Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach treatment in patients with pachychoroid disease who show fluctuating subretinal fluid without visual decline?
What is described has often been called chronic CS(C)R. I do not believe there is any proven treatment better than observation for these patients at this time, so observation it is.
What are the toxic effects of a small amount of intraocular perfluoron on the retina and cornea?
I have seen small amounts of PFO retained in the posterior pole and no inflammation was associated with it. But in some patients, particularly those with any subretinal PFO, retinal atrophy and chronic choroiditis can be seen. This will require surgical removal, especially if the PFO is trapped near...
How do you approach re-treatment in a patient with chronic central serous chorioretinopathy who has residual subretinal fluid after their first half-dose?
If the fovea is dry and the residual fluid is outside the fovea, I usually observe without additional treatment. If the residual SRF is subfoveal in location and decreasing compared with pre-treatment, I typically observe, hoping for continued improvement to a dry fovea. If there is residual subfove...
Has the CONDOR trial changed your first-line approach to treatment-naive proliferative diabetic retinopathy in a patient with good visual acuity who is able to attend regular follow-up visits?
No. In the US, we stopped using brolucizumab (Beovu) because of the risk of retinal vasculitis. So I don’t even think I can get that medicine anymore. For those who don’t know about it, CONDOR was a trial that studied the use of Beovu vs. PRP (panretinal photocoagulation) for proliferative diabetic ...
What is the standard of care for timing of a mac-off retinal detachment repair?
The literature on this topic is mixed and at times contradictory. My own synthesis of the literature, which I believe coincides with the consensus standard of care, suggests that repair of macula-involving rhegmatogenous retinal detachment is relatively time sensitive: urgent but not emergent. The c...
How do you determine the duration and taper of systemic corticosteroids when you add them alongside antibiotics for orbital cellulitis?
There is no 'standard of care' answer for this. My personal preference is the following: Pediatric patients -- 0.25 to 0.5 mg/kg dexamethasone daily (given in AM) for up to 3 days, starting the day after source control/cultures from surgery. Higher dose/longer duration if very inflamed, and lower d...
How effective is weight loss in improving visual function in IIH and how much weight loss/what strategies (i.e., formal exercise program, weight loss medications) do you recommend/counsel patients on?
Weight loss is a cornerstone of IIH management because it lowers intracranial pressure (ICP), which in turn improves papilledema and visual function. It works but should not be used alone for cases with moderate or progressive visual loss. In the IIH Weight Trial,[1] the magnitude of weight loss cor...
What pre-operative features in pseudoexfoliation patients do you feel correlate with intra-op zonulopathy?
This is an excellent question. Several factors play a role in the extent of zonulopathy that one may expect during pseudoexfoliation cases. A history of zonulopathy in the other eye or other factors that could contribute (trauma, falls, prior surgeries like retina procedures) would be one thing to l...
Who are good candidates for light adjustable lenses?
Who is a great candidate? The LAL is a great option for a wide range of patients. In general, patients who prioritize quality of vision but want to achieve meaningful freedom from glasses are excellent candidates for LAL technology. The prototype candidate in my experience is a patient with a histor...
How do you approach the use of Cequa in eyes with severe corneal thinning from a prior, healed corneal ulcer?
The use of Cequa or other cyclosporins has not been associated with an increased risk of thinning. Cequa prescribing information lists no contraindications and reports instillation site pain and conjunctival hyperemia as the main adverse reactions. Corneal thinning, impaired healing, and perforation...