Uday Devgan, MD

I’m very interested in the way that health care is delivered across the globe because I think there is a lot to learn from other cultures and countries.

Every fall for the past many years, I have enjoyed participating in the OSN New York meeting. It brings the combination of good medical education, exposure to new developments in ophthalmology, spending time with colleagues and enjoying Manhattan during the beautiful fall season.

Our current IOL calculation methods have been improving steadily for the past few decades. When the original SRK formula came out, it worked reasonably well for most average eyes, but not so well for others. The SRK II helped to address those other eyes, but it was the emergence of the theoretical formulae such as Holladay 1, SRK/T and Hoffer Q that really improved IOL calculation accuracy.

This was the question asked to me today by a patient. At first, I paused because I have never had this request after tens of thousands of patient visits. I thought about it for a moment and then said, “Sure, no problem.”

Eye clinic charts have such specialized notations that an ophthalmologist can effectively decipher the entire visit no matter the language. You could receive an ophthalmology note from another country and figure out exactly what is going on. Across the globe, ophthalmologists are similar in many regards; however, there is one sector where there are differences: access to different devices and surgery platforms.

Every week, I work with ophthalmology residents in the operating room at a county hospital to teach them surgical techniques, primarily in cataract surgery. The patients at this hospital are among the kindest and most thankful, and often times are in the midst of financial difficulties. Patients can receive low-cost or even no-cost surgery with the understanding that ours is a teaching facility where resident physicians will do their surgery while supervised and assisted by attending-level doctors.

This patient had uneventful cataract surgery 2 weeks earlier and presents with 20/25 vision with some peripheral corneal edema and persistent cell and flare (Fig. 1). Does everything look good to you and are you ready to schedule surgery for his other eye?

The title of a recent CBS article certainly grabbed my attention, “$1 Million Mistake: Becoming a Doctor.” With a title like that I just had to click on the link to read the article.

Patients with retinitis pigmentosa develop cataracts earlier in life and surgery for these patients presents some challenges. While these patients have relatively soft cataracts, primarily with posterior subcapsular changes, there are other aspects which make their surgery more difficult.

I was communicating with a colleague who was adamant that ophthalmology residents should not use a femtosecond laser to assist in cataract surgery since it would hinder the development of their manual skills. That's a reasonable argument, but I have a different perspective.