Editors Column November 2024
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I work with trainees at my hospital, and they look through a teaching tube when I’m behind the slit lamp examining a patient. During the exam, I usually narrate aloud what I see in the oculars. Ostensibly, I do this for the trainee as a way for them to learn what things are and to understand my thought process in performing the exam. But I think subconsciously (or consciously, to be honest), I do this for the patient to know that I’m actually thoroughly evaluating their eyes rather than just mentally checking off a box for the exam requirements (e.g. eyeball: present). Perhaps they’re impressed by the technical words they hear: “here’s a posterior subcapsular change, but when I retroilluminate it, you can see that it doesn’t encroach upon the visual axis.” It’s not unlike a parent talking to their toddler and explaining the world to them as they push them in a stroller: “See that Wiess ring?… Ooh, look- a Mittendorf dot.”
I’m fascinated by the process of how an eponym is bestowed upon a disease. Every time I utter the phrase, I imagine Mittendorf in his clinic or in his lab. In my mind, it’s London in the late 19th century, and it’s dark. Poor Mittendorf is working late again. But after his fortieth dissection, eureka—he discovers a bit of the hyaloid artery still stuck on the posterior capsule of the lens. He sees this enough to know it’s not a one-off but something that happens 3-5% of the time. And that’s good enough for old Mittendorf to make it into the textbooks.
It’s harder to make it into the textbooks nowadays. I can’t tell you the best way to do it, but I know that it requires going above the standard. I attended the NAVAO meeting at AAO this month, and I listened to an optometrist who was the first non-medical doctor to serve as the command surgeon for the U.S. Joint Forces. I was inspired by someone who didn’t stop pushing forward in his career. He chose a path that wasn’t easy, but seemed very rewarding. How do you want to push forward in your career? What is stopping you? How do you want to give back to the field?
Our authors this month saw interesting cases and didn’t just sit on them; they pushed forward down the path to publication. They enhanced their own knowledge by researching their topic, allowing a wide audience to gain insight into it, and put their name out there as a doctor who is knowledgeable about a certain topic. They are on their way to their own Mittendorf dot. Marlin John’s article brings a serious systemic condition – a patent foramen ovale – to an optometric audience and shows us why eye care providers need to know about congenital heart defects. Jenna Koskey took the time to get amazing photos of a large choroidal effusion and showed us that even though a doctor might not be performing complicated cataract surgery, they still need to know any and all complications that might occur.
This issue welcomes a new recurring column: Diplopia Detective by Emily Carr, an optometrist at the Wilmington VA in Delaware. Dr. Carr will go through complex diplopia cases with the audience, searching for clues that will help uncover the cause of the complaint. We can always use more practice with diplopia, and Dr. Carr has the ability to put all the pieces together for us to help “catch the culprit.” I’m excited about it.
Remember to push forward in your career. Doctors who follow the crowd don’t get things named after them.
Dr. Rett is the Editor-in-Chief of the Journal of Medical Optometry and the secretary for the American Board of Certification in Medical Optometry. He is the Chief of Optometry at VA Boston and sits on the national Field Advisory Board for Tele Eyecare at the VA. He is adjunct clinical faculty at several optometry schools, lectures nationally and enjoys writing about eyecare whenever and wherever.
