Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your perspective on using AI with OCTA to assess optic nerve blood flow in glaucoma management?
OCTA provides quick, reliable 3D scans that reveal both structural (NFLA, ON rim, cupping, GCC thickness, FAZ) and vascular (VD retina and ONH) information. Thus, it fulfills the requirements of both the mechanical and vascular theories. However, the busy ophthalmologist must scan through over 30 va...
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-...
How soon do you consider repeating external diode (CPC) for a patient who's IOP remains relatively unchanged and uncontrolled post-op after initial CPC?
My experience is that a reduction is usually apparent by 6-8 weeks. If not at target level IOP, repeat the procedure and adjust parameters of treatment accordingly (duration on, cycle frequencies/duty cycle).
How do you approach the management of a patient with psoriasis and chronic anterior uveitis who is unable to take DMARDs and has tried TNF inhibitors and IL-17 inhibitors but has ongoing bilateral anterior uveitis?
Psoriasis is so common that it is possible that this is a chance association, but published studies do support the likelihood that there is a causal association between psoriasis and uveitis and a much stronger association between psoriatic arthritis and uveitis. The choice of therapy depends to a g...
Do you feel there is a role for capsulectomy for failed Ahmed implants and what is your preferred surgical approach?
There can be a role for capsulectomy after a failed Ahmed implant. In situations where a needling/5FU is insufficient, a capsulectomy provides a higher chance of success. Typically, I would dissect from the limbus backwards to the plate, excise as much capsule as possible, then close after ensuring ...
What is your approach to managing failed trabeculectomies with scarring but controlled IOP?
It's important to differentiate "controlled IOP" from the controlled rate of disease progression. If IOP is consistently 10-12 in the clinic and HVF and OCT are stable, close observation may be all that is needed. However if the IOP is "controlled" but the HVF shows evidence of progressive functiona...
In eyes with chronic DME despite frequent anti-VEGF, what is your threshold to add or switch to intravitreal steroid therapy?
I’m quick to add steroids to anti-VEGF treatment. If there is little to no response to 3 anti-VEGF injections, adding a dexamethasone implant (Ozurdex) can help a lot. I will usually do that before switching in class. I usually switch to a different anti-VEGF if there is good but incomplete response...
How does a history of malignant glaucoma in one eye influence your surgical approach to the fellow eye, particularly regarding prophylactic/intra-operative measures (i.e., iridotomy, IZH)?
Although this is not a common occurrence, a history of malignant glaucoma in one eye will affect my surgical planning in the fellow eye. I have performed a prophylactic IZH in the fellow eye during cataract surgery. Additionally, I make sure that when appropriate, all fellow eyes have received a las...
What surgical strategies do you recommend for managing isolated skew deviation after stroke?
Skew deviation is a tough matter to diagnose and treat, but as a general fact the most cases of skew deviations occur along with an acute stroke or as a consequence of demyelinating disorders. Thankfully, most of them tend to disappear after a few weeks and rarely require treatment. Between the chro...
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...