Insights on glaucoma surgery and far beyond (Dr Eytan Blumenthal)

Dr Eytan Blumenthal, one of our invited speakers, prepared an entertaining and thought provoking talk about glaucoma surgery and the cocept of feedback loops. Writing an article about his talk is akin to dancing about architecture. Nonetheless, here are my notes and thoughts about his lecture. This was presented at 1110hrs on 10Jun2011 during the Canadian Glaucoma Society portion of the 74th Annual Meeting of the Canadian Ophthalmological Society that was held in Vancouver, BC.

The 10:10:10 rule

Dr Blumenthal explains the 10:10:10 rule. 10% of the audience will remember at least 10% of what I say for at least 10 minutes. He is hoping each person leaves with at least one pearl.

Parachute trial

He talks first about the fact that there is no evidence based literature of any randomised control study as to whether the use of a parachute prevents serious injury or death. This was publisehd in BMJ in 2003. What percentage of what we do in the Operating Room is evidence based? How many of you have had dilated exam in past 1, 2, 5years? (Almost nobody in attendance has had a dilated exam recently despite it being a recommended standard.)

Dr Blumenthal mentions that he will not discuss his Katena Blumenthal dissector, or how to obtain histological sections around the disc with imaging devices. OCT and histology and GDx correlation shown. Instead, he will talk about surgical volume and how residents and even fully trained surgeons can get the experience they need by making sure they VIDEO all surgeries! This is a vital part of the surgical education process and is quite often NOT part of everyone’s routine. (As an aside, I do in fact try to video all my surgical procedures to try to learn from what I did and continuously work at doing better. This way when my Residents and glaucoma Fellows are doing part or all of the case, they can review their work.)

Example of IOL inserted without viscoelastic, lens flipped over, tries flipping it back.

Feedback loops: without this there is no learning and no progress. Action, consequence and learn from it. This explains why we are good cataract surgeons and so so at glaucoma. We get spanked on the hand right away. WIth glaucoma we are doomed to failure months later instead of right away.

What is a difficult surgery. Trab far simpler than phaco? How many combined surgeries failed because of phaco vs b/o the trab. Difficult surgery as delta of success vs failure increases.

Procedures best practiced in calm waters before heading out to seas.


PredForte q1h because inflammation will cause the failure.

Best time to decide what will happen on the next visit. Need note to self…if progression consider trab. Most important skill.