Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach a patient who has anterior uveitis and is referred for evaluation of ocular TB with a positive Quantiferon gold (as part of their workup) in countries with low TB incidence?
It is a frustrating problem and is expected to increase without solid evidence. Until then, management should involve an interdisciplinary collaborative approach and a shared decision-making process.I see the following issues. I feel ophthalmologists follow the diagnostic criteria for TB uveitis us...
Do you combine anti-VEGF with PDT for polypoidal choroidal vasculopathy upfront or reserve PDT for refractory cases?
Having considered EVEREST, EVEREST II, and PLANET, I tend to start with monthly aflibercept, with a low threshold for applying PDT during the first 3 months, before the vessel complex is too established to undergo regression.In practice, I only uncommonly encounter PCV early in its clinical course; ...
When should delayed removal of an intraocular foreign body be considered?
If you are deciding whether to close the globe first and then remove the IOFB with a later surgery, then first consider the type of IOFB and its potential to incite infection or inflammation. No matter what type of IOFB it is, the team repairing the ruptured globe should inject intravitreal broad-sp...
How do you decide between initiating systemic immunotherapy versus local treatment for uveitis with associated HLA-B27 and spondyloarthropathy?
I find that most, but not all, HLA-B27 iritis can be controlled with topical therapies. To do so requires eliminating other causes of inflammation. Many patients have GI inflammation due to gluten and dairy, despite not having classic celiac disease or lactose intolerance. Reducing their intake, mod...
How do you decide whether or not to excise a pterygium prior to cataract surgery?
I'll remove a pterygium prior to cataract surgery if I suspect the pterygium will need removal at some point in the future. This could mean: 1.) I have seen evidence of pterygium progression in the recent past (either physical growth onto the cornea as compared to historical measurements/photos, or ...
If a patient is legally blind and on hydroxychloroquine, do you still recommend follow up with ophthalmology to monitor for hydroxychloroquine retinal toxicity?
A patient who is legally blind but taking hydroxychloroquine absolutely needs to be monitored by an ophthalmologist. The usual definition of legal blindness in the United States is vision no better than 20/200 in the better-seeing eye. But 20/200 is far better than say counting fingers (the ability ...
How do you counsel patients interested in LAL monovision about the possibility of reduced glasses dependence?
One of the main advantages of the LAL is the ability to fine-tune monovision after surgery, allowing patients to experience and adjust their visual balance between distance and near before final lock-in. I explain that this flexibility greatly increases satisfaction and can significantly reduce glas...
What factors will most influence your decision to offer ENCELTO to patients with macular telangiectasia type 2?
Yet another (presumably very expensive) surgical treatment for a chronic macular disease was approved on the basis of OCT measurements without demonstrating visual benefit to the patient in a disease with a slow, variable course. Show me quality of life studies and visual benefit justifying surgical...
In extremely premature infants born at <25 weeks gestational age, how do you individualize the timing and frequency of ROP screening?
Those extremely premature infants with an unstable clinical course or where the accuracy of GA was uncertain may need to be screened prior to 31 weeks PMA (post-menstrual age).Please see our paper: Souverein et al., PMID 38878959.In this study, among infants <=24 weeks gestational age at birth, we f...
Given concerns about cooperation, anesthesia, and predictability, under what circumstances do you use adjustable sutures in pediatric strabismus surgery?
With only a few exceptions, I usually do adjustable sutures for patients with double vision (a little older, able to report diplopia well, and when diplopia makes sense and they fuse with prisms in the clinic) or unusual strabismus, where results might be less predictable, and I want to avoid any un...