Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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 ...
What has been your experience with netarsudil in the management of corneal edema, particularly concerning its clinical effectiveness and insurance coverage?
I don't use netarsudil to treat corneal edema - I have discontinued it in patients who developed reticular epithelial edema (aka honeycomb edema), which is a rare but reported side effect with unclear mechanism. If elevated IOP is thought to be contributing to corneal edema, I typically use aqueous ...
How do you predict which patients are most likely to have a positive response to Oxervate?
Works great for peripheral nerve damage. HSV/VZV, burns, chronic dry eye/sicca/gvhd type patients. For central nerve damage from tumor, stroke, or brain/face surgery never found any benefit.
How do you individualize treatment choices for progressive myopia in children?
For all patients, I recommend at least 14 hours/week (on average 2 hours/day) of bright sunlight exposure to slow myopia progression. I also recommend limiting near work to academic work as much as possible. If playing video games or watching shows, better to use a TV at a distance rather than phone...
What are the most effective strategies for managing post-operative complications such as scarring in pediatric oculoplastics surgeries?
Massage, topical steroids.
How would you approach choosing a MIGS procedure for a patient with mild glaucoma with progressively worsening PAS undergoing cataract surgery?
In a patient with mild glaucoma and progressive PAS undergoing cataract surgery, I first assess whether the mechanism is primary or secondary angle closure, such as from uveitis. Context is important here. Given that the angle is at least partially compromised, I generally avoid angle-based MIGS at ...
In which cases of post-injection endophthalmitis should early vitrectomy be considered if there is little to no improvement 48 hours after a tap and inject and there is no organism isolated?
Prompt vitrectomy should be considered in all patients with post-injection endophthalmitis (PIE) if there is no improvement 48 hrs after a tap and inject. The initial tap did not identify the organism. Non-infectious endophthalmitis can be included in the differential diagnosis of persistent inflamm...
What are the clinical indications for performing a second laser peripheral iridotomy (LPI) instead of proceeding directly with cataract surgery?
The only reason for a second LPI in CACGL or occludable angle is if sector iris bombe develops due to posterior synechiae formation. Otherwise, one LPI will normalize the pressures between the posterior and anterior chambers. If you still see progressive angle closure after LPI, you are dealing with...