Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In a patient with prior cataract surgery in one eye with an unknown monofocal lens, how do you approach selection of a monofocal in the second eye?
The choice is completely dependent on the patient and the physician's discretion and discussion. No one choice for everyone.
What has been your experience using Dextenza for postoperative inflammation and pain control?
Dextenza has been an extremely useful tool for reducing the postoperative eyedrop burden in managing inflammation after cataract surgery. I typically reserve Dextenza for patients who may have difficulty adhering to a topical drop regimen. This may include those with limited dexterity, cognitive im...
Are there any important considerations when initiating orbital radiation therapy for TED in a patient with diabetic retinopathy?
Recent research would suggest that the risk of radiation retinopathy in patients with DM undergoing orbital radiation therapy for TED is low (Makhoul et al., PMID 41450582). However, my personal preference is to explore all other medical options (Tepezza, EUGOGO protocol, Actemra, etc.) prior to tre...
In your experience, what factors prompt you to switch a patient with diabetic macular edema to Eylea HD?
In my practice, it isn’t switching to longer acting anti-VEGF, it is the treatment of the peripheral retinal ischemia. I often initially treat CSME with Avastin, but I use an IVFA to evaluate and treat the non-perfused retina with laser. It is the PRP that treats the VEGF production driving the diab...
How do you manage dry eye syndrome due to lacrimal or meiobian gland dysfunction after external beam radiotherapy?
I have also found autologous serum (AS) or platelet-rich plasma (PRP) eye drops/tears to be extremely useful (provided by an ophthalmologist). Dry eye can also be exacerbated by graft vs. host disease, which I have anecdotally seen worsened within radiation fields and is characterized by a lasting m...
How would you approach the upfront management of a patient with acute unilateral vision loss with strong clinical risk factors for both cardioembolic stroke and GCA if an expedited MRI is not possible due to the presence of an AICD?
I'm definitely not an expert in this topic, but you have many clinical tools to increase/decrease your clinical suspicion for GCA vs. cardioembolic stroke. Some things I would ask: Is this patient currently in Afib? What's their CHADSVASC? Are they anticoagulated? Can we get a TTE to check for vege...
How do you approach management of GLP-1 receptor agonist therapy in patients who develop NAION?
Short answer is I recommend stopping the GLP-1 agonist if one eye has already developed NAION, for the sake of protecting the fellow eye. The fact is, our knowledge is still growing in this matter. While some studies indicate links between GLP-1 agonists and NAION, there are so many discussions arou...
What options would you consider for removing dense fibrin deposits from an IOL in a patient with chronic uveitis?
Pre-treat with a steroid and nonsteroid drop, use a low-power YAG laser anterior offset to remove, and post op continue with pre op regimen for as long as recurrence is necessary, then slowly taper off.
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.