Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you decide whether or not to excise a pterygium prior to cataract surgery?
I'll remove a pterygium prior to cataract surgery if I suspect the pterygium will need removal at some point in the future. This could mean: 1.) I have seen evidence of pterygium progression in the recent past (either physical growth onto the cornea as compared to historical measurements/photos, or ...
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 ...
How do you counsel patients interested in LAL monovision about the possibility of reduced glasses dependence?
One of the main advantages of the LAL is the ability to fine-tune monovision after surgery, allowing patients to experience and adjust their visual balance between distance and near before final lock-in. I explain that this flexibility greatly increases satisfaction and can significantly reduce glas...
What factors will most influence your decision to offer ENCELTO to patients with macular telangiectasia type 2?
Yet another (presumably very expensive) surgical treatment for a chronic macular disease was approved on the basis of OCT measurements without demonstrating visual benefit to the patient in a disease with a slow, variable course. Show me quality of life studies and visual benefit justifying surgical...
In extremely premature infants born at <25 weeks gestational age, how do you individualize the timing and frequency of ROP screening?
Those extremely premature infants with an unstable clinical course or where the accuracy of GA was uncertain may need to be screened prior to 31 weeks PMA (post-menstrual age).Please see our paper: Souverein et al., PMID 38878959.In this study, among infants <=24 weeks gestational age at birth, we f...
Given concerns about cooperation, anesthesia, and predictability, under what circumstances do you use adjustable sutures in pediatric strabismus surgery?
With only a few exceptions, I usually do adjustable sutures for patients with double vision (a little older, able to report diplopia well, and when diplopia makes sense and they fuse with prisms in the clinic) or unusual strabismus, where results might be less predictable, and I want to avoid any un...
For patients with Light Adjustable Lenses, what has been your approach regarding YAG capsulotomy timing?
It is best to avoid performing a YAG capsulotomy before or during the light-adjustment period unless the posterior capsule opacification (PCO) is visually significant and functionally limiting. Although the YAG laser itself is safe and effective regardless of its timing relative to lens lock-in, sev...
What is your perspective on the role of digital binocular therapies in amblyopia management?
Digital binocular therapies are great for children who struggle to cooperate with the gold standard of patching. Digital binocular therapies like Luminopia have been studied on children with no or very small angle strabismus, and they are more appropriate for those with anisometropic amblyopia. Also...
What long-term complications have you observed in previously stable preterm infants with incomplete peripheral retinal vascularization who did not undergo ROP laser treatment?
Great question. You can see a range of findings, from absolutely nothing to thinning of the avascular retina, lattice degeneration, abnormal insertion of the vitreous base, and localized staining of the end of the vasculature.
In cataract surgery following penetrating keratoplasty, do you think the use of scleral tunnel incisions versus clear corneal incisions meaningfully influence graft survival or astigmatic stability?
I generally prefer a clear corneal incision for most cataract surgeries following PK. Regarding endothelial safety, there are limited studies directly comparing endothelial cell loss or corneal edema between incision types. In my own experience over the past year, I have not encountered endothelial ...