Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
For those using 5% Betadine as a single-use prep, how are you handling the associated costs or aliquoting?
Very difficult legal question. Other countries make 5 or 10 cc bottles produced by Allergan and other generics for 1 dollar. They are multi-use and sterile. Not legal to import into the USA. By FDA law, for patient use, 10 percent has been used in the USA for 20 years without a significant problem. ...
What has been your experience with netarsudil in the management of corneal edema, particularly concerning its clinical effectiveness and insurance coverage?
I don't use netarsudil to treat corneal edema - I have discontinued it in patients who developed reticular epithelial edema (aka honeycomb edema), which is a rare but reported side effect with unclear mechanism. If elevated IOP is thought to be contributing to corneal edema, I typically use aqueous ...
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.
How has OCT and OCT-A technology impacted your use of FA in the evaluation of retinal diseases?
How do you decide where to place the LPI for angle-closure glaucoma?
For narrow angles, I place it somewhere in the inferotemporal iris in a crypt. I do not use an Argon laser. With the YAG laser at 7 mJ (though different lasers may be more or less). Offset at +250 and only one burst, I can typically get through with 2-4 shots in most irides unless there is absolutel...
What has been your experience with standalone canaloplasty or phaco/canaloplasty in terms of IOP lowering?
As is oftentimes the case with these procedures (the various minimally invasive glaucoma surgeries), results will vary based on surgeon and patient selection. I have found canaloplasty helpful, though I tend to combine it with some percentage of trabeculotomy (i.e., I'd do 360 canaloplasty with 180 ...
How important are retinal fluid fluctuations for long-term vision and how do you factor them in when making treatment decisions for conditions like nAMD and DME?
I think the question has been asked in a different form here. As I have commented on Mednet previously, it depends on a lot of factors, primarily: Are you treating the OCT or the patient? I'd also say the answer is very different for nARMD (or any CNVM) DME or edema from RVO. People: this is not a o...
What has been your experience with the travoprost intracameral implant (iDose)?
My experience has been positive, but I consider patient selection prior to surgical planning to be crucial. At this time, I am mostly targeting mild to moderate POAG patients who are on 1-3 glaucoma medications (at least one being a PGA). I usually perform the iDose along with cataract surgery and a...
In a patient with prior cataract surgery in one eye with an unknown monofocal lens, how do you approach selection of a monofocal in the second eye?
The choice is completely dependent on the patient and the physician's discretion and discussion. No one choice for everyone.
How effective is weight loss in improving visual function in IIH and how much weight loss/what strategies (i.e., formal exercise program, weight loss medications) do you recommend/counsel patients on?
Weight loss is a cornerstone of IIH management because it lowers intracranial pressure (ICP), which in turn improves papilledema and visual function. It works but should not be used alone for cases with moderate or progressive visual loss. In the IIH Weight Trial,[1] the magnitude of weight loss cor...