Uday Devgan, MD

July marked the start of my 13th year teaching ophthalmology residents, and I hope that I can continue doing it for at least another 30. Working with these bright young minds has become the highlight of my week, which is a mix of my private, non-academic practice and part time with UCLA residents at a large county hospital.

Patients often ask if the cataract can come back, and we usually reply that no, once we remove the opaque lens it is gone forever. That's true, unless our IOL optic opacifies.

One of the best ways to learn the complexities of ophthalmology is by working with mentors, initially emulating their style and then later developing your own based on principles learned. Among my most treasured mentors was Gene Pawlowski, MD, who worked together with me teaching ophthalmology residents at our large county hospital in the Los Angeles area. Sadly, Gene peacefully passed away at his home just a few days ago after a tough battle with health issues.

The white intumescent cataract poses a challenge during capsulorrhexis creation because the intralenticular pressure increases as the lens cortex liquefies. In a routine cataract, the lens material is solid and the pressure within the capsular bag is low — lower than the pressure in the anterior chamber, so capsulorrhexis creation is straightforward.

One of the highlights of my week is spending time in the operating room with ophthalmology residents, because they are bright, hard-working and eager to learn as much as possible. This past week, they asked me about the use of femtosecond laser to assist with cataract surgery since I've slowly begun using it at our surgery center in Beverly Hills. While I think that the femtosecond laser can in certain ways improve my cataract surgical procedure, I think it can have a far greater benefit in helping more novice surgeons.

One of my favorite meetings of the year is the Hawaiian Eye meeting, and not just because of the opportunity to enjoy the beautiful islands. With the format of the meeting, it is easy to understand key take-home points and immediately incorporate them into my own practice. Here are some of my highlights: The cataract session led by David Chang and Roger Steinert was excellent as usual, and many speakers presented about toric IOLs. For preoperative evaluation, make sure that the patient has regular, symmetric and stable astigmatism. If there are lesions that are inducing keratometric astigmatism, such as epithelial basement membrane dystrophy or pterygium formation, these must be treated before cataract surgery and even before doing IOL calculations. Placement of the toric IOL must be precise, and there are now systems that allow tracking of eye rotation by limbal vessels. Even better are systems that allow intraoperative aberrometry to assist in optimal alignment. I had the pleasure of participating in David Chang's challenging case symposium, which focused on decentered IOLs and IOL exchange. These were very tricky cases that had panel members giving a wide spectrum of suggestions for surgery. For any IOL that is displaced posteriorly into the vitreous cavity, it may be wiser to have a vitreoretinal colleague remove the IOL, leave the eye aphakic, and then refer the patient back to the cataract surgeon for a secondary IOL implantation. And while sutured or even glued posterior chamber IOLs look pretty in the eye and provide good results, it was pointed out that a properly placed anterior chamber IOL has the same visual results according to a number of published studies as well as the expertise of the panel. Tom Samuelson presented sage advice about trabeculectomies and stated that in many of his patients he prefers other, more predictable glaucoma procedures, such as the new implants, due to an apparently safer risk profile. Kuldev Singh asked a great question, "Is cataract surgery really a glaucoma surgery?" and then presented both sides of the coin. With these newer glaucoma procedures and the benefit, even if temporary, of cataract surgery, I think we will see more general ophthalmologists being involved in the surgical care of glaucoma. In addition to the concurrent retina-specific meeting, there was a session about posterior segment disease for anterior segment surgeons. Carmen Puliafito presented a very novel way of quantifying macular drusen volumetrically with OCT scanning. This may allow an objective way of measuring and then tracking changes in macular degeneration. And finally, I learned something the hard way: If you decide to follow your kids down the giant 60-foot water slide, be sure to hold your nose when you hit the pool - otherwise you'll end up getting a high-pressure sinus cleansing.

I had the pleasure of attending a superb conference at USC's Doheny Eye Institute recently that focused on how to take an idea, patent it, get funding and move towards making it a reality. A notable example of this is the retinal chip implant that Mark Humayun, MD, PhD, took from an idea to a product that has received the European CE mark.

Fundus photos from phone. Photos of patient's fundus via phone. When I was a resident, anterior segment photos were taken with a large (and expensive) camera with a high-power macro lens. These days, I use a handheld digital camera to take most anterior segment photos, and now there's even a way to take good fundus photos with your cellular phone. You can take a photo of a patient's fundus and then email or text it to colleagues.

Area of zonular absence seen between cataract and iris.

White cataract with a wrinkled anterior capsule White cataract with a wrinkled anterior capsule A patient presents to you with a unilateral mature white cataract, and before booking her surgery, you have a hunch that something isn't quite right ...