Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In your experience, what factors prompt you to switch a patient with diabetic macular edema to Eylea HD?
In my practice, it isn’t switching to longer acting anti-VEGF, it is the treatment of the peripheral retinal ischemia. I often initially treat CSME with Avastin, but I use an IVFA to evaluate and treat the non-perfused retina with laser. It is the PRP that treats the VEGF production driving the diab...
How do you manage dry eye syndrome due to lacrimal or meiobian gland dysfunction after external beam radiotherapy?
I have also found autologous serum (AS) or platelet-rich plasma (PRP) eye drops/tears to be extremely useful (provided by an ophthalmologist). Dry eye can also be exacerbated by graft vs. host disease, which I have anecdotally seen worsened within radiation fields and is characterized by a lasting m...
How would you approach the upfront management of a patient with acute unilateral vision loss with strong clinical risk factors for both cardioembolic stroke and GCA if an expedited MRI is not possible due to the presence of an AICD?
I'm definitely not an expert in this topic, but you have many clinical tools to increase/decrease your clinical suspicion for GCA vs. cardioembolic stroke. Some things I would ask: Is this patient currently in Afib? What's their CHADSVASC? Are they anticoagulated? Can we get a TTE to check for vege...
What options would you consider for removing dense fibrin deposits from an IOL in a patient with chronic uveitis?
Pre-treat with a steroid and nonsteroid drop, use a low-power YAG laser anterior offset to remove, and post op continue with pre op regimen for as long as recurrence is necessary, then slowly taper off.
What is your approach to atropine dosing for myopia in children and when do you consider higher concentrations?
I have little experience with this. From what I understand, it offers inconsistent results at best.
What has been your experience with occluder contact lenses for intractable diplopia?
Poor, I’ve had better luck with scotch tape on one glasses lens placed in the center. It usually only needs a piece about an inch by an inch. This allows peripheral vision. Unfortunately, many don’t want to do this.
Which patients are good candidates for micropulse CPC?
Micropulse CPC is a suitable option for treating elevated IOP in a number of scenarios: advanced VF loss resulting in a small central or temporal island, intolerant to topical/oral glaucoma meds, poor general health limiting interventional surgery, no social support, and non-compliance.
What supportive care measures do you prioritize to manage or prevent toxicity in patients receiving Dato-DXd?
My supportive care approach is centered around early identification and management of interstitial lung disease (ILD) and mucositis, both of which were observed in the TROPION-Breast01 trial. Twelve patients (3.3%) in the Dato-DXd arm had adjudicated drug-related ILD/pneumonitis. I routinely obtain ...
What strategies do you use to manage refractory cystoid macular edema in uveitis patients who have already received ocular steroids and systemic immunosuppression?
For this clinical situation, especially if the CME is bilateral, systemic peg-interferon alpha is an excellent option. Commence with peg-interferon 180 mcg injected subcutaneously weekly. Check baseline CBC/diff and complete metabolic panel prior to starting treatment and at least weekly initially (...
How do you modify CPC (i.e., parameters, location of probe) in high myopes that may have thin sclera or more posterior ciliary bodies?
I often illuminate the eye to help visualize the ciliary processes. If I am worried about a thin sclera, I may start with a slightly lower energy and titrate up as needed.