Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your follow-up protocol with the light adjustable lenses?
I did all my own adjustments for my LAL patients for 2+ years before deciding to delegate these adjustments to my extender OD (not the referring OD). I have not seen any change in outcomes with this shift, but I find myself being more willing to offer LAL to patients now because I don't dread the po...
How do you approach the treatment of "normal tension glaucoma" and how do you discuss this with patients?
I explain that what's "normal" or "low" for most people may in fact be too high for them, and we therefore need to lower their pressure below a target of 15, or 12, or 30% lower than baseline (depending on severity, baseline IOP, corneal thickness, status of other eye, etc). I tell them that patient...
How do you incorporate intravitreal methotrexate injections into the management of traumatic retinal detachment repairs?
I do not use intravitreal methotrexate after ocular trauma. I assume the question is directed at the prevention and/or treatment of PVR. Multiple studies have shown this medication is not effective in the treatment or prevention of PVR.
In cases where placing an IOL in the bag/sulcus is not possible, how do you decide between leaving a patient aphakic for a scleral-fixated IOL (assuming this can't be done immediately) vs. placing an ACIOL?
In 2 situations, I would leave a patient aphakic even without an IOL: highly myopic patients where the actual IOL power is minimal +\- 3 D, in that case, glasses can correct residual refraction, supposing that the patient does not develop anisometropia monocular patients with up to 5 D residual ref...
How do you decide on when to start or continue anti-VEGF injections during pregnancy?
The safety of anti-VEGF medications in pregnant women hasn't been adequately evaluated with regard to fetal safety. If at all possible, I don't initiate anti-VEGF injections during pregnancy. If a patient is currently on anti-VEGF therapy and then becomes pregnant, I hold treatment at that point. Id...
For patients with xanthelasma, aside from a lipid panel, do you perform any additional lab workup or send referrals?
Agree that recurrence is common, but there are no data that a high cholesterol or increased serum lipid is associated with them.
How do you approach tube shunt placement in very high myopes with thin sclera?
Due to decreased scleral rigidity in highly myopic eyes, there is a higher risk of hypotony and hypotony maculopathy with filtering surgeries, including tube shunts. In choosing the type of tube shunts, I would favor a valved tube shunt in high myopes. For surgical technique, I take great care when ...
How do you approach offering multifocal IOLs to patients with prior retinal pathology and surgery (i.e., mac-off RD) who have had relatively good recovery of vision?
As a retina specialist, I have seen a significant increase, over recent years, in patients doing badly because someone inserted a multifocal IOL in the context of prior or impending retinal disease. In most of these cases, the patients seemed naive to the implications, reporting that they were told ...
How do you approach patient selection for starting intravitreal complement inhibitors?
Because complement inhibition seems to have only a modest effect on GA progression, no clear functional benefit in pivotal trials, and a not-insignificant risk of CNV and optic neuropathy, I tend toward a conservative view when deciding whether to recommend it to patients. A good candidate, in my v...
Do you routinely perform ILM peeling in all epiretinal membrane (ERM) cases or do you selectively peel based on OCT features and membrane characteristics?
With rare exceptions, I peel ILM in all ERM cases for two main reasons. First, it is the best way (and in some cases the only way) to ensure that the ERM is removed completely, thereby avoiding the postoperative scenario of persistent ERM causing persistent visual symptoms. Second, there is good evi...