Establishing a Glaucoma Practice Fresh Out of Fellowship

Emily Schehlein, MD

Eyetube

Emily Schehlein, MD, recaps her article, “Establishing a Glaucoma Practice Fresh Out of Fellowship,” which was featured in the March/April issue of Glaucoma Today. When ophthalmology training ends, the work of building a practice officially begins. In her article, Dr. Schehlein, a glaucoma specialist at Brighton Vision Center in Brighton, Michigan, offers insights and strategies for young ophthalmologists in building a successful, specialized practice.

Don’t “Lump” All Lid Lesions Together

Be thorough in creating your differential diagnosis.

Jacob Lang, OD, FAAO

Modern Optometry

The term chalazion is of Greek origin, meaning hailstone, small lump, or pimple.1 In eye care, a chalazion (Figure) is a chronic cyst of lipogranulomatous material possibly caused by the obstruction of a sebaceous gland of the eyelid (ie, meibomian gland or gland of Zeis).1 Risk factors of chalazia include blepharitis, dry eye disease, eyelid dermatitis, rosacea, and conjunctivitis.1 Figure. Chalazion of the upper lid in a patient with concomitant rosacea. For such a common ocular pathology, it’s surprising we still don’t completely understand the pathophysiology of chalazia. Does a bacterial component alter the lipid composition of meibomian secretions and trigger an inflammatory response? What activates the lipogranulomatous inflammation that causes chalazia? As more attention is focused on the ocular surface and meibomian glands, researchers may find answers to these and other questions about lid lumps. A VARIETY OF LUMPS Not all lid lumps are chalazia. Clinicians must also be on the watch for neoplasms, such as sebaceous, basal, or squamous cell carcinoma, which should be included in the differential diagnosis of chalazia, especially when lesions are recurrent in the same location or have atypical features.1 Infectious etiologies, including herpes simplex virus, varicella zoster virus, molluscum contagiosum, leishmaniasis, sarcoidosis, and tuberculosis, can also mimic chalazia.1 Of note, eye care clinicians observed an increased incidence of chalazia during the COVID-19 pandemic, and some hypothesized that this uptick could be related to mask wear. Silkiss et al reported on this observation, alluding to a multifactorial nature of chalazion development.2 The proposed factors include exacerbation of dry eye disease, meibomian oil hardening, poor lid hygiene, and airflow direction changes leading to oral microbiota contacting the eyelids.2 MANAGEMENT There is little statistically significant evidence supporting the effectiveness of many common treatments for chalazia, especially comparative efficacy, at this time.1 Possible chalazion treatment options include hot compresses and other thermal treatments (eg, Systane iLux MGD Treatment System [Alcon], TearCare System [Sight Sciences], TearScience LipiFlow Thermal Pulsation System [Johnson & Johnson Vision]), topical antibiotics and/or steroids, oral antibiotics and/or steroids, probiotics, intralesional injection of corticosteroids or 5-fluorouracil, incision and curettage, tea tree oil wipes, and light therapy (ie, intense pulsed light or low-level light therapy).

Tips for Retaining Staff and Keeping Them Happy

A solid team is at the core of any successful practice. Here’s how you can do your part as a leader to ensure employee satisfaction.

Michael J. Cymbor, OD, FAAO; Mila Ioussifova, OD, FAAO, CNS; and Caitlin Morrison, OD, FAAO, FSLS

Modern Optometry

Having trouble with employee turnover, or just want to be proactive so you (hopefully) never have to deal with it? We spoke with three established practice owners and asked them to share their secrets to building and maintaining a strong optometric team in today’s world. Read their insights for retaining staff and keeping them happy and productive. — Alex Brodin, Associate Editor Modern Optometry (MOD): Tell us about your practice. Mike Cymbor, OD, FAAO: Nittany Eye Associates has five locations in Pennsylvania. We employ 12 optometrists, one ophthalmologist, 18 technicians, and more than 60 staff members. Mila Ioussifova, OD, FAAO, CNS: South Waterfront Eye Care is a full-scope optometric practice with a boutique optical. We provide medical eye care with a special emphasis on dry eye disease management, offering advance treatments such as intense pulsed light therapy, radiofrequency, TearScience LipiFlow Thermal Pulsation System (Johnson & Johnson Vision), TearCare System (Sight Sciences), and MiBo ThermoFlo (MiBo Medical Group). We perform in-office procedures, including blood draws for autologous serum and platelet-rich plasma eye drop preparations, and offer aesthetic services. As a certified nutrition specialist, I offer personalized nutrition counseling tailored to enhance ocular health.