Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
For a patient with orbital sarcoidosis who has achieved sustained clinical remission on adalimumab in combination with mycophenolate mofetil, how long would you recommend continuing mycophenolate before considering a gradual taper and discontinuation?
This is an excellent question. And sarcoidosis is certainly a disease that can enter spontaneous remission.Unfortunately, my answer is based more on eminence (I hope) rather than evidence.We have very little data about withdrawing treatment for sarcoidosis, and I am not aware of data specifically fo...
In which cases of post-injection endophthalmitis should early vitrectomy be considered if there is little to no improvement 48 hours after a tap and inject and there is no organism isolated?
Prompt vitrectomy should be considered in all patients with post-injection endophthalmitis (PIE) if there is no improvement 48 hrs after a tap and inject. The initial tap did not identify the organism. Non-infectious endophthalmitis can be included in the differential diagnosis of persistent inflamm...
How has immediate patient access to their medical records changed your documentation?
Sadly, EMR has destroyed medical records... trying to figure out what happened, etc., is like an archaeological dig.
What is the appropriate interval before safely performing cataract surgery after plaque radiation therapy for iris melanoma?
Great question, but one that requires a nuanced answer. Often, patients with iris melanomas have some degree of lens opacity, and following brachytherapy, the cataract will surely progress. I recommend carefully following up on the iris melanoma after radiation to ensure the lesion is regressing pro...
In what cases do you consider mannitol for cataract surgery?
I have found IV mannitol VERY helpful for dehydrating vitreous for short axial length, especially around 20.5 or less. Otherwise, in short eyes, there is less working space and a greater tendency for the iris to want to prolapse out, even in the absence of typical IFIS-type medications. I’ve typical...
Do you prescribe pre-operative drops prior to cataract surgery, if so which ones and why?
I do not use preoperative drops. There are no published clinical trials that have established any benefit for preoperative antibiotics or NSAIDS. The strongest evidence supports preoperative povidone-iodine drops and intracameral antibiotics such as cefuroxime or moxifloxacin. This has been validate...
What has been your experience adopting office-based surgery and has it meaningfully improved patient access or practice efficiency?
We have demeaned and minimized what we do, and in response, Medicare and insurance companies have decreased our reimbursements. We (ophthalmologists) have advertised how easy cataract surgery is, and in general, what we do, and we are our own worst enemies.
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...
Which MIGS do you feel has the most durable IOP lowering effect?
Consider the results of this poll itself to be a bit flawed. People are going to answer based on the options they themselves are familiar with. If they are not using some of these options, they will elect for ones they believe, in their hands, have the most durable lowering effect.
What has been your experience with Xdemvy?
Expensive - most drug plans won't cover without prior authorization and documentation of failure of other therapies. So far, I have found that if patients discontinue early, they end up coming back and have to restart a full course of therapy.