epmaybe

The reason people get endophthalmitis is rarely due to a contaminated batch, but it certainly happens. But frankly it’s unsustainable to have all patients on branded drug, it would be too costly for patients and payers. Not to mention it is slightly unethical in the US due to drug rebates incentivizing branded drug use.

Endophthalmitis is bad, but we can treat it if caught promptly. Patient education, informed consent, good hygiene practices, and easy access to their ophthalmologist can make a tremendous difference.

Source: I do these injections for a living.

I’m in ophthalmology where AI diagnostics have been promised for almost a decade. We have FDA approved diagnostics for diabetic retinopathy screening that has been commercially available since 2018, and papers claiming board certified ophthalmologist level classification accuracy as far back as inceptionv3. Maybe it’s just an economic barrier but these tools still haven’t made any meaningful impact in the US. Other countries without healthcare access? It’s helpful for culling the herd, but it doesn’t fix the last mile problem of what you do when you find referable disease that needs treatment.

My philosophical take: if AI can outperform the average, it’s probably a net benefit for society that I won’t have a job. Until then, I’m going to take my income and save up for an early retirement.

It’s not often that an ophthalmology study makes it into the New England journal of medicine. This is pretty neat technology, but subretinal surgery is a skill mostly forgotten by retina surgeons. It will be interesting to see who will end up offering this kind of surgery.

They didn’t really demonstrate that patients without the implant had worse vision. You could argue that with the magnifying glasses themselves that patients could improve their vision without surgery. So it will be up to a future study to determine this.

As someone at an academic institution, this drives me insane. I mean, have some sort of pride in your work. Copy forward but make the necessary changes!!

Isn't that a Stark law violation?

Most people don't get blocks nowadays for cataract surgery. I will do so for patients with wandering eye movements or for more difficult cases, or for more invasive surgery besides cataract surgery. I just did a cataract surgery on a young patient today using topical numbing drops. But I have them monitored by an anesthetist with mild sedation during the entire case.

Eye surgeon here: FLACS isn't really that amazing. I would actually argue that a man made incision using steel or diamond (yes, diamond) is better than the incision made using the femto laser for long term safety/sealing. Number of studies have borne this out.

95% success rate seems low. you need to define success in this scenario. Are we aiming for 20/20 vision outcomes? Just getting the cataract out in full?

Eye doctor here: some hot takes in this thread about the diagnostic abilities of the specialists involved in this patient's care. It's easy to be an armchair clinician.

The timeline for delayed immune reaction to a leptospirosis infection makes diagnosis incredibly difficult. There was no mention of an acute febrile illness preceding this during the patient's trip to the tropics, which I assume a uveitis specialist would ask.

While empiric treatment with doxycycline wouldn't be a bad idea, you have to decide what to empirically treat with, and for how long, and what the ramifications of increasing resistance to antibiotics are for society. Do I commit a patient to the hospital for two weeks of IV penicillin because I "suspect" syphilis? of course not.

Better diagnostics for these occult diseases should be applauded. But we shouldn't be vilifying the clinicians that are by all accounts doing their best.

This is something that really bothered me - I had an app that was small and worked fine on the latest Android OS, yet they took the app and account down because we hadn’t uploaded a new version in a year. Appeals didn’t help

Advantage is relevant. Medicare advantage is a specific type of plan that isn’t quite Medicare that insurance companies offer. And it’s at the center of that case.

This reminds me of https://timezen.com/

“Up to”

holy crap, that’s insane. You don’t just accidentally add sildenafil or tadalafil to your supplements. Unless the FDA is misidentifying compounds present in the herbs in these supplements, which seems unlikely but I’m no pharmacology expert.

Also, most cornea research in vivo is done on rabbits, not dogs.

Has anyone ever brought up superficial keratectomy to you? Risk benefit discussion at least. Also, muro drops are otc and can help acutely

Note this strategy is mainly only being executed by Nintendo, who insists on selling their hardware at a profit. I still suspect they are making more money on their software though.

I believe Microsoft And Sony lose money per console sold

Most if not all MacBooks today are still 16:10 ratio..

This is correct. Do you know what percent of lung cancer is attributable to smoking? 90%! 9/10 lung cancer deaths are attributable to smoking.

Compare this to ~5% of cancer related death attributable to alcohol use.

It's just not even an accurate comparison.

To be honest though? I am willing to bet that cost to healthcare system for alcohol related illness is outpacing that of smoking related illness. Cirrhosis of the liver is a very costly disease when it gets close to end stage.

Just a small note - lenacapavir has been approved by the FDA since December 2022

Armchair thought that the author never brought up - food with high protein “tasted gross” per author, until starting what they thought provided anti histamine activity. I know that if I have a stuffed nose from cold or allergy, I also find that food tastes miserable, because sense of smell is so important in human perception of taste.

I don’t think there’s truly a competitor but opencl is the alternative to shoot for. Otherwise for machine learning purposes amd helps develop ROCm.

I think zigbee is more "resilient" because it piggybacks off all the other zigbee devices via mesh instead of each device talking to the central router.

At the same time I agree with parent that this persons ophthalmologist was a liar and should honestly be reported for that kind of shady behavior.

EDIT: also re corneal disease unless the treatment is a contact lens go to an ophthalmologist for that one too

My unpopular opinion is that Multifocal and extended depth of field IOLs are all attempting to cheat physics unsuccessfully and are a cash grab by ophthalmologists and manufacturers.

The other option you have is some form of refractive surgery. Also the wholesale cost of a toric IOL is somewhere around $700 so unless the surgeon fee is thru the roof it shouldn’t be costing you $3k each eye.

This gets into the weeds a little but the reason boils down to money and tradition, and “what is needed” is a shifting goalpost for society.

Just thirty years ago you may have never even gotten an IOL due to tradition or cost. After adoption in the developed world there was a huge push to prevent lower income countries from accessing the technology because they “didn’t need” that technology and could benefit from lower cost interventions such as glasses.

So as companies started to innovate and lower cost, single vision non toric IOLs became cheap enough for insurance to cover. Then to make some money on premium lenses companies (and ophthalmologists, sadly) really started to push torics and multifocal lenses.

The fact of the matter is that few patients benefit all that much from toric lenses that fix astigmatism. Most people have less than 1 diopter of astigmatic error, which they don’t even manufacture a toric lens for at any usable tolerance (the FDA allows a +/-0.50D tolerance to all lenses including torics), and surgical modifications can nullify that to some extent. Veterans get it free at most VA hospitals though, so they probably get more implanted than the average population.

In the next fifteen years though I bet Medicare will begin to cover toric lenses, and the rest of the insurance industry will follow. The surgery doesn’t change much between toric and non toric. The Multifocal IOLs will remain “premium” for a while to come I expect.

Ophthalmologist or optometrist? Very different, and I think the difference needs to be overstated more and more.

The incentive is not being ridiculed and belittled and being taken through the media circuit for a minor loss in profit margin?

But then again, all press is good press

This kind of already fits a little bit with how the brain processes images where there is information lacking. Neurocognitive specialists can likely correct me on the following.

Glaucoma is a disease where one slowly loses peripheral vision, until a small central island remains or you go completely blind.

So do patients perceive black peripheral vision? Or blurred peripheral vision?

Not really…patients actually make up the surrounding peripheral vision, sometimes with objects!

Something I have experience with - it’s a big step towards grafts not using human tissue. Results are promising and hopefully we have continued lack of rejection, and long term results (the average human transplant lasts around 10-15yrs, this study only followed patients up to 2 years so more info needed).

One might ask, where is this needed? In the US we actually probably have a surplus of donor corneas. However in other countries with less robust infrastructure this may fill a gap.

I don’t think it’s actually 13 million people but probably a big chunk of that group could benefit.

If you think this is bad, wait till you hear about [insert field of medicine here]!

In all seriousness, fraud is rampant, and cash pay or low regulation fields like dentistry can easily take advantage of patients and their health literacy.

In ophthalmology, you hear of “laser” cataract surgery, “floaterectomies”, telling patients they need cataract surgery well before they are symptomatic, dry eye treatments.

Hell, in cardiology there have been multiple cases of fraud uncovered where doctors were putting pacemakers and defibrillators in people that didn’t even need them!

Maybe I’m jaded, but when there exists such a profit incentive, we as healthcare providers struggle to “do no harm”. I’m lucky to be surrounded by mentors and other doctors that try and exemplify the moral behavior patients expect in healthcare, but imagine if I had a mentor early on like Dr Lund in the article..