Two Eyes, Two Problems

Which eye would you treat?

Devesh K. Varma, MD, FRCSC; Sahar Bedrood, MD, PhD; Leon W. Herndon, MD; Yannek Leiderman, MD, PhD; Joseph F. Panarelli, MD; and Pradeep Ramulu, MD, PhD

Glaucoma Today

Key Takeaways Zonular instability can lead to the dislocation of primary and secondary IOLs and raises concern about glaucomatous progression. The potential consequences of a malpositioned IOL, such as disease progression and chronic inflammation, rather than the dislocated lens itself are key factors in the decision whether to intervene surgically. A 72-year-old woman is referred for an evaluation of bilateral pseudophakic complications. The patient’s ocular history is notable for pigment dispersion syndrome before she underwent uncomplicated bilateral cataract surgery in 2012. A capsular tension ring (CTR) and one-piece IOL were implanted in the left eye, and the same one-piece IOL was placed in the right eye. In 2014, the right eye received a +2.00 D piggyback three-piece IOL in the sulcus to address a hyperopic refractive surprise. The visual acuity in each eye remains good, but the patient presents with concerns about both eyes. Ultrasound biomicroscopy (UBM) shows a tilted and partially subluxated piggyback IOL in the right eye (Figure 1). An examination reveals iris transillumination defects consistent with chronic iris chafing, raising concern about a mechanical pigment dispersion syndrome related to the piggyback IOL. The eye is quiet without active inflammation or hyphema.

The OD’s Role in Halloween Eye Safety Awareness Month

Modern Optometry

Real Estate: Invest in the Future of Your Practice

These financial, operational, and strategic considerations can help you make the right decision between renting and owning.

Jefferey T. Brockette, MSHA

Retina Today

Key Takeaways Real estate decisions don’t sit in one lane; they touch operations, finance, strategy, and even culture. Talking through different real estate structures with multiple advisors—rather than relying on input from a single source—often reveals options that make the path forward feel more manageable. Hybrid real estate structures can take several forms, including physician ownership alongside outside capital partners, joint ventures with developers or health systems, or staggered buy-in models that allow newer partners to participate over time. For most retina specialists, investing in real estate is a major decision. However, the question isn’t whether it makes sense—it’s how to approach it in a way that fits your practice. It’s important to recognize that real estate decisions don’t sit in one lane; they touch operations, finances, strategy, and even culture. Without a carefully constructed strategy to go about purchasing real estate, it may become easier to over-analyze every deal or put it off entirely. When making important real estate decisions, start by focusing on three crucial areas: strategy, financial structure, and operations. Within each of these three areas, explore at least three options, rather than relying on one perspective. PRACTICE CULTURE Ownership tends to create a stronger sense of alignment and long-term commitment among physicians, particularly when they are participating in both the practice and the real estate entity.