Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How should ectasia risk be triaged using RSB, PTA, and tomography?
Randleman ectasia risk score is very helpful in assessing the risks. It takes into consideration RSB PTA topography, CT, and age. Randleman Ectasia Risk Factor Score System
In cataract surgery following penetrating keratoplasty, do you think the use of scleral tunnel incisions versus clear corneal incisions meaningfully influence graft survival or astigmatic stability?
With a PK or DSEK, I do what I can to stay out of the cornea... scleral tunnel.
How do you manage corneal ectasia after refractive surgery?
Corneal cross-linking should be the first step to halt progression. I would then typically encourage patients to try hard contacts, which help improve the vision in the most conservative way. There are a variety of surgical interventions that can be considered depending on how advanced the ectasia i...
How do you approach re-treatment in a patient with chronic central serous chorioretinopathy who has residual subretinal fluid after their first half-dose?
If the fovea is dry and the residual fluid is outside the fovea, I usually observe without additional treatment. If the residual SRF is subfoveal in location and decreasing compared with pre-treatment, I typically observe, hoping for continued improvement to a dry fovea. If there is residual subfove...
Is there benefit for anterior chamber washouts for the treatment of infectious keratitis extending into the anterior chamber and when do you consider utilizing it?
When it comes to corneal infections, there is no evidence that an 'anterior chamber washout' and putting antibiotics in the AC does anything. In ophthalmology, we can 'carpet bomb' the cornea with antibiotics. Fungal infections and acanthamoeba are much harder to treat, but still not clear than doin...
Are there any special considerations for cataract surgery in a patient with ICE syndrome (Chandler) with a relatively clear cornea?
It is important to try and get a cell count before surgery to manage patient expectations in case of increased risk of endothelial failure. The cataract surgery should be straightforward unless there is a correctopia needing a pupillary dilator. To note that MIGS are usually not successful when comb...
When do you consider adding steroids alongside intravenous antibiotics for patients with orbital cellulitis?
If the orbital cellulitis is infectious, I never add steroids. There is no literature or proof that they do anything, and decreasing immunity, in my opinion, is simply a bad idea. If it is inflammatory, then absolutely. Most infectious orbital cellulitis is from the sinuses and is more common in chi...
How aggressively do you treat the ocular surface before cataract surgery in a patient with inconsistent K readings and mild dry eye who is otherwise ready for surgery and does this differ based on the type of IOL offered?
It is definitely recommended to manage mild dry eye first, as it may progress into a moderate dry eye in the postoperative period and increase the risks of complications. In patients with mild dry eye who are in a hurry to get surgery, I usually place plugs and plan the surgery shortly. Many times, ...
What is your follow-up protocol with the light adjustable lenses?
I did all my own adjustments for my LAL patients for 2+ years before deciding to delegate these adjustments to my extender OD (not the referring OD). I have not seen any change in outcomes with this shift, but I find myself being more willing to offer LAL to patients now because I don't dread the po...
What has been your experience with EDOF lenses in patients with glaucoma?
Multifocal lenses and refractive surgeries require a lot of consideration and discussion with patients. Making sure you provide honest information and setting expectations is crucial to providing the best outcomes we can for patients. Regarding glaucoma, if someone has visual field changes, they hav...