Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What has been your impression of the clinical outcomes for photobiomodulation for dry AMD?
I’m not impressed by a 2.4-letter improvement over placebo after 27 treatments. It sounds like noise and can be compared to a drop of preservative-free artificial tears. It’s not like we have tons of clinic availability to spend our time on such trivial improvements. We need a better assay to find t...
In patients with retinitis pigmentosa–associated cystoid macular edema that is refractory to medical management, does pars plana vitrectomy have a therapeutic role?
Patients with RP have an increased incidence of macular edema (CME) and epiretinal membranes (ERM). If CME is associated with ERM, then there may be a role of PPV with membrane peel, but if CME is isolated, oral or topical carbonic anhydrase inhibitors would be considered the treatment of choice.
What brain imaging findings do you find reliable to help support a diagnosis of idiopathic intracranial hypertension?
In a study by Bidot et al., PMID 26457687, transverse venous sinus stenosis (TVSS) was the most useful sign of IIH because of its high pooled sensitivity (97%) and specificity(93%). Orbital findings, such as optic nerve head protrusion, posterior scleral flattening, optic nerve tortuosity, and diste...
What clinical or OCT-based parameters guide your decision to perform an ERM peel in patients with DME and concurrent ERM?
The presence of an ERM in a patient with DME negatively impacts the response to anti-VEGF injections and reduces the efficacy of the injections. The ERM acts as a physical barrier, reducing drug penetration, and can also contribute to the progression and persistence of DME through the production of ...
What is the most appropriate next step for a patient experiencing prolonged hypotony following Ahmed glaucoma valve implantation and unsuccessful medical management?
To reduce aqueous flow through the tube, a less invasive approach involves occluding the tube lumen using a 2-0 or 3-0 Prolene suture via an ab interno technique. For complete occlusion, a Supramid suture may be used instead of Prolene. The ab interno approach minimizes conjunctival disruption. Alte...
What has been your experience with Durysta (bimatoprost implant) for glaucoma management?
Excellent option for glaucoma patients. I have been offering routinely for about a year now. Topicals are also an option, but compliance, insurance coverage, side effects (ocular surface), and monthly cost all affect quality of life and efficacy of treatment. I prefer SLT + Durysta over topical trea...
What is the appropriate interval before safely performing cataract surgery after plaque radiation therapy for iris melanoma?
Great question, but one that requires a nuanced answer. Often, patients with iris melanomas have some degree of lens opacity, and following brachytherapy, the cataract will surely progress. I recommend carefully following up on the iris melanoma after radiation to ensure the lesion is regressing pro...
What is your approach to patients with biopsy proven giant cell arteritis that continue to have symptoms after initiation of high dose glucocorticoid therapy?
First, let's define and discuss “high-dose” steroids. Oral therapy is typically 60-100 mg of prednisone daily, and IV is 500-1000 mg of methylprednisolone daily for three days, followed by oral prednisone. There has been no difference in long-term outcomes for vision loss or diplopia. The complicati...
What factors influence your decision to pursue surgical management in cases of infectious keratitis caused by multidrug-resistant pathogens?
I would consider operating sooner rather than later for a keratitis that’s headed in the wrong direction. It’s important to intervene prior to the development of extensive CNV or limbal involvement or corneal perforation for a more controlled, straightforward operation. The exception may be fungal k...
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...