Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach a patient with idiopathic anterior uveitis who has ongoing disease despite adalimumab every two weeks?
This is a style question, I think. I thought it would be useful to note the choice here might depend on testing for anti-adalimumab antibodies as there is some suggestion that changing to once weekly adalimumab in the presence of anti-adalimumab antibodies might not be efficacious. (Ismayilova et al...
For patients with nAMD who are developing GA in the same eye, do you consider adding anti-complement therapy?
My personal perspective, shared by many colleagues around the country, is that the minimal anatomic and functional benefit of anti-complement therapy does not outweigh the aggregate risks and costs of perpetual treatment with these agents. I discuss these issues with my GA patients (including those ...
What is your approach for treating allergic conjunctivitis in a patient who has failed ketotifen and olopatadine?
Agree with Dr. @Dr. First Last - and for in-office treatments, I've been increasingly impressed with Rinsada irrigation in some cases (rinse out the fornix, which seems to trap some allergens there), as well as mitigation and desensitization therapy if the allergist can find specific allergens to fo...
In a bedridden, medically fragile patient with a symptomatic conjunctival cyst superior to the limbus, what is the optimal management approach?
I would first attempt medical management with lubricants, ketorolac, olopatadine, and naphazoline. If those failed, then I would use the following drops: topical anesthetic, a vasoconstrictor, and ketorolac twice over a five-minute period, then insert a lid speculum, and unroof the cyst by grasping ...
How do you approach the decision to escalate from conservative medical therapy to surgical intervention in a patient with EBMD-related recurrent corneal erosions who has not responded to several months of nighttime lubricating ointment?
In the case of recurrent erosion in the setting of EBMD, we first attempt to optimize the conditions for a pristine and smooth ocular surface. This includes non-preserved lubricants, hypertonic saline to avoid swelling and sloughing at night, and treatment of any dry eye and meibomian gland dysfunct...
In quiescent patients with history of herpetic keratouveitis with uncontrolled IOP on topicals, do you prescribe PGAs?
The evidence on prostaglandin analogues (PGAs) in the setting of herpetic anterior uveitis is nuanced. Traditionally, we have been taught to avoid PGAs in the setting of herpetic disease, given the theoretical concerns that these drugs could compromise the host's interferon defense system. But, more...
What do you feel are some of the advantages and disadvantages of dropless cataract surgery and what are your preferred agents?
A clear advantage of dropless surgery is that the patient no longer needs to use post-op drops. This may not necessarily present as an advantage to the surgeon, as any additional techniques will add time and cost to the cataract surgery, especially if a particular technique is not covered by insuran...
How do you decide to use MIGS versus traditional surgical options like trabeculectomy or tube shunt placement in the management of glaucoma?
Current IOP and your IOP goal are key. Angle MIGS will typically reduce IOP from the low to mid-20s to the mid to upper teens. I consider Xen a MIBS procedure. I’ve been able to use Xen as my bleb surgery of choice, even in patients who have had multiple prior ocular surgeries, including PPV, tube s...
What are some special considerations for treatment of glaucoma and IOP lowering in patients with optic disc drusen?
Optic disc drusens (ODDs) in patients with glaucoma provide unique challenges for clinicians. ODDs on the surface of the optic disc are easy to spot; deeper (buried) DDs are difficult to diagnose. They require deeper B-scan cuts or require extended depth (ED) options. One must be cautious not to ove...
In patients with glaucoma who are not ideal candidates for goniotomy, angle stenting, tubes, or trabeculectomy, does the use of AlloFlo provide safe and predictable IOP control compared to other surgical options?
I am cautiously optimistic in this situation, one in which we frequently find ourselves in tertiary care glaucoma practices. I will say that it is helpful to have another option that seems (so far) to be safe, even in severe glaucoma cases. Unfortunately, we are not really going to know about the pr...