Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your preferred surgical intervention for lagophthalmos secondary to a facial paralysis and signs of exposure keratopathy?
If temporary or early in the recovery, consider stick-on external eyelid weights. If it has been several months without any improvement, I like to do gold or platinum permanent weights sutured to the tarsus, in addition to a lower lid tightening as Dr. @Dr. First Last mentioned.
Do you feel there is value to Schirmer testing in clinic prior to starting dry eye treatment?
Schirmer's testing is a low-cost, readily available test for a majority of ophthalmologists. It has several limitations and can be quite variable in its results. Consistently low Schrimers I results suggest an aqueous tear film deficiency and can be a clue toward the mechanisms of dry eye problems, ...
In bilateral sequential NAION, do you expect any progressive worsening of OCT/VF years from the ischemic event and when would you have these patients evaluated for another progressive optic neuropathy?
One should not see progressive loss of vision years after the initial insult with NAION. One may see variability in the automated field testing, but it should not be steady progression. OCT should be at its lowest nadir for both rNFL and GCL by 6 months, without further loss beyond age-appropriate c...
Do you feel there is value to getting endothelial cell counts in the absence of frank edema/visual significance in your management endothelial dystrophies?
I would, yes, mostly for patient understanding of their condition and following up on it objectively. There is a clinical benefit, but it is limited. Clinically, I use it to give the patients an assessment about their risks of edema post cataract surgeries or to push for early cataract surgeries in...
What options would you consider for removing dense fibrin deposits from an IOL in a patient with chronic uveitis?
Pre-treat with a steroid and nonsteroid drop, use a low-power YAG laser anterior offset to remove, and post op continue with pre op regimen for as long as recurrence is necessary, then slowly taper off.
How do you adjust postoperative refraction targets for LAL in patients with altered corneal anatomy?
I don't adjust any postoperative refraction targets based on prior refractive surgery or previous EK, but modify the approach to adjustments. In patients with a history of PRK/LASIK, we wait at least 6 weeks to initiate adjustments. In patients with a history of RK, we wait 8+ weeks to start adjustm...
How do you determine the timing and necessity of surgical removal for retained subretinal perfluorocarbon?
Timing: Defer PFO removal until after you are convinced the retina is attached and will likely stay attached (e.g., after gas resolves or, if under oil, later than 8 weeks). Necessity: Plan for surgical removal if subretinal PFO is foveal or perifoveal. If not, then defer indefinitely unless PFO loc...
Should teprotumumab be used in patients with active, moderate Graves thyroid eye disease in the absence of proptosis?
Teprotumumab is NOT a benign therapy with multiple serious side effects and complications. In the setting of acute TED with significant disease, it has a place. For the average patient, there are multiple other treatments and other Biologics with fewer complications.
When do you use GLP-1 receptor agonists for the management of patients with idiopathic intracranial hypertension (IIH)?
I would use GLP-1 agonists in all overweight IIH patients who did not have a contraindication if it wasn't for the cost. In the IIH treatment trial, 6% weight loss over 6 months lowered intracranial pressure by about 50 mm (acetazolamide also lowered ICP by about 50 mm, but of course, it did it much...
When should methotrexate injections be initiated for proliferative vitreoretinopathy?
This is an excellent question with a nuanced answer. Currently, we lack substantial level 1 evidence to guide precise treatment strategies for off-label use of methotrexate (MTX) in the treatment or proliferative vitreoretinopathy (PVR). Based on animal and human clinical retrospective studies, the ...