Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
When would you consider discontinuing immunosuppressive treatment in a quiescent uveitis patient without systemic manifestations of inflammation?
I typically monitor patients on immunosuppressive therapy for at least 2 years before considering stopping or weaning off such therapy. There could be exceptions to this, including patients who insist on being taken off their meds (side effects, trying to conceive, etc.), in which case I can try aft...
In a bedridden, medically fragile patient with a symptomatic conjunctival cyst superior to the limbus, what is the optimal management approach?
I would first attempt medical management with lubricants, ketorolac, olopatadine, and naphazoline. If those failed, then I would use the following drops: topical anesthetic, a vasoconstrictor, and ketorolac twice over a five-minute period, then insert a lid speculum, and unroof the cyst by grasping ...
What is your preferred surgical intervention for children with congenital nystagmus?
Eye-muscle surgery in patients with INS improves their beat-to-beat nystagmus, thus they receive more useful vision per unit time. The common clinical misperception is that eye-muscle surgery only serves to improve "letter" acuity, centralize the INS null position, or reposition the eye(s) in the or...
How do you manage the severe adverse drug reaction of central serous retinopathy with MEK inhibitors?
Fortunately, the ICSC-like association of subretinal fluid with MEK inhibitor exposure is usually reversible after cessation of the drug. When working with this class of medications, it is important to coordinate care with the treating oncologist. If a patient presents with subretinal fluid and is o...
Which MIGS procedure do you believe provides the most sustainable IOP reduction when performed alongside cataract surgery?
There is no single consensus on this question. There are several MIGS options available in the market, and most glaucoma specialists use only a subset of these options. If you ask five ophthalmologists, you might hear six different answers. I prefer to categorize MIGS into two types: non-filtering a...
What has been your experience with the travoprost intracameral implant (iDose)?
My experience has been positive, but I consider patient selection prior to surgical planning to be crucial. At this time, I am mostly targeting mild to moderate POAG patients who are on 1-3 glaucoma medications (at least one being a PGA). I usually perform the iDose along with cataract surgery and a...
What’s your threshold for initiating treatment in patients with optic nerve cupping but normal IOP, normal visual fields, and borderline OCT findings?
My answer relies on the appearance of the OCT findings, the patient's and family history, and the progression over time. A Borderline OCT finding is broad. Patients who have a myopic fundus, or just a displacement of the retinal vessels near the optic nerve, do not worry me, and I choose to wait. If...
How would you approach a patient who is unable to undergo the recommended ophthalmologic examinations during treatment with mirvetuximab soravtansine?
Until more data are available regarding the ocular safety and reviewed by the agency, I follow the recommendations. I feel there is a decent chance real-world experience may change this but officially I follow the recommendations as stated. Having said this, the testing recommended (“Conduct an opht...
How do you utilize Diamox in patients with cerebral venous sinus thrombosis and vision symptoms who do not undergo thrombectomy/recanalization?
Diamox (acetazolamide) is often used to treat papilledema with associated visual loss in cases of CVST. While there is a theoretical risk of dehydration from acetazolamide with potential worsening of the thrombosis, 1) acetazolamide is a weak diuretic and 2) the risk of blinding visual loss usually ...
What work-up do you recommend for optic nerve edema in a patient who is immunocompromised?
Symptoms (is visual loss present or not?) and time of onset/pace help to direct the workup. For unilateral optic nerve edema with vision loss, optic neuritis and NAION are always high on the differential. In immunocompromised patients, an infectious cause such as herpes zoster, syphilis, TB, and art...