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2016-07-26T00:00:00.000Z

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Dr. Mitchell P. Weikert

Associate Professor

Baylor College of Medicine

Direct Phone: (713) ***-****       

Email: m***@***.edu

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Baylor College of Medicine

One Baylor Plaza, Room 176B

Houston, Texas 77030

United States

Company Description

Baylor College of Medicine in Houston is recognized as a premier academic health sciences center and is known for excellence in education, research and patient care. It is the only private medical school in the greater southwest and is ranked 21st among m ... more

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Background Information

Employment History

Pipeline Engineer

Exxon Pipeline Company

Affiliations

Chair of the Online Education Committee
American Academy of Ophthalmology

Education

Bachelor of Science

Biomedical Engineering

University of Texas

Bachelor of Science

Electrical Engineering

University of Wisconsin

Doctor of Medicine

Baylor College of Medicine

MS

degrees

electrical and bio-medical engineering

medical degree with honors

Baylor College of Medicine

Web References (66 Total References)


Boston Foundation for Sight | Alkek Doctors

www.bostonsight.org [cached]

Mitchell P. Weikert, M.D., M.S.

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Mitchell P. Weikert, MD
Prior to pursuing a career in medicine, Dr. Weikert received degrees in both electrical and bio-medical engineering. He received his medical degree with honors from Baylor College of Medicine. During his ophthalmology residency, completed at Baylor and the Cullen Eye Institute, he received the Everett L. Goar Award for Best Resident Research and served as Chief Resident during his third year of training. Dr. Weikert completed a fellowship in cornea, external disease, cataract and refractive surgery at the University of Utah School of Medicine's John A. Moran Eye Center and then had appointments at several Salt Lake City hospitals. He joined the faculty of the Department of Ophthalmology at Baylor College of Medicine in July 2003.
Dr. Weikert's research interests include ophthalmic applications of wavefront technology, ocular surface rehabilitation and biomedical optics. He has also authored several book chapters, research articles and abstracts in ophthalmic literature. Dr. Weikert is an active lecturer in his specialization of cornea, external disease, cataract and refractive surgery and is a current member of several professional organizations, including the American Academy of Ophthalmology, where he serves as chair of the Online Education Committee.


“Cassini is impressive. We’ve compared Cassini for IOL placement in cataract surgery.� - i-Optics

i-optics.com [cached]

"We've been comparing the Cassini with Placido ring and Scheimpflug to see where it excels, if and where there are any disagreements and why, and which one is right," says Dr. Weikert. So far, having imaged a couple of hundred patients, he says he is impressed with the Cassini. Dr. Weikert is running studies comparing the effectiveness of the Cassini's in imaging the cornea for IOL placement in cataract surgery.

One study by Dr. Weikert compared the Cassini's measurements of corneal curvature, astigmatism, and aberrations in both normal eyes and eyes with prior laser refractive surgery with those produced by a Humphrey Atlas and a Galilei combined Placido-Scheimpflug device. The findings were presented at the American Society of Cataract and Refractive Surgery this spring. "We found very good agreement between the devices, especially in normal eyes, and only a little disagreement in the pattern in eyes that had had prior refractive surgery, so I think the Cassini shows promise," comments Dr. Weikert. "All current measurement techniques fall short, so there is plenty of potential to improve and we are hopeful that the Cassini will help us do that. And as far as aberrations go, the Cassini does a very good job at measuring them."
Indeed, Dr. Weikert sees a lot more potential in the Cassini's ability to measure discrete points. One example he gives is non-circular aberrations.
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Dr. Mitchell P. Weikert, Baylor College of Medicine, Houston, TX
Dr. Mitchell P. Weikert, MD, M.S. is an Assistant Professor of Ophthalmology at Baylor College of Medicine, where his research interests include biomedical optics, anterior segment imaging, intraocular lens technology, and wavefront applications in cataract and refractive surgery.


“Cassini is impressive. We’ve compared Cassini for IOL placement in cataract surgery.� - i-Optics

i-optics.com [cached]

"We've been comparing the Cassini with Placido ring and Scheimpflug to see where it excels, if and where there are any disagreements and why, and which one is right," says Dr. Weikert. So far, having imaged a couple of hundred patients, he says he is impressed with the Cassini. Dr. Weikert is running studies comparing the effectiveness of the Cassini's in imaging the cornea for IOL placement in cataract surgery.

One study by Dr. Weikert compared the Cassini's measurements of corneal curvature, astigmatism, and aberrations in both normal eyes and eyes with prior laser refractive surgery with those produced by a Humphrey Atlas and a Galilei combined Placido-Scheimpflug device. The findings were presented at the American Society of Cataract and Refractive Surgery this spring. "We found very good agreement between the devices, especially in normal eyes, and only a little disagreement in the pattern in eyes that had had prior refractive surgery, so I think the Cassini shows promise," comments Dr. Weikert. "All current measurement techniques fall short, so there is plenty of potential to improve and we are hopeful that the Cassini will help us do that. And as far as aberrations go, the Cassini does a very good job at measuring them."
Indeed, Dr. Weikert sees a lot more potential in the Cassini's ability to measure discrete points. One example he gives is non-circular aberrations.
...
Dr. Mitchell P. Weikert, Baylor College of Medicine, Houston, TX
Dr. Mitchell P. Weikert, MD, M.S. is an Assistant Professor of Ophthalmology at Baylor College of Medicine, where his research interests include biomedical optics, anterior segment imaging, intraocular lens technology, and wavefront applications in cataract and refractive surgery.


Review of Ophthalmology® > Continuing Education > Reaching New Peaks in Ophthalmic Surgery

www.reviewofophthalmology.com [cached]

Mitchell P. Weikert, MD, is assistant professor of Ophthalmology at Baylor College of Medicine.

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Baylor College of Medicine assistant professor Mitchell P. Weikert, MD, in collaboration with Christian Hester, MD, covered the topic of ophthalmic photography and videography.
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Fortunately, smartphones offer a cheaper and more flexible alternative, and Dr. Weikert explained how. He recommends a minimum of 5 megapixels, but adds that "really, the more the better. He also pointed out that a telephone contract isn't necessary to use a phone's camera as long as you have wi-fi connectivity.
ADAPTORS & APPS
Dr. Weikert uses a slit lamp adaptor from EyePhotoDoc (Haag-Streit BQ and Advanced I-Illuminator), which goes directly over the slit lamp ocular. It has a little post so you can put it on the left ocular and it stabilizes it so it sits nice and horizontal (or vertical, but you get a little bit more real estate for your efforts in landscape mode). He shared that, with a light, it costs about $500, which, in the grand scheme of ophthalmic photography, is not that expensive. The adaptor without the light costs about $350 and is available for iPhones as well as the iPad and iPad mini.
He pointed out that Zarf Enterprises and OculoCAM also have adaptors for iPhones and Android devices and noted that if you're more of a do-it-yourselfer, you can create your own adaptor with the cap from a Gillette shaving foam travel pack container, the rubber disc from an empty CD stack box and rubber-based adhesive.
According to Dr. Weikert, ProCamera has a versatile, but inexpensive photography app. "The advantage of the ProCamera app," he says, "is that it allows you to separate your exposure and focus and move them independently. He also made a point about illumination, noting that, "if you just use a slit lamp and you put the broad beam on, you can't light the whole area of the eye. It's about 8mm maximum. But, he explained that if you put a diffuser on and flip it up, you can get broader illumination. He added that a transilluminator works really well, explaining that you can hang it on the dial for the slit lamp or have a scribe or tech hold it for you. Or, you can use a clip-on light source. His transilluminator is from EyePhotoDoc, and he says it has a blue light and a white light, allowing him to also do some fluorescein photographs. Additionally, the instrument also has a little rheostat, so he can vary the illumination.
THE VALUE OF VIDEO
Before ending his talk, Dr. Weikert commented that taking a slit lamp video is helpful-especially in the operating room (OR). "We all know that just seeing a static image is not always as valuable as seeing motion and being able to maneuver the light," he said. The ProCamera app is capable of shooting video as well as taking still photographs, and you can do that with the app in the iPhone as well. The Magnifi iPhone photoadapter case is useful in the OR, and he says it fits well on a Zeiss scope with f125 oculars.
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iPhone slit lamp photography and videography is a nice, inexpensive, portable and efficient alternative for ophthalmic photography, Dr. Weikert concluded. He added that physicians can bill for it just like any ophthalmic photography, and said it can be used to review surgical videos, etc. "It may be applicable in telemedicine, as you could FaceTime with it," he postulated. "And it might be useful for screening clinics that are manned by nonMDs. Keep HIPAA in mind, Dr. Weikert cautioned, and don't record any images with identifying information (e.g., facial picture, date of birth). You can use the medical record number to reference images. His final advice: don't underestimate using the zoom feature on your iPhone when it's on the eyepiece. "Just remember, you're doing a digital zoom- not an optical zoom, so you may lose a few pixels," he said.
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These days, patients expect painless, complication-free surgery at minimal cost and with instant excellent uncorrected visual acuity and minimal downtime," Mitchell P. Weikert, MD, began his second presentation. Thus, he submitted, good, accurate intraocular lens (IOL) calculations are absolutely necessary for meeting patients' expectations.
Dr. Weikert said that when many ophthalmologists consider IOL calculations, the formula is sort of a big black box. "We take measurements and enter them into the calculator, which spits out the lens power that we're supposed to implant in our patient," he stated. He believes it's valuable to look into this black box because it contains other black boxes that have limitations and make assumptions that can effect our results. But first, Dr. Weikert discussed IOL power calculation formulas.
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As Dr. Weikert noted, basically, you have light coming into the first surface, which creates an image that becomes the object for the second surface, which creates an image that becomes the object for the third surface, which hopefully is on the retina. "That gives us the vergence formula," he added, "which is the basis for the most common IOL calculation formulas used today."
He noted that the effective lens position (ELP), true corneal power, index of refraction, and the axial length are all other black boxes, which he went on to discuss.
THE "OTHER" BLACK BOXES
ELP. This is the estimate of the position where the IOL will sit in the eye. It's not a physical distance; it's the effective refractive plane of the lens. Dr. Weikert noted that ELP changes with axial length, so this black box has a lot of potential for improvement. The following formulas rely on ELP.
Dr. Weikert explained that the Holladay 1 formula is based on corneal height and increases the base of the cornea proportionally with axial lengths, according to average axial lengths and average angleto-angle distances. He added that it also includes the surgeon factor (an optimization constant), which is the difference between the corneal height and the effective IOL plane. He explained that the Holladay 1 has a very shallow linear relationship, as ELP increases with axial length. He then pointed out that one source of error lies in the fact that although ACD will increase as the eye gets bigger and the axial link increases, the surgeon factor is a constant number and thus stays the same.
The SRK/T formula uses the same model, Dr. Weikert noted. "It changes how it increases the base of the cornea depending on the axial length," he explained. "The SRK/T formula has something called an offset, which is basically the same as the surgeon factor. The SRK/T offset can be calculated from the IOL's A constant, so you can directly convert an A constant into a surgeon factor for ELP."
He finished the roundup of formulas with the Hoffer Q, an empiric derivation dependent on axial length and corneal power to create a personalized A constant as its optimization factor, and the Haigis, another empiric derivation, that is a linear model that depends on axial length and preoperative ACD rather than on corneal power.
"All of these ELP formulas are different," Dr. Weikert pointed out.
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Dr. Weikert explained further that a flatter corneal is going to measure a larger area, and a steeper cornea is going to measure a smaller area. "And we implant those results back into the same formulas," he noted. "Most devices that we typically use still measure the anterior surface only and reduce the index of refraction to account for the negative value of the posterior surface. And they assume a fixed frontto-back curvature ratio for the cornea. Corneal power also varies with pupil size," he reminded his colleagues.
Index of refraction. The cornea is a prolate surface, steeper in the center, flatter in the periphery. "When you have incident light coming in, overall the effect is to have positive spherical aberration of the cornea with peripheral rays are refracted more strongly than paraxial rays, so you end up with a little overall myopic shift as you sample larger areas of the cornea," Dr. Weikert explained. In the United States, ophthalmologists use 1.3375 for our keratometers, which simply models the cornea as the sum of two refractive surfaces with a curvature ratio equal to the Gullstrand ratio. In Europe, they use 1.3315 because their model factors in the corneal thickness. Newer devices can measure the front and back cornea, but they rely on measuring elevation, which is more difficult to do because you need much higher resolution to extract curvature information.
Axial length. This is one of the most critical steps in calculating IOL power, according to Dr. Weikert. "Small errors can have large effects on our postoperative results and errors about 0.1 mm can have 0.27D+ of error in the spectacle plane," he stated.
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Dr. Weikert advised the doctors in the audience to remember that these optical biometers are calibrated to ultrasound, which is calibrated to an average population of patients, and pointed this out as another source of error. He explained, "You're taking a direct measurement and changing it to agree with a bunch of other patients who are going to have variation in and of themselves."
IOL Design. This is the final black box Dr. Weikert spoke about. The refractive effect of an IOL depends o


Cataract & Refractive Surgery Today > Cornea Channel

crstoday.bmctoday.net [cached]

Mitchell P. Weikert, MD, MS, assistant professor of ophthalmology at Baylor College of Medicine, tau...

Management of Difficult and Challenging Cases Presented in 3-D High Definition

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