Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your go-to multifocal lens?
As of today, the Alcon PanOptix for most patients who want a multifocal-type outcome. But more importantly, I think matching the strengths/weaknesses/side effect profile of each lens type with each patient's optical system and expectations. Well-controlled head-to-head studies regarding this would b...
What do you feel are some of the advantages and disadvantages of dropless cataract surgery and what are your preferred agents?
A clear advantage of dropless surgery is that the patient no longer needs to use post-op drops. This may not necessarily present as an advantage to the surgeon, as any additional techniques will add time and cost to the cataract surgery, especially if a particular technique is not covered by insuran...
Do you find that framing refractive surgery success around functional goals rather than visual acuity targets improves patient satisfaction in your practice?
The only time I would frame it this way is in someone who has limited best corrected vision pre-op. For most patients, their goal is to see as good as possible without correction, and the way they determine that is how well they see, which correlates directly to their Snellen acuity. 20/happy is a t...
In cases where placing an IOL in the bag/sulcus is not possible, how do you decide between leaving a patient aphakic for a scleral-fixated IOL (assuming this can't be done immediately) vs. placing an ACIOL?
In 2 situations, I would leave a patient aphakic even without an IOL: highly myopic patients where the actual IOL power is minimal +\- 3 D, in that case, glasses can correct residual refraction, supposing that the patient does not develop anisometropia monocular patients with up to 5 D residual ref...
What is your approach for treating allergic conjunctivitis in a patient who has failed ketotifen and olopatadine?
Agree with Dr. @Dr. First Last - and for in-office treatments, I've been increasingly impressed with Rinsada irrigation in some cases (rinse out the fornix, which seems to trap some allergens there), as well as mitigation and desensitization therapy if the allergist can find specific allergens to fo...
How do you approach diagnosis and management of orbital myositis?
Orbital myositis is an umbrella diagnosis that includes a wide range of potential underlying conditions. Patients with this presentation are often first evaluated by neuro-ophthalmology to exclude causes such as isolated orbital myositis, myasthenia gravis, thyroid eye disease, infection, and diabet...
How does corneal sensation testing play into your evaluation of a patient presenting with a chronic or recurrent epithelial defect of uncertain etiology?
Decreased corneal sensation may indicate the presence of neurotrophic keratitis (NK). The differential for NK is large but common causes are viruses such as HSV/VZV, DES, or diabetic keratopathy. Prior to topical anesthetic, I use a tissue folded to a point and touch the cornea at various locations ...
Do you routinely recommend IV systemic antibiotic therapy in additional to intravitreal antibiotic therapy for exogenous bacterial endophthalmitis?
Post-surgical (exogenous) endophthalmitis is an uncommon complication with the incidence ranging from 0.04%-0.3%, 0.019%- 0.54%, and 0.11% - 0.03% following cataract surgery, intravitreal injection, and vitrectomy, respectively (Soliman et al., PMID 32467482). Initial management of exogenous endopht...
How do you approach tube shunt placement in very high myopes with thin sclera?
Due to decreased scleral rigidity in highly myopic eyes, there is a higher risk of hypotony and hypotony maculopathy with filtering surgeries, including tube shunts. In choosing the type of tube shunts, I would favor a valved tube shunt in high myopes. For surgical technique, I take great care when ...
How do you manage uncontrolled glaucoma in patients in their mid 90s and beyond?
This truly depends on their lifestyle, activity level, and mental status. I will still consider trabeculectomy in patients who are highly functional and compliant if their glaucoma is truly uncontrolled and they are losing vision. Trabeculectomy is still a highly effective surgery, and elderly patie...