Yale L. Fisher, MD » Videos

Dec 5 2012 by Yale L. Fisher, MD

Dr. Jay Duker examines the critical issue of OCT artifacts and discusses how to identify and remedy them. NOTE: This movie is based on a live lecture and contains a few minor audio defects- they're not significant enough to interfere with your viewing experience and should not be confused with any problems with your viewing system. Dr. Duker's Financial Interest Disclosure: Stockholder- Hemera Biosciences Research Support- OptoVue Carl Zeiss Meditech Topcon Scientific Advisory Board- Paloma Pharmaceuticals Consultant- Alcon Genentech Ophthotech Novartis Neovista

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Edwin H. Ryan, MD shares his technique for scleral buckle procedures, honed from vast experience and extensive research.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Steve Charles discusses his successful approach to performing vitrectomy for diabetic tractional retinal detachment using 25 gauge.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. SriniVas Sadda shares a case study of a patient with Retinitis Pigmentosa.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Robert W. Flower, Dr.h.c reveals the evolution of Indocyanine Green from an industrial colorant to an indispensable diagnostic tool for hepatic function, cardiology and ophthalmology.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Ciliary body imaging is possible with the endoscope when patients are aphakic or pseudophakic. The ciliary processes are easily visualized in this short movie clip.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Peripheral endoscopic imaging of the pars plana region. The second instrument can be seen in the sclerotomy site moving in and out. Scanning of the more anterior region reveals a large particle of retained lens material following phacoemulsification. This particle was responsible for recurrent inflammation and cystoid macular edema. Subsequent removal ended the inflammation and retinal edema.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Cleaning of the endoscope is possible intraocularly with a protected and extendible sponge like wiper (pat). The device is useful to remove water droplets and non-adherent debris, especially following an air fluid exchange with the endoscope located in the air bubble.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Endoscopy: open angle glaucoma and retinal detachment PVR.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Endoscopically controlled surgical repair of a rhegmatogenous retinal detachment in a phakic glaucoma patient with a fixed miotic pupil. The formed vitreous is still attached in the posterior pole but separated peripherally. A horseshoe tear is located in the superior nasal portion of the globe. The flap is trimmed and the posterior formed vitreous face is removed from the optic nerve and posterior pole with an open vertical scissors blade. An air fluid exchange through the break completes the reattachment.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

With this patient microscopic control was not possible due to a small fixed pupil with vascularized synechiae to a posterior chamber IOL. There was recurrent intraocular bleeding and elevated IOP. The ciliary body ablation was accomplished first with a 532 laser fed through the working channel of the endoscope. Examination of the peripheral retina revealed a ring-like rhegmatogenous retinal separation and a large inferior tear with persistent traction. Endoscopically controlled imaging and a second instrument (suction/cutter) removed the tractional elements and permitted an air fluid exchange. Retinal reattachment occurred as the air-fluid exchange was completed permitting laser ablation of the ring like area that had been separated. The entire procedure was performed utilizing the small gauge endoscope.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher discusses the history, technique, and other basics of ophthalmic endoscopy for use in vitreoretinal surgery.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Another movie from Dr. Yale Fisher's collection of endoscopic imaging- in this case, anterior neovascularization in a case of diabetic retinopathy. No retinal detachment is present.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Another movie from Dr. Yale Fisher's collection of endoscopic imaging- this is another case of anterior neovascularization with diabetic retinopathy. No retinal detachment is present.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Steve Charles shares his approach to 25G PPV without scleral buckling for RRD, PVR and giant breaks. NOTE: A narration by Dr. Steve Charles will soon be available for this movie- please check back periodically.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Steve Charles reviews the tools and techniques he uses for 23G, 25G, and 27G PPV. NOTE: A narration by Dr. Steve Charles will soon be available for this movie- please check back periodically.

Condition/keywords: pars plana vitrectomy (PPV), video

Dec 10 2012 by Yale L. Fisher, MD

Pars plana incision site endoscopic imaging of vitreous incarceration from Dr. Yale Fisher's collection.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Pearls of wisdom from Dr. Steve Charles for surgeons examining their approach to 25G vitreomacular surgery. NOTE: A narration by Dr. Steve Charles will soon be available for this movie- please check back periodically.

Condition/keywords: video, vitreomacular surgery

Dec 10 2012 by Yale L. Fisher, MD

Dr. Steve Charles examines the process of innovation in ophthalmic surgery. NOTE: A narration by Dr. Steve Charles will soon be available for this movie- please check back periodically.

Condition/keywords: ophthalmic surgery, video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Steve Charles offers pearls of wisdom for the management of infusion during ophthalmic surgery. NOTE: A narration by Dr. Steve Charles will soon be available for this movie- please check back periodically.

Condition/keywords: infusion management, ophthalmic surgery, video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Steve Charles discussed his well researched approach to managing ruptured capsules experienced during cataract surgery. NOTE: A narration by Dr. Steve Charles will soon be available for this movie- please check back periodically.

Condition/keywords: cataract, ruptured capsules, video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Steve Charles discusses his approach to performing successful diabetic tractional retinal detachment surgery. NOTE: A narration by Dr. Steve Charles will soon be available for this movie- please check back periodically.

Condition/keywords: diabetic mellitus, video

Dec 10 2012 by Yale L. Fisher, MD

Yale tells a True Story for the Donate slider page.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher describes his approach to learning ophthalmic endoscopy.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Another movie from Dr. Yale Fisher and the OphthalmicEdge.org Contact B-scan ultrasonography can be of great help in diagnosing buried drusen of the optic nerve head. When drusen are buried deep in the nerve and invisible to white light, ultrasound has proved to be diagnostically helpful. Drusen of the nerve head are excellent reflectors of sound (probably due to the presence of calcification). Drusen themselves have an extensive shadowing effect, but since we are already shooting through the optic nerve shadow, much of this effect is not evident. They stand out like small pebbles on the head of the optic nerve and their characteristic hyper-reflective signal persist at the lowest decibel levels of gain. Also in this eye, scattered vitreous opacities of very low reflectivity are visible, which may be related to advancing age. In younger eyes, the clear vitreous body generally produces no echoes.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

This is a partial vitreous separation that demonstrates a mildly reflective curvilinear shape of the partially separated vitreous face. The vitreous is attached inferonasally and inferotemporally, but detached and freely mobile at 6 o'clock.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

VA 20/20. In asteroid hyalosis, there is a space between the posterior hyaloid face and the calcified asteriod lesions. Use gain to differentiate between VH and asteroid hyalosis (asteroid still present when gain is decreased).

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

In asteroid hyalosis, accumulations of calcium soaps dispersed throughout the vitreous produce bright echoes in the usually echolucent vitreous. The appearance of asteroid hyalosis should not be confused with that of vitreous hemorrhage or vitritis. Many of the larger aggregates in asteroid hyalosis are easily seen as the gain is reduced to below 60 db, unlike vitreous hemorrhage or vitritis which usually disappears at low gain settings. There is also an area of clear echolucent vitreous between the posterior hyaloid face and the asteroid particles, which is usually not present in vitreous hemorrhage or vitritis.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Elevated, dome like, mass of the choroid with high reflectivity throughout the lesion and mild shadowing of the orbital fat behind the tumor.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Observe orbital cystic structures temporal to optic nerve. Orbital cyst transmits sounds easily. Small optic nerve shadow is visible superior to the cyst in the upper portion of the screen. Strong reflections from choroidal region are consistent with calcification. Tilting of the probe vertically demonstrates communication of the orbital cyst to the vitreous cavity as well as posiible communication to optic nerve.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher presents a sagittal view of a complete posterior detachment demonstrated by the thin preretinal reflection (yellow arrow). Scleral depression (green arrow) at the ora serrata demonstrates the ability to register anatomical position on ultrasound using a scleral depressor.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

An intraocular lens (IOL) implant can dislocate posteriorly and appears as a large foreign body within the vitreous cavity. ; The IOL demonstrates shadowing within the orbit.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

This is a dislocated lens. You can see a large ovoid object resting against the ocular wall shadowing the orbital fat. Internal reflectivity demonstrates a nucleus within the larger ovoid structure. Moderate reflections from the subcapsular space and nuclear area are visible, conistent with hypermature cataract (Morgagnian type structure).

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

The buckle is an encircling element. the anterior posterior view shows a cross section above and below on the screen. Rotation vertically demonstrates a superior and inferior cross-section of a highly elevated scleral buckle. There is movement of the separated formed vitreous and far anterior (visible at the left of the screen). Optic nerve shadow is visible as the nerve moves vertically.

Condition/keywords: B scan ultrasound, scleral buckle, video

Dec 10 2012 by Yale L. Fisher, MD

Foreshortening in a phtisical eye with a thickened choroid.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Tilting of the probe coronally reveals foreign body of choroid and choroidal hemorrhage. Foreign body tract is visible from the anterior-temporal to posterior-inferior-nasal postion.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher introduces his series of Essential Lectures on Ophthalmic Ultrasound.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher discusses the origins of this imaging modality in this installment of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher discusses the basic physical principles that make ultrasound possible in this installment of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher discusses the Basic Instrument Design of the typical Ophthalmic Contact B-Scan ultrasound machine in this installment of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher discusses how an A-Scan becomes a B-Scan in this installment of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher explains the importance of Real Time, or movement, when performing ocular ultrasound in this installment of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher explains the importance of Real Time, or movement, when performing ocular ultrasound in this installment of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher explains the importance of Gray Scale when performing ocular ultrasound in this installment of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher explains the importance of 3D thinking when performing ocular ultrasound in this installment of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher discusses his approach to making a diagnosis using Contact B-Scan Ultrasound in this episode of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Yale Fisher discusses vocabulary relevant to ophthalmic ultrasound in this installment of Essential Lectures.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

In this ultrasound movie there is little movement of the vitreous. Observe the operculated, small, relatively strongly reflective tissue on the detached, mildly reflective, vitreous back surface (yellow arrow). There is a sagital view of the superior aspect of the lateral rectus muscle (orange arrow). Operculated tear at 10 o'clock position.

Condition/keywords: operculated tear, ultrasound, video, vitreous

Dec 10 2012 by Yale L. Fisher, MD

This B-scan demonstrates a partial PVD. A posterior vitreous detachment (PVD) may occur in a normal aging eye or may be associated with pathology such as vitreous hemorrhage or inflammation. In a normal eye, as in this example, the PVD appears as a thin and smooth line (arrow) on B-scan. When the globe is moved voluntarily by the patient, real time echography demonstrates a quick jerky motion of the sheet-like echo with movements continuing after the globe movement has ceased. This is helpful in differentiating a PVD from a retinal detachment, which typically has a slower undulating pattern of motion. If there was presence of blood or inflammatory debris associated with the PVD, the echogenic line might appear thicker, especially in the most gravity dependent portions of the globe (i.e., posterior and inferior).

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

There is a posterior vitreous face separation with remaining attachment to a retinal flap tear. Movement of the tear is visible during voluntary motion of the patient's eye. There is strong reflectivity from the flap tear (yellow arrow) and moderate reflectivity from the vitreous face (green arrow). The peripheral retinal tear is seen in this sagittal nasal cut near the medial rectus muscle insertion, which localizes the tear to the ora serrata around the 3 o'clock position.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

In this movie formed vitreous hemorrhage (yellow arrow) can be seen moving slowly inside this open-coned retinal detachment, which demonstrates no motion. ; Sub-retinal material (green arrow) with moderate reflectivity is seen moving in an undulating fashion slower than movement usually seen in the vitreous cavity.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Retinal tear with demonstration of flap movement.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Partial PVD, retinal tear due to vitreous traction.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Localize macular staphyloma seen as an outpouching of the normal posterior ocular wall (arrow). Optic nerve is seen superior to macular area.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Staphyloma due to high axial myopia. Notice that the eye is so long that visualiization of the pupil and iris is possible at the front of the ultrasound image!

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Dr. Steve Charles discusses his primary steps in managing ocular trauma.

Condition/keywords: surgical management

Dec 10 2012 by Yale L. Fisher, MD

This B-scan ultrasound demonstrates a combination of vitreous haemorrhage plus subretinal haemorrhage, due to polypoidal choroidal neovascularisation

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Retinal detachment secondary to PVR, patient is NLP. Yellow arrow indicates intraretinal cyst due to longstanding detachment.

Condition/keywords: video

Dec 10 2012 by Yale L. Fisher, MD

Total PVR Detachment

Condition/keywords: detachment, proliferative vitreoretinopathy (PVR), video

Dec 10 2012 by Yale L. Fisher, MD

Total PVR Detachment

Condition/keywords: detachment, proliferative vitreoretinopathy (PVR), video

Dec 10 2012 by Yale L. Fisher, MD

High reflectivity (strong mismatch in acoustic impedance) of the linear structure consistent with a tractional retinal detachment involving the macula and nasal area around the optic nerve.

Condition/keywords: high reflectivity, macula, retinal detachment, video

Dec 10 2012 by Yale L. Fisher, MD

Funnel retinal detachment due to PVR - the patient is barely LP. Total detachments always connect and extend from the optic nerve.

Condition/keywords: proliferative vitreoretinopathy (PVR), retinal detachment, video

Dec 10 2012 by Yale L. Fisher, MD

Hypotony can produce specific findings on ultrasound examination such as diffuse thickening of the choroid, scleral thickening, and shortened axial length.

Condition/keywords: choroid, hypotony, scleral thickening, uveitis, video

Dec 10 2012 by Yale L. Fisher, MD

Type 1 CNV (polypoidal choroidal vasculopathy) with vitreous hemorrhage and suprachoroidal hemorrhage.

Condition/keywords: polypoidal choroidal vasculopathy (PCV), suprachoroidal hemorrhage, video, vitreous hemorrhage

Dec 10 2012 by Yale L. Fisher, MD

Examination techniques for the beginner.

Condition/keywords: beginner, examination techniques, video

Dec 10 2012 by Yale L. Fisher, MD

The vitreous is attached and demonstrates after-movements of formed vitreous as the patient is asked to look to the right and left. There is mild reflectivity in the formed vitreous from collagen. The optic nerve is visible in the superior aspect of the image and the lateral rectus muscle is seen inferiorly.

Condition/keywords: floaters, video, vitreous

Dec 10 2012 by Yale L. Fisher, MD

This video demonstrates endoscopic visualisation of incarceration of the anterior flap of a giant retinal tear

Condition/keywords: endoscopy, retinal tear, video

Dec 11 2012 by Yale L. Fisher, MD

Infusion cannula positions can be visualized with the endoscope, especially useful when microscopic views are limited or impossible as in this short movie. Here, the infusion cannula had been placed in a standard fashion but endoscopic imaging reveals partial engagement of peripheral retinal tissue. Manipulation of the tip under endoscopic viewing eliminates the undesired engagement and reveals the proper infusion position with no obstruction.

Condition/keywords: endoscopy, infusion cannula positions, video