Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Do you feel there is benefit to subconjunctival steroid or MMC injection at the time of valved tube placement?
In my opinion, there is a lack of compelling clinical evidence and studies to support the injection of subconjunctival MMC at the time of valved tube placement. I consider the injection of a subconjunctival steroid in patients with poorly controlled inflammation and those who I think may be less com...
How do you adjust your glaucoma management strategy for pregnant patients who require IOP lowering?
Managing glaucoma during pregnancy is challenging and requires a multidisciplinary approach in collaboration with the patient’s OB-GYN team. Several management strategies can be considered. Initially, close observation with frequent intraocular pressure monitoring and visual function/nerve assessmen...
When do you consider initiating zoster prophylaxis in patients?
I do this when more than one episode of keratitis or uveitis per year; If a planned surgery, would start treatment doses one week before surgery and for 14 days after. Nothing worse than reactivation of zoster.
Has adopting a 3D heads-up digital visualization system changed your approach to anterior segment surgical teaching of residents or fellows?
We have been using NGENUITY to teach our cornea fellows, residents, and med students for the last 3-4 years. It has been a tremendous addition because it allows multiple people to have a real-world view, not just one surgical assistant. In addition, visiting students who may not be approved to scrub...
How do you approach perioperative steroids for a quiescent uveitis patient undergoing cataract surgery?
Preop: If the patient is using topical steroids chronically, I increased the dose of the drops to four times a day the week prior to surgery. If the patient is using chronic oral prednisone, I will increase the prednisone to 0.5 mg/kg, 3 days prior to surgery, followed by a quick taper every 3 days...
What follow-up monitoring would you recommend for an adult with self-resolved idiopathic acute pupil-sparing third nerve palsy?
Pupil-sparing third nerve palsy is a relatively common presentation for neuro-ophthalmologists. They typically resolve completely by 12 weeks, and I will typically follow them until they are fully resolved, watching them once a month. The most common are microvascular and associated with a variety o...
What is your preferred surgical intervention for lagophthalmos secondary to a facial paralysis and signs of exposure keratopathy?
If temporary or early in the recovery, consider stick-on external eyelid weights. If it has been several months without any improvement, I like to do gold or platinum permanent weights sutured to the tarsus, in addition to a lower lid tightening as Dr. @Dr. First Last mentioned.
Do you feel there is value to Schirmer testing in clinic prior to starting dry eye treatment?
Schirmer's testing is a low-cost, readily available test for a majority of ophthalmologists. It has several limitations and can be quite variable in its results. Consistently low Schrimers I results suggest an aqueous tear film deficiency and can be a clue toward the mechanisms of dry eye problems, ...
In bilateral sequential NAION, do you expect any progressive worsening of OCT/VF years from the ischemic event and when would you have these patients evaluated for another progressive optic neuropathy?
One should not see progressive loss of vision years after the initial insult with NAION. One may see variability in the automated field testing, but it should not be steady progression. OCT should be at its lowest nadir for both rNFL and GCL by 6 months, without further loss beyond age-appropriate c...
Do you feel there is value to getting endothelial cell counts in the absence of frank edema/visual significance in your management endothelial dystrophies?
I would, yes, mostly for patient understanding of their condition and following up on it objectively. There is a clinical benefit, but it is limited. Clinically, I use it to give the patients an assessment about their risks of edema post cataract surgeries or to push for early cataract surgeries in...