Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What strategies do you use to manage refractory cystoid macular edema in uveitis patients who have already received ocular steroids and systemic immunosuppression?
For this clinical situation, especially if the CME is bilateral, systemic peg-interferon alpha is an excellent option. Commence with peg-interferon 180 mcg injected subcutaneously weekly. Check baseline CBC/diff and complete metabolic panel prior to starting treatment and at least weekly initially (...
How has your evaluation of IRDs changed with advances in molecular genetics?
Comprehensive medical history and physical examination, and review of all pertinent medical records.
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...
How do you decide whether to continue hydroxychloroquine in a young patient who develops subretinal neovascularization with no other risk factors?
Hydroxychloroquine (HCQ), an anti-inflammatory and immunomodulatory agent, is used to treat autoimmune diseases (rheumatoid arthritis, lupus, Sjogren’s disease, etc.) and malarial prophylaxis. Vision problems can ensue resulting from these deleterious irreversible effects of HCQ on retina if the cum...
When should you seek hyperbaric oxygen therapy for patients with CRAO?
I usually pursue hyperbaric oxygen therapy within the 24-hour window from symptom onset for CRAO. This can be performed following TNK if given. In reality, though, there are multiple barriers to achieving this, including: Few centers offer hyperbaric oxygen therapy Labor intensive Difficulty with i...
If a patient is legally blind and on hydroxychloroquine, do you still recommend follow up with ophthalmology to monitor for hydroxychloroquine retinal toxicity?
A patient who is legally blind but taking hydroxychloroquine absolutely needs to be monitored by an ophthalmologist. The usual definition of legal blindness in the United States is vision no better than 20/200 in the better-seeing eye. But 20/200 is far better than say counting fingers (the ability ...
Which patients do you routinely prescribe ketorolac for after cataract surgery?
I recommend bromfenac (not ketorolac) to all patients undergoing cataract surgery - based on work by Drs. @Dr. First Last and John Whittpen that found that starting topical NSAIDs 1-3 days preop provided. Lower risk of CME Larger pupils throughout cataract surgery Less discomfort during cataract su...
How does pseudoexfoliation change expected long-term success of trabecular MIGS?
I have not found results to differ in my patients with either trabecular bypass shunts or goniotomy and/or canaloplasty in patients with pseudoexfoliative glaucoma. In my experience, the larger issue is the cataract surgery portion of the case in the case of combined phaco/trabecular MIGS. I usually...
What treatment strategies do you use to reduce the risk of post-herpetic neuralgia after herpes zoster ophthalmicus?
For prevention, our best tool is the VZV vaccine (Shingrix). I recommend that all patients over age 50 consider receiving it. However, if an individual develops VZO and has persistent pain, I begin with antiviral therapy to assess whether subclinical viral activation is contributing to the pain (dur...
For LALs, after lock-in, when does a residual refractive shift justify corneal enhancement rather than continued observation?
I would wait at least 4 weeks. There could be some residual diffusion occurring in the LAL after the monomers have been locked. In theory, if some of the monomers were not polymerized during the lock-in, they can diffuse within the LAL. Water then follows to equilibrate, and you can get a change in ...