Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
For patients with Light Adjustable Lenses, what has been your approach regarding YAG capsulotomy timing?
It is best to avoid performing a YAG capsulotomy before or during the light-adjustment period unless the posterior capsule opacification (PCO) is visually significant and functionally limiting. Although the YAG laser itself is safe and effective regardless of its timing relative to lens lock-in, sev...
What pre-operative features in pseudoexfoliation patients do you feel correlate with intra-op zonulopathy?
This is an excellent question. Several factors play a role in the extent of zonulopathy that one may expect during pseudoexfoliation cases. A history of zonulopathy in the other eye or other factors that could contribute (trauma, falls, prior surgeries like retina procedures) would be one thing to l...
How often and in what way do you monitor patients who are receiving teprotumumab (Tepezza) for thyroid eye disease?
A week or two after completion unless having an issue.
What is your approach to offering PRK for 1 diopter of myopia in patients over 45 with a corneal thickness of 450 microns and no keratoconus?
I am not sure why you would treat this patient? One diopter of myopia over 45 years old. The patient probably has pretty good reading and distance vision without glasses. What is the patient’s visual goal? They want 20/20 distance without correction and now lose all ability to read?
Do you feel there is benefit to subconjunctival steroid or MMC injection at the time of valved tube placement?
In my opinion, there is a lack of compelling clinical evidence and studies to support the injection of subconjunctival MMC at the time of valved tube placement. I consider the injection of a subconjunctival steroid in patients with poorly controlled inflammation and those who I think may be less com...
How do you adjust your glaucoma management strategy for pregnant patients who require IOP lowering?
Managing glaucoma during pregnancy is challenging and requires a multidisciplinary approach in collaboration with the patient’s OB-GYN team. Several management strategies can be considered. Initially, close observation with frequent intraocular pressure monitoring and visual function/nerve assessmen...
When do you consider initiating zoster prophylaxis in patients?
I do this when more than one episode of keratitis or uveitis per year; If a planned surgery, would start treatment doses one week before surgery and for 14 days after. Nothing worse than reactivation of zoster.
Has adopting a 3D heads-up digital visualization system changed your approach to anterior segment surgical teaching of residents or fellows?
We have been using NGENUITY to teach our cornea fellows, residents, and med students for the last 3-4 years. It has been a tremendous addition because it allows multiple people to have a real-world view, not just one surgical assistant. In addition, visiting students who may not be approved to scrub...
How do you approach perioperative steroids for a quiescent uveitis patient undergoing cataract surgery?
Preop: If the patient is using topical steroids chronically, I increased the dose of the drops to four times a day the week prior to surgery. If the patient is using chronic oral prednisone, I will increase the prednisone to 0.5 mg/kg, 3 days prior to surgery, followed by a quick taper every 3 days...
What follow-up monitoring would you recommend for an adult with self-resolved idiopathic acute pupil-sparing third nerve palsy?
Pupil-sparing third nerve palsy is a relatively common presentation for neuro-ophthalmologists. They typically resolve completely by 12 weeks, and I will typically follow them until they are fully resolved, watching them once a month. The most common are microvascular and associated with a variety o...