Sunday, August 28, 2016

Ocular Emergency: Retinal Artery Occlusion (RAO), A Non-Ophthalmologist Approach to Initial Treatment and Referral

Image Credit: Flickr

This post was peer reviewed.
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Author: Fernando Pellerano, MS-V
Universidad Iberoamericana (UNIBE) School of Medicine

Retinal artery occlusion (RAO) is considered a true ophthalmic emergency requiring immediate assessment and initiation of treatment. Appropriate initial emergency management may be the most important factor in determining visual outcome.[1]

RAO can either be central or branch. Central retinal artery occlusion (CRAO) results from a blockage anywhere between the origin of the artery (off the ophthalmic artery), to its first branch at the entry to the retina.[2] The site of obstruction is therefore not generally visible on ophthalmoscopy and in most cases the entire retina is affected. Branch retinal artery occlusion (BRAO) occurs when the blockage is distal to the optic nerve, within the visible vasculature of the retina. A BRAO can involve as large an area as three quarters of the retina, or as small an area as just a few micrometers.[1]

Epidemiology and Etiology
Incidence of RAO is approximately one per 100,000 per year and increases with age, peaking in the sixth and seventh decades. The central retinal artery is more commonly blocked than the branch retinal artery. [1] Although many systemic diseases are associated with RAO, more than 50 % of all affected patients will manifest no apparent systemic or local causes for the retinal disease.[2] Possible Etiology and Risk Factors for both CRAO and BRAO are listed in Table 1 and Table 2.[3, 4]

Thursday, August 25, 2016

The Salesman-Doctor

Image Credit: Flickr
Author: Edward Siegel, MD MBA
RSA Secretary-Treasurer '13-'14
Originally Published: Common Sense March/April 2014

I remember one of the early classes at my business school, when the lecturer asked how many of the students had been in sales prior to starting their MBA. I was one of the minority of students who raised their hands, as most of my classmates were in fields like engineering, consulting, and finance before starting their MBA program. Then the lecturer asked how many of us thought we would be in sales after graduating with our new degree. Though my memory is hazy, I think I was the only person to raise his hand. The lecturer asked me why I wanted to be in sales, and I told her that it wasn’t because I wanted to be in sales, but that I was going to be required to be in sales — that all of us, no matter what our background, skills, or abilities — were at one point going to have to sell ourselves to get jobs, convey the value of our ideas, and work with others. I went on to say that I had been working in sales in one form or another since I was a teenager, and that being a salesman was nothing to be ashamed of.