Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How does LAL+ compare with other EDOF lenses?
Customizable: The LAL+ provides a *customizable depth of focus*. Typically, patients achieve excellent distance and intermediate vision, with some functional near vision depending on postoperative adjustments. Surgeons can create mini-monovision or slightly blended vision to extend range as desired...
What has been your experience using sutureless Müller’s Muscle-Conjunctival Resection (MMCR) for ptosis repair?
Personally, I get the desire to be less interventional, but if you are going to do this and it is 'less aggressive' than a levator resection, just put in a suture; it is not so hard.
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...
Which IOL do you prefer for patients with a history of hyperopic LASIK to minimize the risk of inducing spherical aberration?
I prefer an IOL without any induced spherical aberration, such as the enVista monofocal, in my post-hyperopic LASIK patients. Other standard monofocal lenses (such as clareon monofocal, J&J monofocal, etc.) have a built-in negative spherical aberration that is intended to offset the standard positiv...
How do you determine whether to switch to a different anti-VEGF agent or to Ozurdex after a patient with diabetic macular edema fails a series of Avastin?
For my practice, macular oedema (CSME) is based on three factors. Ischemia, inflammation, and traction: the three factors which lead to persistent oedema. IVFA will show the level of non-perfusion in the far periphery, which is a major producer of VEGF, and laser (PRP) is the treatment. IV anti-VEGF...
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...
How would you approach the management of a patient presenting with bilateral central corneal perforations following treatment with Ipilimumab/Nivolumab?
I am aware of at least one case report describing this situation (Aschauer et al., PMID 36072439).Ideally, the offending medication is halted, but when dealing with life-threatening cancer, this may not be possible, especially if the treatment is working. In the acute setting, trying to stabilize th...
Is there a role for PDT in a young patient with PXE and bilateral CNVM who requires intravitreal anti-VEGF injections every 4 weeks and is beginning to develop atrophy?
I am not a fan of PDT for patients who are developing incipient atrophy. The question says anti-VEGF therapy is being given every 4 weeks, but it is not clear what agent is being used. I would try 2nd generation therapy such as faricimab, 8 mg aflibercept, or possibly brolucizumab (after discussion ...
How do you approach recommending ocular exams for asymptomatic candidemic patients considering the discordance between the IDSA and American Academy of Ophthalmology guidelines?
Endogenous endophthalmitis due to Candida sp. occurs in <1% of patients with candidemia. The IDSA 2016 guidelines for management of candidiasis outline evaluation and treatment of patients with endophthalmitis, with recommendations to perform a dilated ophthalmologic exam on all patients with candid...
In what scenarios do you consider using an amniotic membrane graft for macular hole closure?
Given that the success rate of closing macular holes is excellent when the hole is worth closing, and that there are no studies demonstrating the benefit to the patient of amniotic membranes for (presumably) very large and chronic holes, I can't recommend this approach. Having said that, I have no e...