Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do visual outcomes differ among scleral lenses, refractive surgery, and phakic IOLs in keratoconus patients with irregular astigmatism following cross-linking?
These are three distinct avenues of treatment for KC. The visual disability in keratoconus is secondary to perturbation of the corneal optics. This manifests itself in changes in sphere, cylinder, and optical aberrations. Scleral contact lenses, for the most part, correct all three and often give ex...
What alternative treatments do you recommend trying for patients struggling with persistent, chronic ocular surface pain following refractive surgery unresponsive to traditional methods (i.e., lubrication, topical cyclosporine, punctal plugs)?
The first step is to identify the underlying cause of pain. If nociceptive: Target the visible source of pain. If peripheral neuropathic (e.g., due to corneal nerve abnormalities): Consider topical therapies that modulate nerve function, such as autologous blood-derived products (PRGF, AST, PRP) or...
What is the role of femtosecond laser–assisted techniques in pediatric cataracts?
Theoretically, FLACS would be a great tool for pediatric cataracts because the anterior capsule in children is elastic and can be quite unpredictable, making the capsulorhexis step one of the most challenging in the procedure. FLACS would potentially minimize the complication rate in this step. Pati...
How do you typically manage the use of intravitreal antibiotics during globe repair?
At the end of the case, if no allergies, I will inject vancomycin and ceftazidime intravitreal. If there was vegetable matter involved in the injury (tree branch), I would include an antifungal like voriconazole.
How has intraoperative OCT influenced your surgical decision-making during complex macular cases?
I use iOCT very frequently because I am sent a lot of patients who failed surgery elsewhere. The most common situation is failure of macular hole closure. Sometimes it’s not clear what areas have been peeled, even with staining with ICG or Brilliant Blue G (BBG). Having the iOCT makes it easier to s...
In cases of severe ocular trauma with NLP vision, under what circumstances do you consider proceeding with pars plana vitrectomy?
I don’t. Often, it is time to have a difficult discussion with the patient about the timing of eviseration or enucleation, if the eye presents as an open globe. The risk of endophthalmitis, worsening ptysis and pain, as well as the small risk of sympathetic ophthalmia, are sound reasons to consider ...
What has been your impression of the clinical outcomes for photobiomodulation for dry AMD?
I’m not impressed by a 2.4-letter improvement over placebo after 27 treatments. It sounds like noise and can be compared to a drop of preservative-free artificial tears. It’s not like we have tons of clinic availability to spend our time on such trivial improvements. We need a better assay to find t...
In patients with retinitis pigmentosa–associated cystoid macular edema that is refractory to medical management, does pars plana vitrectomy have a therapeutic role?
Patients with RP have an increased incidence of macular edema (CME) and epiretinal membranes (ERM). If CME is associated with ERM, then there may be a role of PPV with membrane peel, but if CME is isolated, oral or topical carbonic anhydrase inhibitors would be considered the treatment of choice.
What brain imaging findings do you find reliable to help support a diagnosis of idiopathic intracranial hypertension?
In a study by Bidot et al., PMID 26457687, transverse venous sinus stenosis (TVSS) was the most useful sign of IIH because of its high pooled sensitivity (97%) and specificity(93%). Orbital findings, such as optic nerve head protrusion, posterior scleral flattening, optic nerve tortuosity, and diste...
What clinical or OCT-based parameters guide your decision to perform an ERM peel in patients with DME and concurrent ERM?
The presence of an ERM in a patient with DME negatively impacts the response to anti-VEGF injections and reduces the efficacy of the injections. The ERM acts as a physical barrier, reducing drug penetration, and can also contribute to the progression and persistence of DME through the production of ...