Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What brain imaging findings do you find reliable to help support a diagnosis of idiopathic intracranial hypertension?
In a study by Bidot et al., PMID 26457687, transverse venous sinus stenosis (TVSS) was the most useful sign of IIH because of its high pooled sensitivity (97%) and specificity(93%). Orbital findings, such as optic nerve head protrusion, posterior scleral flattening, optic nerve tortuosity, and diste...
For patients with evidence of prior bilateral uveitis (PS, pupillary membranes, inactive KP, no view posteriorly) who reports no prior symptoms and who has had negative lab work-up, when do you consider repeat work-up and which labs would you repeat?
This is a difficult question to answer succinctly, as so much information is missing to provide a complete response. However, it does raise some important points that are worth mentioning:There is a prevailing tenet, which I was taught as a resident and hear often from residents today, that 1st epis...
How do you decide between repeat surgical correction vs. botulinum toxin injections for recurrent intermittent exotropia after previous surgery?
If the lateral rectus muscle has been recessed, it would be very challenging to get Botox accurately administered. Bilateral medial rectus resection would be easier and is very effective.
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...
For presumed Posner-Schlossman syndrome, how useful is viral PCR on aqueous, and is there value in treating empirically with antivirals?
Aqueous fluid analysis, specifically viral PCR, in the setting of Posner-Schlossman syndrome (or glaucomatocyclitic crisis) is extremely useful. Most of these cases are in fact CMV-associated uveitis; some smaller proportion may be HSV-, VZV-, or even rubella-related. Our typical (and much safer) an...
Are there any special considerations when approaching ptosis repair in a patient with a prior trabeculectomy?
I have two main concerns with trabeculectomy patients (or any glaucoma filtering procedure). The first is avoiding overcorrection of ptosis, which can expose the bleb and increase the risk of blebitis. The second is respecting the conjunctiva. I generally avoid posterior ptosis repair (MMCR or Fasan...
What is your approach to audiometric monitoring for patients on teprotumumab and how do you discuss the possibility of irreversible hearing loss with your patients?
I have set up a connection with our institution’s ENT and audiometry service to do a baseline test for any patient who is a candidate for teprotumumab. If the patient already has abnormalities in the high and ultrahigh frequencies, would not proceed to treatment. Would also repeat the test if the pa...
What factors guide your decision to test for or start empiric treatment for Acanthamoeba keratitis in cases of corneal ulcers?
I can't say that I've ever started empiric treatment for acanthamoeba keratitis prior to other workup/testing/culture results, although I suppose if you have a slam dunk case with a known acanthamoeba exposure, I would do so. The question of whether to test for AK is far more interesting. New-onset ...
What has been your experience with dSLT?
Overall positive. The procedure is quick and the interface is intuitive. We have to warn the patients that they are going to feel it, and oh man, if you look at the anterior chamber about 20 minutes after the dSLT, you are going to see a lot of cells floating around there. I have been able to perfor...
What criteria do you use to decide the duration of IV steroids in patients with optic neuritis?
This question has long gone unanswered because it is complicated. Short optic nerve segment enhancement (MS):In this situation, I do not routinely recommend steroid treatment. For the optic neuritis of multiple sclerosis, the Optic Neuritis Treatment Trial (Beck and Gal, PMID 18625951) clearly showe...