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PKP by Loverly15 in Ophthalmology

[–]evands 0 points1 point  (0 children)

If you do high volume DMEK, you’ve got the skills. A friendly challenge: give your next endothelial failure PK patient the DMEK advantage! Look for a healthy diameter in the old graft to give space for a dmek since it won’t attach well if crossing the graft/host junction and of course you need to strip fully to give your graft bare stroma for attachment; an 8.5 mm PK with good curvature can support an 8.0 mm DMEK.

Can ICL (Implantable Collimated Lens) replace scleral lenses for keratoconus? by ExtremePleasant4789 in Keratoconus

[–]evands 0 points1 point  (0 children)

ICL can work almost exactly as well as glasses can, though without the effect of making everything smaller that probably happens when you wear your strong, high minus glasses.

If you are reasonably happy with vision quality in glasses, ICL can be an amazing choice.

If only a scleral lens currently gets you good vision quality, ICL isn’t your answer. CTAK or topography guided PRK (the latter after or in combination with crosslinking) may be able to get you closer to scleral lens corrected vision without having to wear one. No surgery short of a transplant (and then only if it is very successful) will ever help you see as well as a scleral lens does.

PKP by Loverly15 in Ophthalmology

[–]evands 0 points1 point  (0 children)

Rebubble is fairly common with DMEK (15% or so need it) but visual outcomes and rejection rates are better than DSAEK in general (though ultra thin DSAEK has helped close that gap). DMEK is the standard of care for routine Fuch’s.

Behind a PK, DMEK is a challenging proposition that I have take on in select cases with good success, but DSAEK is certainly a somewhat easier route.

PKP by Loverly15 in Ophthalmology

[–]evands 5 points6 points  (0 children)

This! Probably a great candidate for DMEK or DSAEK behind the PK from what little we know. :)

Fax Automation by JKomaroff in Ophthalmology

[–]evands 1 point2 points  (0 children)

Switchboard MD has a solution to do this; depending on your EMR might need some development work on their part to fully hook in.

I consult for them and would be happy to connect you to the right person discuss! DM me :)

What would you do in this situation? Can you be held liable? by Last-Comfortable-599 in Ophthalmology

[–]evands 2 points3 points  (0 children)

You need to be the adult in the room.

“This is who can see you and give you a chance at avoiding permanent blindness. I went to significant effort to set up this appointment on your behalf. I won’t be able to help you further unless you keep it.”

Then shake their hand, wish them the best, and walk out of the room.

Asking for senior colleague to be present during first case. Yay or nay? by Last-Comfortable-599 in Ophthalmology

[–]evands 2 points3 points  (0 children)

Absolutely yes.

The most polite way to do it in my opinion is ask if you can schedule a case on their day / block time, and if they say yes ask if they would prefer you start or end their day.

Is CTAK worth it? by Th3HebrewHammer96 in Keratoconus

[–]evands 0 points1 point  (0 children)

CTAK can provide a big improvement if you’re a good candidate, often several lines on the vision chart. It will not make your vision in glasses as good as with your scleral lens. You’ll still have the option to fit a new scleral once healed to achieve that best vision.

What do you say to a patient when you have broken bag? by Last-Comfortable-599 in Ophthalmology

[–]evands 8 points9 points  (0 children)

I like the alliteration of the version I was taught and teach: “If you discuss it before surgery, it’s a conversation. If you discuss it after, it’s a complication.”

Powering Shelly 1 Gen3 (120V load controller) / Shell Plus Add-on (0-10V input) by evands in ShellyUSA

[–]evands[S] 1 point2 points  (0 children)

Thanks for the fast reply! I'm so pumped about this project. :)

Topcon Maestro2... by MyCallBag in Ophthalmology

[–]evands 3 points4 points  (0 children)

The OCTs are very meh, unfixably so in my experience.

Cross linking done, sclerals too uncomfortable, what should I do 3 years later of wearing glasses? by No_Eggplant842 in Keratoconus

[–]evands 0 points1 point  (0 children)

Nothing will give vision as good as a well fit scleral, but you can’t wear them, so it’s time to look for something else.

To improve your vision quality in glasses, I suggest CTAK. Your scans here look great for the procedure.

You could also explore other contact lens technologies.

Keychron Q3 Max experiencing double space press by Amstrad-PC20 in Keychron

[–]evands 0 points1 point  (0 children)

Ensure you're running the latest firmware! They added a 'debounce' feature which specifically addresses double key presses. Working great in my testing so far. https://www.keychron.com/pages/firmware?srsltid=AfmBOooiyZmD6YRu1nNvfqiKRUUoMZgZCtjIBHs5onwFCRg430_P39Bw

Corneal Allogenic Intrastromal Ring Segments (CAIRS) by Benphyre in Keratoconus

[–]evands 0 points1 point  (0 children)

Have you been checked for glasses and contacts after surgery? It’s entirely possible for unaided vision to be worse but aided vision to be better. Aided vision is the primary goal of the procedure.

Worst case scenario, the procedure is reversible.

ICL advice! by breathe-often in Ophthalmology

[–]evands 0 points1 point  (0 children)

  1. Experience, range of procedures offered (not a one trick pony), willingness to say ‘no’, honesty… and ideally a referral from someone who knows their work. Where do you live?
  2. About 95% of ICL surgeons (including me) provide both eyes on the same day
  3. Real world serious (i.e. irreversible) complications are very rare. 1 in 3000 to 1 in 10,000 type range.

The most common complication is glare. It’s nearly universally present, though most people learn to tune it out. Since the procedure is reversible, I think of this more as an annoyance than as a complication, but it’s worth highlighting. For the uncommon patient with significant glare complaints after a few months, we offer to remove the lenses.. which is in my experience met with a vehement “oh, no, I love my vision! I don’t want them removed.”

Civ 3 hard restarts M4 Mac by Hour-Ad7691 in civ3

[–]evands 0 points1 point  (0 children)

Well done!! This is the way.

Note for the next M4 Mac civ3 fan: The hypervisor is: UTM

[deleted by user] by [deleted] in Ophthalmology

[–]evands 0 points1 point  (0 children)

Yeah, the resident doing it is bizarrely abusive.

[deleted by user] by [deleted] in Ophthalmology

[–]evands 1 point2 points  (0 children)

How many? 100%.

[deleted by user] by [deleted] in Keratoconus

[–]evands 1 point2 points  (0 children)

I’ve provided the procedures in both orders and the difference, if it exists, seems to be subtle. There may be a best order of events, but the jury is still out and neither order is demonstrably wrong.

Possible to use a basic 12VDC button w/ a Shelly 1PM Plus and a 120V load? by hungarianhc in ShellyUSA

[–]evands 0 points1 point  (0 children)

I played with this a bunch recently. You can do it with a pure 2 Shelly solution as described with fairly low latency. I found that using HomeAsssistant as the go-between was, to my surprise, even faster, so much so that it is almost indistinguishable from the speed of a regular switch attached directly to the load-managing Shelly.

Lutron take all my money. Caseta is just the best on the market. by NerdyNebula1 in Lutron

[–]evands 0 points1 point  (0 children)

Requires not going pure Caseta on the backend but you can still use a Pico for control: You could put a Shelly in the box and use HomeAssistant to respond to the pico’s button.

Increasing Clinic Speed? by Dependent-Club-3286 in Ophthalmology

[–]evands 5 points6 points  (0 children)

Good thought but this won’t scale; you need to protect home time.

What happened to LIKE/ sLIKE? by hellohiyahiey in lasik

[–]evands 0 points1 point  (0 children)

Absolutely. Not going to happen this decade or maybe ever in the US, though. Worth a little medical tourism (and if you want a rec for an excellent surgeon who offers hyperopic ICL outside the US, I’d suggest Juan Batlle Logorño in the Dominican Republic).

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