Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you manage corneal ectasia after refractive surgery?
Corneal cross-linking should be the first step to halt progression. I would then typically encourage patients to try hard contacts, which help improve the vision in the most conservative way. There are a variety of surgical interventions that can be considered depending on how advanced the ectasia i...
How do you approach re-treatment in a patient with chronic central serous chorioretinopathy who has residual subretinal fluid after their first half-dose?
If the fovea is dry and the residual fluid is outside the fovea, I usually observe without additional treatment. If the residual SRF is subfoveal in location and decreasing compared with pre-treatment, I typically observe, hoping for continued improvement to a dry fovea. If there is residual subfove...
Are there any special considerations for cataract surgery in a patient with ICE syndrome (Chandler) with a relatively clear cornea?
It is important to try and get a cell count before surgery to manage patient expectations in case of increased risk of endothelial failure. The cataract surgery should be straightforward unless there is a correctopia needing a pupillary dilator. To note that MIGS are usually not successful when comb...
When do you consider adding steroids alongside intravenous antibiotics for patients with orbital cellulitis?
If the orbital cellulitis is infectious, I never add steroids. There is no literature or proof that they do anything, and decreasing immunity, in my opinion, is simply a bad idea. If it is inflammatory, then absolutely. Most infectious orbital cellulitis is from the sinuses and is more common in chi...
How aggressively do you treat the ocular surface before cataract surgery in a patient with inconsistent K readings and mild dry eye who is otherwise ready for surgery and does this differ based on the type of IOL offered?
It is definitely recommended to manage mild dry eye first, as it may progress into a moderate dry eye in the postoperative period and increase the risks of complications. In patients with mild dry eye who are in a hurry to get surgery, I usually place plugs and plan the surgery shortly. Many times, ...
What is your follow-up protocol with the light adjustable lenses?
I did all my own adjustments for my LAL patients for 2+ years before deciding to delegate these adjustments to my extender OD (not the referring OD). I have not seen any change in outcomes with this shift, but I find myself being more willing to offer LAL to patients now because I don't dread the po...
What has been your experience with EDOF lenses in patients with glaucoma?
Multifocal lenses and refractive surgeries require a lot of consideration and discussion with patients. Making sure you provide honest information and setting expectations is crucial to providing the best outcomes we can for patients. Regarding glaucoma, if someone has visual field changes, they hav...
What is your go-to multifocal lens?
As of today, the Alcon PanOptix for most patients who want a multifocal-type outcome. But more importantly, I think matching the strengths/weaknesses/side effect profile of each lens type with each patient's optical system and expectations. Well-controlled head-to-head studies regarding this would b...
Do you find that framing refractive surgery success around functional goals rather than visual acuity targets improves patient satisfaction in your practice?
The only time I would frame it this way is in someone who has limited best corrected vision pre-op. For most patients, their goal is to see as good as possible without correction, and the way they determine that is how well they see, which correlates directly to their Snellen acuity. 20/happy is a t...
In cases where placing an IOL in the bag/sulcus is not possible, how do you decide between leaving a patient aphakic for a scleral-fixated IOL (assuming this can't be done immediately) vs. placing an ACIOL?
In 2 situations, I would leave a patient aphakic even without an IOL: highly myopic patients where the actual IOL power is minimal +\- 3 D, in that case, glasses can correct residual refraction, supposing that the patient does not develop anisometropia monocular patients with up to 5 D residual ref...