Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In a patient with recurrent episodes of GCA that flare shortly after steroid tapering, how do you differentiate between steroid-dependent inflammatory relapse, an alternative autoimmune vasculitic process, and a paraneoplastic phenomenon?
This could certainly be worrisome for a paraneoplastic phenomenon. GCA is associated disproportionately with myeloid lineage mutations (CHIP - clonal hematopoiesis of indeterminate significance). TET2 is think is the best-studied mutation, but in my experience, any other CHIP mutations such as ASXL1...
What has been your experience with CP250 vs CP350 in terms of ease of implantation, post-operative course and efficacy in IOP lowering?
We did look at this in our study from Wills (Ahmed ClearPath vs. Baerveldt Glaucoma Implant: A Retrospective Noninferiority Comparative Study. Ophthalmol Glaucoma. 2024 May-Jun;7(3):251-259.) and did not find a difference in IOP control or medication use between the CP250 or CP350. However, the CP35...
How does pseudoexfoliation change expected long-term success of trabecular MIGS?
I haven't noticed a difference in long-term trabecular MIGS success between my pseudoexfoliation patients and my POAG patients, but I looked into the literature since the question came up.If anything, the data leans the other way. A 5-year study of iStent in PXG eyes showed sustained IOP reduction, ...
What are some methods to deal with IOP elevations with intravitreal injections in a patient without glaucomatous damage that does not want to have AC taps with each injection?
In this situation, depending on the elevated IOP, use the standard medical approach: Iopidine1%, Cosopt, Alphagan 0.2%, and in some cases, Diamox 250 mg. Wait for half an hour and repeat if necessary, or send the patient home with one or more drugs. Of course, make sure of drug selective contraindic...
What precautions do you take when doing cataract surgery in nanophthalmic eyes?
Pearls for operating on nanophthalmic eyes Consider general anesthesia IV mannitol -12.5 mg if no systemic contraindications Digital massage with scleral depressor or Honan balloon Healon 5 or Healon HV Can make capsulorhexis with microforceps through a paracentesis
In an elderly patient with limited transportation issues, is there a hypofractionated regimen you have found acceptable for a localized squamous cell carcinomas of the eyelid?
I am fortunate to work with a “XRT for skin cancer” guru, Dr. W.H. Morrison, and sought his counsel to answer this question, as largely with the conversion of skin cancers from a radiation-treatable disease to a surgical disease with the advances in Mohs surgery and oculoplastics, at MDA we rarely s...
How do you counsel patients with GCA on the benefits of steroids who have already experienced vision loss?
I first tell the patient they are at considerable risk for further visual loss in the same eye or the other eye over the next 1-2 weeks. I also let them know that, even though their risk of visual loss has been reduced, their best option for preventing further visual loss is immediately starting hig...
How do you optimize retinopathy screening schedules for patients on hydroxychloroquine while also prioritizing cost-effectiveness?
I'll approach this from the cost-effectiveness standpoint as I agree with Drs. @Dr. First Last and @Dr. First Last on their excellent points.Patients with SLE have remarkably high costs when you add up copays, medications, imaging studies, travel, missing work, etc. Anything we can do to help reduce...
How do you approach management of GLP-1 receptor agonist therapy in patients who develop NAION?
Short answer is I recommend stopping the GLP-1 agonist if one eye has already developed NAION, for the sake of protecting the fellow eye. The fact is, our knowledge is still growing in this matter. While some studies indicate links between GLP-1 agonists and NAION, there are so many discussions arou...
How do you counsel patients when discussing risks/benefits of ECP vs. CPC?
I don't regularly use ECP, but I have a lot of experience with micropulse CPC (referred to as MP-TLT or MPCPC) and traditional CPC. Firstly, although MPCPC involves less energy compared to traditional CPC, that does not mean that the procedure is without risk. Because of these risks, MPCPC should no...