Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you determine the appropriate toric IOL when there is a discrepancy in axis or cylinder power between optical biometry and corneal tomography during preoperative evaluation?
Always difficult. Always re-measure when discrepancies occur. For axis discrepancies, Auto Ks, topography, biometry, and past refraction. Past refraction is where the patient lived their entire life before their cataract surgery. Which of these tests aligns the most? Past refraction, especially pre-...
If Acanthamoeba testing is unavailable locally, what immediate management is reasonable while arranging urgent referral?
It is always best to have a LOW threshold to initiate Acanthamoeba treatment. If you really suspect Acanthamoeba and have NO culture/PCR capability, I would recommend starting anti-Acanthamoeba therapy and getting the person to a cornea specialist who can confirm the diagnosis asap. Delay in treatme...
How do you decide timing of repair of a chronic macula threatening tractional retinal detachment?
There are many factors that are important in managing a chronic macula-threatening tractional retinal detachment. The general health of the patient affects surgical risk and candidacy, as well as the presence of other ophthalmic conditions like neovascular glaucoma and the status of the other eye. F...
How has your approach to dry eye management evolved with the advent of new prescription medications and nutraceuticals?
Dry eye disease is the most common reason for a patient visit to an eye care professional. Management of dry eye affects quality of life and quality of vision. In managing dry eye, the first step is making the diagnosis correctly and this can sometimes be difficult because of the varying symptoms as...
In cases of severe ocular trauma with NLP vision, under what circumstances do you consider proceeding with pars plana vitrectomy?
I don’t. Often, it is time to have a difficult discussion with the patient about the timing of eviseration or enucleation, if the eye presents as an open globe. The risk of endophthalmitis, worsening ptysis and pain, as well as the small risk of sympathetic ophthalmia, are sound reasons to consider ...
How do you go about assessing a patient that has had refractive surprise following cataract surgery when determining the cause for surprise and in preparation for the other eye?
Pretty simple, if at the visit at 1 week BEFORE the second eye is done, if the vision is NOT good and they are refracted and there is a surprise, then look again. If necessary, DON'T do the 2nd eye until you know what is going on with the first surgery!
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...
How do you approach the management of recurrent episcleritis in a patient with RA that is otherwise well-controlled?
The episclera lies on top of the sclera. The majority of patients with episcleritis do not have a systemic disease, although patients with rheumatoid arthritis are more prone to develop episcleritis. Episcleritis must be distinguished from scleritis, which is also associated with rheumatoid arthrit...
What are the clinical indications for performing a second laser peripheral iridotomy (LPI) instead of proceeding directly with cataract surgery?
The only reason for a second LPI in CACGL or occludable angle is if sector iris bombe develops due to posterior synechiae formation. Otherwise, one LPI will normalize the pressures between the posterior and anterior chambers. If you still see progressive angle closure after LPI, you are dealing with...
What is your approach to long-term suppressive therapy of valganciclovir for a patient with a history of CMV anterior uveitis?
Once I confirm a diagnosis of CMV anterior uveitis (+ PCR), I treat patients with valganciclovir 900 mg PO twice daily for 21 days and then switch to prophylactic dosing of 900 mg daily for 6 months to 1 year. That being said, many patients have recurrences even on prophylactic dosing and need, in m...