Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you decide whether to continue hydroxychloroquine in a young patient who develops subretinal neovascularization with no other risk factors?
Hydroxychloroquine (HCQ), an anti-inflammatory and immunomodulatory agent, is used to treat autoimmune diseases (rheumatoid arthritis, lupus, Sjogren’s disease, etc.) and malarial prophylaxis. Vision problems can ensue resulting from these deleterious irreversible effects of HCQ on retina if the cum...
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-...
What is your approach to treatment for recalcitrant MGD?
Recalcitrant MGD is a frequently seen clinical problem, especially in older patients. Standard treatment encompasses warm compresses and lid hygiene. The latter can be performed with over-the-counter lid wipes or simply with baby shampoo. Tropical antibiotics such as Polytrim drops and bacitracin/po...
How do you approach surgical repair of a 6-clock-hour retinal dialysis with posteriorly folded retina, and what strategies do you use to minimize retinal slippage?
First of all, make sure it’s a dialysis and not a GRT. For dialysis, I would definitely start with a buckle.
In cases of failed endothelial keratoplasty with concurrent cataract, do you favor repeat keratoplasty plus lens extraction in the same setting or sequential surgeries?
I tend to favor combining the two into one surgery. If the view is not clear enough or the patient is interested in a more accurate refractive outcome, the surgery can, of course, be staged with the endothelial keratoplasty first, followed by cataract surgery about 3 months or so later. With the use...
How do you counsel patients when discussing risks/benefits of ECP vs. CPC?
I don't regularly use ECP, but I have a lot of experience with micropulse CPC (referred to as MP-TLT or MPCPC) and traditional CPC. Firstly, although MPCPC involves less energy compared to traditional CPC, that does not mean that the procedure is without risk. Because of these risks, MPCPC should no...
How does pseudoexfoliation change expected long-term success of trabecular MIGS?
I haven't noticed a difference in long-term trabecular MIGS success between my pseudoexfoliation patients and my POAG patients, but I looked into the literature since the question came up.If anything, the data leans the other way. A 5-year study of iStent in PXG eyes showed sustained IOP reduction, ...
What precautions do you take when doing cataract surgery in nanophthalmic eyes?
Pearls for operating on nanophthalmic eyes Consider general anesthesia IV mannitol -12.5 mg if no systemic contraindications Digital massage with scleral depressor or Honan balloon Healon 5 or Healon HV Can make capsulorhexis with microforceps through a paracentesis
How do you approach management of GLP-1 receptor agonist therapy in patients who develop NAION?
Short answer is I recommend stopping the GLP-1 agonist if one eye has already developed NAION, for the sake of protecting the fellow eye. The fact is, our knowledge is still growing in this matter. While some studies indicate links between GLP-1 agonists and NAION, there are so many discussions arou...
In patients with end-stage glaucoma requiring surgery (cataract or incisional glaucoma surgery), how do you approach discussion of possible "snuff" and how does this factor in your decision to proceed with surgery?
I have operated on hundreds, if not thousands, of patients with end-stage glaucoma over my career. Many CAT IOL + bleb surgery or Cat IOL alone. I cannot remember a snuff directly related to surgery. Judicious use of ER acetazolamide immediately postoperatively goes a long way. If cat IOL alone and ...