Alex Sigmund, DVM, DACVO, is a dedicated advocate for advancing veterinary ophthalmology and empowering fellow veterinarians through continuous learning. You may know him from his popular Instagram account @theveteyeguy, where he provides accessible information on veterinary ophthalmology for veterinarians and owners alike.
Dr. Sigmund discusses some of the unique aspects of veterinary ophthalmology, the impact of ongoing education in enhancing patient outcomes, and essential fundamentals in ophthalmic care that every veterinarian should know.
For those who don’t know you, tell us about yourself, your background, and how you got started in the veterinary industry.
So, I first became interested in veterinary medicine at a young age. My aunt was a veterinarian and practice owner in South Georgia; I was always at her clinic. She had horses, and my mom was a big horseback rider. I did some horseback riding and was always around animals growing up. I volunteered at her clinic when I was getting ready to apply for veterinary school.
When I was in undergrad, I kind of accidentally selected a major that put me in the College of Agriculture, which then put me in the College of Poultry Science. I got to do a lot of hands-on work with chickens, including medical procedures, which helped me develop some of my technical skills for vet school. Because of my interest in animals, my mentor suggested I go to vet school based on my experiences with my Aunt and then my undergraduate degree.
I went to the University of Georgia for undergrad and grad school. I did a rotating internship at the University of Tennessee, and it was an amazing experience. I also met some lifetime friends of mine. I actually did not get a residency during my first application season. Ophthalmology residencies are really tough to get because of the number of applicants there and the limited number of placements. Instead, I ended up doing a specialty internship with BluePearl Pet Hospitals in Tampa, where I worked with a few different ophthalmologists and honed my skills. It set me up really well for my residency, which I went back to the University of Tennessee for.
Given that extra year in intensive ophthalmology training, I think I started off in a really good place. The residency at UT was three years, and I would honestly go back and do it again because it was so great; I had such incredible mentors.
Where did you end up after your residency?
When I finished my residency in 2021, I moved to Atlanta and worked for two years at BluePearl. I recently left BluePearl in December 2023 to start my journey toward opening my private ophthalmology practice.
I am currently operating through my LLC, Insight Veterinary Eye Care. We focus on teleconsultations and CE events with primary veterinarians, such as general practitioners or hospitals. I’ve partnered with a company called The Eye Vets out of Nashville, and we are working together to bring The Eye Vets to Chattanooga.
How did you decide on a specialty in veterinary ophthalmology?
I liked everything going through vet school, so I knew it would be difficult for me to pick a specialty. I originally was leaning towards internal medicine because I liked the puzzles involved with the cases. But as soon as I went into my ophthalmology rotation in my third year of vet school, I saw a cataract surgery for the first time and thought, ‘I need to do that’ because it was the coolest thing I had ever seen.
When I started looking closer into ophthalmology as a profession and what’s involved in training, I decided that it was going to be a great marriage of all the things that I liked to do. In ophthalmology, you get to do:
- Internal Medicine: Systemic workups for diseases that you can detect in the eye, like high blood pressure, some types of cancer, and even detect hormonal imbalances in the eye.
- Oncology: Eyelid and orbital tumors, tumors inside the eye.
- Surgery: A little bit of surgery and a lot of microsurgeries, including interocular procedures, blepharoplasty, and corneal procedures.
- Dermatology: Allergies affecting the eyes and even some allergic skin diseases around the eye.
So, as ophthalmologists, we really get to do a little bit of everything, but on a smaller scale.
We know you have a popular Instagram, The Vet Eye Guy. How did you first start that?
It had been brewing in the back of my mind for a while because I had seen a lot of great content on Instagram through the #Vetstagram hashtag. But all the ophthalmology stuff that I saw online was just pictures with a little caption; there wasn’t much of a dynamic presentation of the information. I had actually made the Instagram account but never really used it because I just wanted to have the account name (I didn’t want anyone to get the same great idea as me and take it!).
Ironically, last year, during the ACVO/Epicur National Service Animal Eye Exam Event, one of the participants tagged my account in a post, and that sparked me to start posting on the account. It just blossomed from there!
Why do you think Instagram or other platforms serve as such a useful learning tool for veterinary professionals?
I think there is a need for micro-continuing education to present information to veterinarians. In vet school, not everyone learns a ton about ophthalmology and I know some programs don’t get any information on it because they might not have an ophthalmologist to teach the information. Some schools have ophthalmology as an elective, but students can only choose so many electives. A lot of times, students will take the neurology and cardiology electives over ophthalmology, which limits the amount of training you get for ophthalmology.
Because of that, I knew that general practitioners felt uncomfortable with ophthalmology. And when you look at the continuing education events available for ophthalmology, there are typically one or two a year. I knew that this social media platform would be a great opportunity to get out there, spread my passion for ophthalmology, and hopefully demystify the scariness of ophthalmology.
I am actually collaborating with some other Instagram veterinarians, including Dr. Lisa Lippmann (@drlisalippman), Dr. Monica Tarantino (@seniordogdoc), and Dr. Lauren Adelman (@the_tinyvet). They are putting together a geriatric dog care certificate program and originally hadn’t included ophthalmology in the program. So, we got connected and now I am doing some ophthalmology lectures for them. I am really passionate about ophthalmology education and social media has allowed it to grow.
Ophthalmology Webinar
Practical Corneal Ulcer Management for General DVMs
Presented by Alex Sigmund, DVM, DACVO
May 21 | 8 pm ET
Has the comfortability with ophthalmology grown with more available education for both veterinarians and pet parents on social media?
Yeah! I’ve received photos from veterinarians saying they saw my post and were able to diagnose an eye disease. A photograph is worth 1000 words so I think it really has been beneficial for continuing education. And then, for pet parents, I’ve had a lot of people reach out and ask me what is going on with their pet – they send me a picture and ask me to help. Unfortunately, I can’t diagnose anything for them, but I can let them know to have their own veterinarian reach out for a tele-consult to help.
How does improving veterinarians’ knowledge of ophthalmology benefit patient care overall?
I think the benefit is being able to support general practitioners with specialty support through CE without creating delays in patient care, which benefits everyone involved! General practitioners have to know so much information that I feel like a lot of their knowledge of ophthalmology gets condensed to what they see most often and what they can remember. An example of this would be corneal ulcers. A lot of times, if there is a corneal ulcer that’s not healing, there’s an assumption it must be infected. So they’ll treat it based on what they remember from school. But what’s hard to remember is some of the other features of an infected ulcer that point away from this case being an infected ulcer. Maybe it’s just a non-healing ulcer, which would be treated differently. This can delay the patient care that the animal needs and can cause frustration for the pet owners.
Something I like about ophthalmology is that it is very pattern recognition-oriented. I definitely see cases where they’ve been treating the eye for a month with no improvement, and within about a minute or two from running an exam I know what is going on. So you have that answer before the patient leaves. And sometimes that answer comes from having a little more education on the specialty.
Obviously, the eyes are super important, and especially with different eye diseases like ulcers, glaucoma, and dry eye, they need to be tackled quickly so you can improve their outcome later down the road. Delayed care, in some cases, can cause blindness for the animal.
How do you boil down the basics of ophthalmology when educating others?
I would say solidify your ophthalmic exam first. The best approach is to start on the outside and work your way in. Just like with a physical exam, you have a pattern or order that you go in so you don’t miss anything. The same applies to ocular exams. Start by just watching the animal walk around. You can tell from that whether the animal can see or not. Then look at the eyelids – do they have sensation and nerve function? You’ll go through each area, the cornea, the anterior chamber, and the optic nerve, until you check everything.
Establishing that order will help you ensure that you’ve evaluated each section and can then note any abnormalities. Because ophthalmology is pattern recognition, many times, you just need to know what “normal” looks like so you can understand and see what abnormal is.
There are five conditions that veterinarians need to be comfortable with because they are the most common.
- Corneal Ulcer
- Glaucoma
- Uveitis
- Retinal diseases
- Cataract/lens issues
Ulcers are probably the most common because dogs can randomly get ulcers, but they’re also prone to injuries because their eyes are less sensitive than humans. They also don’t necessarily protect their eyes as much, especially with breeds like Frenchies, where their eyes are bugging out of their heads.
For ulcers, what are some common warning signs?
When any dog comes in that is squinting or has a red eye, they’ll need three diagnostics done:
- a fluorescein stain
- a pressure check
- a tear test
Each of these is typically super accessible in general practice and relatively easy to do. A few features you’ll want to look for are:
- Any depth to the ulcer – so does it have a divot?
- Is there white, creamy, snot-looking stuff around the ulcer? That is a sign of infection, so it is important to check.
- Or, do you see puss inside of the eye? That is also an indication that there’s a corneal infection.
If you don’t see any of those things, then you are hopefully dealing with just a routine ulcer, which, with antibiotics, should be healed within a week. But if it’s not, you’ll start looking or reassessing to see if there is any underlying cause for it not healing. Do they have any eyelid abnormalities? Do they have a foreign body that is rubbing on the eye? If you can rule out any of those things, then you’re left with a lazy ulcer, and those are non-healing ulcers, where you’ll have to reset the healing process because the healing process itself is abnormal. You have to strip away the abnormal healing tissue to start fresh.
When did you start working with Epicur?
I first met Branson and Sam when I was a specialty intern with BluePearl and have been working with them kind of ever since. I went to dinner with them and one of the ophthalmologists at BluePearl in Atlanta. When I was finishing my residency, she remembered that I wanted to come back to Atlanta and that’s how I got back here after residency. BluePearl pretty much only uses Stokes and Epicur products, and I think that is because of the amount of research there is to ensure the products’ quality, effectiveness, and efficacy. Stokes and Epicur are literally making these drugs with the standards where they could be used on humans.
Sometimes, I see patients come in, and they have been using crazy compounded medication, and their eyes are irritated and red. They’ve been using corn oil in a clear bottle that is yellow when it shouldn’t be or something similar. I can’t trust the quality of drugs like I can with Stokes and Epicur.
Do you think the lack of education on ophthalmic drugs comes from the lack of overall education in ophthalmology?
I do. Many general practitioners don’t even know about tacrolimus, and that is shocking to me. especially since I almost exclusively use tacrolimus because so many pets respond well to it. But that’s why it’s so important to introduce or at least educate them about the drug options, what’s available, and what they should be looking for.
Before we close our conversation, we heard you have a pretty unique story about your dog. Can you share?
So, at the University of Georgia, they work with the Guide Dog Foundation, which is one of the largest training programs. As a student, you can apply to raise a puppy and teach them basic manners—like sitting and staying and using the bathroom—and take them anywhere on campus or the public to help them gain exposure and determine which dogs are going to be trained as Service Dogs; about a third of the dogs move on to the training. A friend of mine had a puppy, and this dog would not stop sniffing the ground, which is not good for a guide dog, but it’s great for other Working Animal duties! This dog was able to do different training and become a bomb-sniffing dog, so they really tried to find a match. I was selected to raise a puppy named Asima.
Asima went off to training, passed, and got paired with a blind man in Pennsylvania. She worked with him for about 10 years. And then a couple of years ago I got a text message from a woman from the Guide Dog Foundation letting me know that Asima was going to be retiring and the handler wasn’t going to be able to keep her. They asked if I wanted her back! So now I have my sweet, 14-year-old Asima back; she is the sweetest lady.
