. We have a long way to go to truly understand these interactions. My[...] Read More
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Role of Resveratrol in Transmitochondrial AMD RPE Cells January 17, 2020 Fishman commentary: Neat finding by Dr. Kuppermann and colleagues. Role of Resveratrol in Transmitochondrial AMD RPE Cells by Sonali Nashine 1, Anthony B. Nesburn 1,2, Baruch D. Kuppermann 1 and Maria Cristina Kenney 1,3,* Nutrients 2020, 12(1), 159; https://doi.org/10.3390/nu12010159 Abstract Resveratrol is a phytoalexin, stilbenoid compound with antioxidant properties attributable to[...] Read More
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Full Length Meibomian Gland Expression January 13, 2020   Dr. Fishman demonstrates a particularly dramatic example of oil expression from the full length of an individual meibomian gland followed by manual expression of it's neighbor. The eyelids were first heated using MiboFlow to "prep" the glands and then manual expression as shown below. Dr. Fishman uses a variety[...] Read More
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Novel, Non-Invasive Method for Addressing Acute and Chronic Chalazia: a case series- Dr. Laura Periman January 12, 2020 Dr. Periman (a.k.a Dry Eye Master - @dryeyemaster) and colleagues present wonderful work on the use of IPL to treat chalazia. As described, IPL shows incredible promise of a drug-free, incision-free and injection-free method of addressing chalazia. IPL was offered to these patients to manage their acute or chronic chalazion/chalazia as[...] Read More
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Debridement-Scaling of a Capped Meibomian Gland January 8, 2020 Dr. Fishman employs a multitude of techniques to treat meibomian gland dysfunction. Debridement-Scaling of a of the eyelid margin is a very effective technique that Dr. Fishman often combines with heating and expressing the eyelid margin (using iLux or MiboFlow).   [videopress P9ABeMjM]   Read More
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Dry Eye as a Mucosal Autoimmune Disease January 7, 2020 Fishman commentary. Classic review article by Dr. Pflugfelder. We need to better understand the innate immune system - " the field is rapidly realizing the complexity of other innate and adaptive immune factors involved in the development and progression of disease" Authors: Michael E. Stern, Chris S. Schaumburg & Stephen[...] Read More
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Probing and expressing a meibomian gland pre-stye January 4, 2020 In this video, Dr. Fishman uses a Maskin Probe to first probe then express an inspissated meibomian gland.  The beginning of the video shows how expressing the inspissated meibomian gland alone does not produce meibum. After probing the gland, milky meibum is expressed.   [videopress MgKnELLT]     Read More
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Changes in brainstem excitatory and inhibitory pathways in dry eye syndrome December 31, 2019 Fishman Commentary: In many patients, dry eye disease present with a neuropathic component, which I refer to as the "trigeminal ganglion pain continuum." In this paper, the authors show that changes at the synaptic level in the brainstem occur in dry eye disease. Highlights * Patients with dry eye have[...] Read More
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Effects of Platelet-rich Plasma on Ocular Surface in Patients with Dry Eye Syndrome: Clinico-experimental Analysis December 28, 2019 Fishman commentary: PRP and PRGF (made at FishmanVision) are purified versions of serum tears and may have excellent efficacy in ocular surface disease including dry eye, epithelial defects, chronic inflammation.  This is a nice paper on PRP for dry eye disease. Authors:  Jae Uk Jung, MD,1 Sang Hee Lee, MD,[...] Read More
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High-dose curcuminoids are efficacious in the reduction in symptoms and signs of oral lichen planus December 15, 2019 Dr. Fishman's commentary: Potentially a very powerful steroid sparring way to treat oral Lichen Planus. It would be interesting if we could perform a clinical trial involving high dose curcuminoids for treating Lichen Planus of the conjunctiva. Lichen planus is an autoimmune condition of unknown aetiology affecting the skin and mucous membranes. Conjunctival[...] Read More
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Confocal microscopy of a neuropathic cornea December 6, 2019 Patient with corneal neuropathy from a refractive surgery 7 years ago. Read More
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MSC Transplantation Improves Lacrimal Gland Regeneration after Surgically Induced Dry Eye Disease in Mice December 6, 2019 Fishman Comments: Incredibly interesting work on stem cell transplantation for restoring the lacrimal gland function. MSC in 2 µl saline were injected into the LG. Important basic science in the field of dry eye disease. Authors: Jana Dietrich, Lolita Ott, Mathias Roth, Joana Witt,Gerd Geerling, Sonja Mertsch& Stefan Schrader  Scientific Reports[...] Read More
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Ocular inflammation induces trigeminal pain, peripheral and central neuroinflammatory mechanisms November 24, 2019 Fishman commentary: This study provides the first demonstration that corneal inflammation induces activation of pathways within sensory trigeminal complex. These results suggest that this altered activity in intracellular signaling caused by ocular inflammation might play a priming role in the central sensitization of ocular related brainstem circuits, which represents a[...] Read More
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Composition and Diversity of Bacterial Community on the Ocular Surface of Patients With Meibomian Gland Dysfunction November 20, 2019 Fishman Commentary: The research on the microbiome of the eye continues to show potential avenues for treating chronic ocular conditions such as dry eye disease. In this study,  they found that patients with MGD can have various degrees of bacterial microbiota imbalance in the conjunctival sac. Staphylococcus, Corynebacterium, and Sphingomonas may play roles[...] Read More
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Nonsteroid management of residual ocular surface disease on dupilumab (ROSDD) November 18, 2019 Fishman commentary: Treatment pearls for dupilumab associated ocular surface disease. Authors: JodieRaffiabRaaginiSureshaTimothyBergeraHarveyFishmancJenny E.Murasead https://doi.org/10.1016/j.ijwd.2019.08.007 International Journal of Women's Dermatology . Available online 24 August 2019.   Dear Editors, Atopic dermatitis is associated with a range of ocular complications. Additionally, an increase in dupilumab-associated conjunctivitis, dry eye, and recently characterized residual[...] Read More
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Investigating the role of allergic contact dermatitis in residual ocular surface disease on dupilumab (ROSDD) November 17, 2019 Fishman commentary. Excellent article on ocular surface disease and dupilumab.  Significant improvement after patch testing in nearly half of patients suggests that allergic contact dermatitis contributes to some cases of dupilumab-associated eye complications. Click here for PDF Authors:  JodieRaffiabRaaginiSureshaHarveyFishmancNinaBottoaJenny E.Murasead Abstract Background The mechanisms underlying eye-related complications with dupilumab are[...] Read More
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Eyeliner Induces Tear Film Instability and Meibomian Gland Dysfunction November 16, 2019 Dr. Fishman commentary: Makeup can be toxic to the meibomian glands and can result in tear film abnormality. This is further evidence that patients with dry eye disease need to consider makeup very seriously.----------------------------------------- Published ahead of print in Cornea, Nov 2019. Authors: Prabhasawat, Pinnita MD*; Chirapapaisan, Chareenun MD*; Chitkornkijsin,[...] Read More
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Macular pigment optical density is positively associated with academic performance among preadolescent children November 12, 2019 Dr. Fishman comment: 2 interesting take aways- the use of MPOD to track diet and how brain Lutein may be important for cognitive achievement . "This is the first study to demonstrate that retinal L and Z, measured as MPOD, is positively related to academic achievement in children" Published in : Nutr[...] Read More
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Dry Eye Disease Associated with Lower Gut Microbiome Diversity November 6, 2019 Abiya Farhan Baqai; Harvey A. Fishman, MD PhD Abstract Purpose : The human microbiome has been studied for centuries and recently has been associated with health issues ranging from metabolic disorders such as obesity and diabetes to inflammatory disorders such as inflammatory bowel disease.5 However, only recently have associations of[...] Read More
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Why Don’t Yellow Night Vision Glasses Work? by Dr. Robert W. Massof November 6, 2019 Fishman comment: Excellent in JAMA by Hwang et al1 and neat follow-up commentary by Massof. Take home message that Massof makes: "yellow night vision glasses do not live up to their product claims, but more work is needed to better understand and ultimately ameliorate a ubiquitous problem that is growing with[...] Read More
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Corneal Manifestations of Inflammatory Bowel Disease November 1, 2019 Fishman comment: Another interesting manifestation of systemic disease in the eyes. IBD patients have thinner corneas and reduced tears. ABSTRACT Purpose: To evaluate detailed corneal parameters of inflammatory bowel disease (IBD) patients, including Crohn’s disease (CD) and ulcerative colitis (UC) patients, and to assess associations between anterior segment values and[...] Read More
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Novel Light Intensity Device (LuxIQ) for Quantitative Evaluation of Dry Eye Disease October 27, 2019 We report on a novel light intensity device (LuxIQ) that helps clinicians assess the severity of dry eye disease in a quantitative manner. Currently, the inability to quantify and accurately assess the severity of dry eyes is a huge impediment in the field of dry eye disease.  This novel device[...] Read More
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Long-term regular exercise and intraocular pressure: the Hisayama Study September 8, 2019 PURPOSE: To investigate the association between long-term regular exercise (exercise frequency and exercise time) and 5-year changes in intraocular pressure in a general Japanese population. METHODS: This population-based, cohort study was conducted in 2007. A total of 3119 Japanese community dwellers aged ≥ 40 years underwent eye examinations including intraocular pressure measurement[...] Read More
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Ocular blood flow in course of glaucoma April 27, 2019 Study explores influence of ocular blood flow in course of glaucoma: New techniques shed light on roles of blood, perfusion pressure in ocular blood flow   Many other factors, including demographic influences and individual susceptibilities, also make it challenging to study relationships between ocular blood flow and glaucoma. To overcome the[...] Read More