Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How long should you wait after superficial keratectomy for accurate IOL measurements?
I wait at a minimum of 4 weeks and reassess the topography to see if it stabilizes. If not stable, I will repeat every 4 weeks until stable (usually no more than 3 months needed).
What is your approach to incorporating IPL therapy for meibomian gland dysfunction?
We use a protocol that treats the whole upper and lower eyelid, and periocular area that includes the brow, crows feet and lower eyelid/cheek junction. We treat the nose as well. That said, I don’t believe a study exists to support IPL/BBL for MGD control, and IPL is questionable as a treatment for ...
Do you incorporate diurnal or nocturnal IOP measurements in your management of progression despite seemingly adequate daytime control?
The advent of home-based tonometry can make diurnal or nocturnal IOP measurements more convenient to obtain, though the cost of renting or buying these devices may be prohibitive for some patients. Glaucoma specialists sometimes use diurnal or nocturnal IOP measurements to identify whether there are...
What is your approach to antiviral treatment of HSV acute retinal necrosis?
Acute Retinal Necrosis (ARN) is a rapidly progressive syndrome usually caused by varicella-zoster virus (VZV)and herpes simplex virus 1 or 2 (HSV). The syndrome is rapidly progressive in the absence of antiviral treatment. PCR performed on aqueous or vitreous sampling is highly sensitive and strongl...
What is your perspective on using AI with OCTA to assess optic nerve blood flow in glaucoma management?
OCTA provides quick, reliable 3D scans that reveal both structural (NFLA, ON rim, cupping, GCC thickness, FAZ) and vascular (VD retina and ONH) information. Thus, it fulfills the requirements of both the mechanical and vascular theories. However, the busy ophthalmologist must scan through over 30 va...
How soon do you consider repeating external diode (CPC) for a patient who's IOP remains relatively unchanged and uncontrolled post-op after initial CPC?
My experience is that a reduction is usually apparent by 6-8 weeks. If not at target level IOP, repeat the procedure and adjust parameters of treatment accordingly (duration on, cycle frequencies/duty cycle).
How do you approach the management of a patient with psoriasis and chronic anterior uveitis who is unable to take DMARDs and has tried TNF inhibitors and IL-17 inhibitors but has ongoing bilateral anterior uveitis?
Psoriasis is so common that it is possible that this is a chance association, but published studies do support the likelihood that there is a causal association between psoriasis and uveitis and a much stronger association between psoriatic arthritis and uveitis. The choice of therapy depends to a g...
In eyes with chronic DME despite frequent anti-VEGF, what is your threshold to add or switch to intravitreal steroid therapy?
I’m quick to add steroids to anti-VEGF treatment. If there is little to no response to 3 anti-VEGF injections, adding a dexamethasone implant (Ozurdex) can help a lot. I will usually do that before switching in class. I usually switch to a different anti-VEGF if there is good but incomplete response...
How does a history of malignant glaucoma in one eye influence your surgical approach to the fellow eye, particularly regarding prophylactic/intra-operative measures (i.e., iridotomy, IZH)?
Although this is not a common occurrence, a history of malignant glaucoma in one eye will affect my surgical planning in the fellow eye. I have performed a prophylactic IZH in the fellow eye during cataract surgery. Additionally, I make sure that when appropriate, all fellow eyes have received a las...
What surgical strategies do you recommend for managing isolated skew deviation after stroke?
Skew deviation is a tough matter to diagnose and treat, but as a general fact the most cases of skew deviations occur along with an acute stroke or as a consequence of demyelinating disorders. Thankfully, most of them tend to disappear after a few weeks and rarely require treatment. Between the chro...