Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your approach to atropine dosing for myopia in children and when do you consider higher concentrations?
I have little experience with this. From what I understand, it offers inconsistent results at best.
What has been your experience with occluder contact lenses for intractable diplopia?
Poor, I’ve had better luck with scotch tape on one glasses lens placed in the center. It usually only needs a piece about an inch by an inch. This allows peripheral vision. Unfortunately, many don’t want to do this.
Which patients are good candidates for micropulse CPC?
Micropulse CPC is a suitable option for treating elevated IOP in a number of scenarios: advanced VF loss resulting in a small central or temporal island, intolerant to topical/oral glaucoma meds, poor general health limiting interventional surgery, no social support, and non-compliance.
What supportive care measures do you prioritize to manage or prevent toxicity in patients receiving Dato-DXd?
My supportive care approach is centered around early identification and management of interstitial lung disease (ILD) and mucositis, both of which were observed in the TROPION-Breast01 trial. Twelve patients (3.3%) in the Dato-DXd arm had adjudicated drug-related ILD/pneumonitis. I routinely obtain ...
How do you modify CPC (i.e., parameters, location of probe) in high myopes that may have thin sclera or more posterior ciliary bodies?
I often illuminate the eye to help visualize the ciliary processes. If I am worried about a thin sclera, I may start with a slightly lower energy and titrate up as needed.
What recommendations do you provide to patients who develop ocular side effects with Dupixent?
I would start with over-the-counter artificial tears without preservative and then refer to an ophthalmologist, ideally a corneal specialist who is experienced in the nuances of treating this condition. I have also had success switching from Dupixent to Adbry, although JAK inhibitors are a better o...
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...
Is there any role for topical corticosteroids in the treatment of photokeratitis?
Typically not, as this is not an inflammatory condition. The goal is to provide supportive care with aggressive lubrication and pain control with topical cycloplegics until epithelial regeneration occurs.
Do you stop netarsudil or brimonidine for patients with very injected conjunctiva prior to trabeculectomy, and what do you feel is the benefit?
I find Rhopressa helpful in lowering IOP pre-op surgery, but it can cause inflamed conjunctiva, so I stop 1 week prior to surgery and prefer brimonidine 0.15% (Alphagan P), and it may have neuroprotective value as well.
What is your approach to intralesional steroid injection for chalazia (in terms of dosage, approach, timing)?
I offer the option of intralesional steroid to all patients with chalazia, particularly if there is significant inflammation present. I give up to 1 cc of a 10 mg/mL solution of dexamethasone. I have approached this by both transconjunctival as well as transcutaneous. I think transconjunctival hurts...