Things Worth Sharing
Wu H, Wang Y, Ni Z, et al. HOTV Vision Test Compared With Tumbling E for Pediatric Vision Screening. JAMA Ophthalmol. Published online August 27, 2026. doi:10.1001/jamaophthalmol.2026.3425
This reminds me of a lesson I learned that directionality doesn’t fully form until 7-8 years old. Tumbling E and and Landolt C’s are better language barriers in adults than pediatric screenings.
“Spray” dilation was talked about in my schooling, but never utilized. It wasn’t until I read Dr. Oatts and Dr. Chan’s article that I understood why. While mydriasis shows noninferiority to drops, cyclopegia does not.
Field Note
After 4 years in practice, I removed my first pseudomembrane from an EKC infection. At first, I wasn’t sure what to do with it. I even considered referring it to ophthalmology.
For whatever reason, I decided to manage it. I did the best I could on day one. Then I refreshed my knowledge on the topic and got ready to see the patient on day two. Once I figured out what to do, the procedure itself was straightforward.
But what struck me was that I had just experienced another “clinical first.”
Those “firsts” are less frequent, but I highly doubt they’ll disappear totally. Dr. Michael Twa was the dean at the University of Houston College of Optometry when I graduated. I’ll never forget his graduation speech. I’m paraphrasing, but he said:
You are not good doctors. You are simply deemed adequate enough to not harm people. Becoming a good doctor involves continuous learning that comes from clinical application in the real world.
Ouch. All that work just to step on a road with no end.
But four years later, I begin to understand what he means. There is a difference between theoretical knowledge and seeing it play out in practice. Reading theory puts the knowledge in your head, but seeing it in practice puts the knowledge in your bones.
Walking that road is the work of a good doctor.
See what’s in front of you. Refresh your knowledge. Be willing to do something for the first time.
Cheers to more “clinical firsts.”
What are some of your notable clinical firsts? Feel free to respond directly to this email.