Eyeworld

26 October 2018 EW NEWS & OPINION Shannon McCole, MD, chair- man and program director, Eastern Virginia Medical School, Norfolk, Virginia, who has been involved as an instructor at the course for 3 years, said that the course is in- valuable to military ophthalmolo- gists and residents who might face deployment, but the inclusion of civilian ophthalmology residents has important applications also. "To my knowledge, there is no course like this. … We're also serving the needs of injured civilians and injured U.S. citizens here. All around in ophthalmology we need to be competent in dealing with traumatic eye injuries," said Dr. McCole, who sees a fair share of ocular trauma injuries at Sentara Norfolk General's level 1 trauma center serving the entire Hampton Roads area. Michael Ullman, MD, a third- year ophthalmology resident at Georgetown University/Washington Hospital Center, Washington, D.C., is one such civilian resident. "I will be pursuing a corneal fellowship at the end of this year," Dr. Ullman said. "The trauma course was extremely applicable to my education. After 1 week, I felt more confident in my ability to assess and treat ocular trauma. I have attended several surgical courses and nothing comes close to the ocular trauma course. There are extremely realistic surgical models and one-on-one teaching with experts. I can't think of a more educational week in my entire residency." "This type of extensive course is important," Dr. Ullman continued. "Unfortunately, most eye trauma occurs sporadically and often at inopportune times. With a con- densed, content heavy course filled with realistic surgical scenarios, I was able to rapidly pick up skills that I currently rely on. I was also able to learn from military experts who 'wrote the book' on ocular trauma and have unparalleled real-world experience with trauma." EW Editors' note: The physicians have no financial interests related to their comments. Contact information Colyer: marcus.h.colyer.mil@mail.mil Karesh: jkaresh@lifebridgehealth.org Kim: wonkim74@hotmail.com McCole: MccoleSM@EVMS.EDU Ullman: mullman@gmail.com Rex: tonia.rex@vanderbilt.edu the application of new equipment for physicians in the armed services. One example is the 3-D NGENUITY system (Alcon, Fort Worth, Texas), which uses TrueVision (Santa Bar- bara, California) technology, to see if it can provide a more ergonomic, comfortable experience for physi- cians who might otherwise spend 12+ hours craning their necks at an operating microscope. The course is also a place where a few key industry players can meet and discuss potential collaborative opportunities that could benefit military ophthalmologists. Three Army logistics personnel were on hand to help take and provide feedback on what military ophthal- mologists need, the current state of technology, and if new technology is "hardened enough" for the mili- tary's purposes (i.e., can withstand conditions like heat, sand/dust, and drop delivery). Down a few floors into the belly of Uniformed Services University is a room with a blast tube, a device that could mimic a "pure blast" situation, without all the other factors one might associate with an explosion, such as shrapnel. "The blast is an injury separate from objects that hit the eye or heat generated," Dr. Colyer said. "There is some sort of injury in the blast itself." That's what Tonia Rex, PhD, associate professor of ophthal- mology, Vanderbilt Eye Institute, Nashville, Tennessee, is researching. Dr. Rex was on hand to show how the eye can look after a pure blast. Wearing ear protection and behind a closed door, looking through the small window that showed a pig eye in a 3-D-printed artificial eye socket, a short countdown proceeded the brief blast. The eye looked normal. This was a teaching tool to convey to residents what the blast can do to the eye, Dr. Rex said. It could result in hyphema or a ruptured globe, but that often doesn't happen, she said. Rather, subclinical damage can worsen over time and result in vision loss. "Letting residents know what [a pure blast] looks like, hear that sound, and see that the eye doesn't have to appear damaged" drives home the point that if it's known a patient has been exposed to a blast, they need a different level of follow-up to monitor how their posterior structures might respond over time, even if everything looks normal in the anterior segment, Dr. Rex said. Reporting continued from page 24

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