Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach the management of recurrent episcleritis in a patient with RA that is otherwise well-controlled?
The episclera lies on top of the sclera. The majority of patients with episcleritis do not have a systemic disease, although patients with rheumatoid arthritis are more prone to develop episcleritis. Episcleritis must be distinguished from scleritis, which is also associated with rheumatoid arthrit...
Would you consider using a JAK inhibitor for a patient with RA associated scleritis?
Yes, I have used it before with success when with limited options. I recommend speaking to the MSL from one of the JAKi developers and they can provide the data to make an informed decision or to appeal to insurance if denied.
Does a low serofast RPR titer (such as 1:1 or 1:2) in the setting of a remote history of appropriately treated latent syphilis in a patient with now uveitis of yet unknown etiology referred from ophthalmology for possible ocular syphilis make a diagnosis of ocular syphilis less likely?
I err on the side of offering empiric treatment. As syphilis rates have risen over the past 20 years, so has the incidence of syphilitic uveitis (Mir et al., PMID 37991790), and the question posed, therefore, represents a not uncommonly encountered conundrum for infectious disease consultants. Syphi...
When should methotrexate injections be initiated for proliferative vitreoretinopathy?
This is an excellent question with a nuanced answer. Currently, we lack substantial Level 1 evidence to guide precise treatment strategies for off-label use of methotrexate (MTX) in the treatment or proliferative vitreoretinopathy (PVR). Based on animal and human clinical retrospective studies, the ...
What alternative treatments are available for refractory filamentary keratitis in a patient for whom bandage contact lenses provide the only relief and who has failed cyclosporine and N-acetylcysteine drops?
Need to figure out what other eye issues exist that are related to this. Are there lid problems such as various lid malpositions, collagen vascular disease, systemic disease, or medication side effects? Then treat accordingly.
How do you determine the most appropriate intraocular lens choice for children/teens based on age and developmental stage?
By intraocular lens (IOL) choice, I presume that you are asking mostly about choosing the appropriate power of the implant in the child who is growing. I now try to personalize that choice for each child. We developed a formula that can predict the future globe axial length of an individual eye usin...
What factors guide the decision to proceed with trabeculectomy in a patient with advanced glaucoma who retains good central vision?
You have to ask yourself, what is your IOP goal? What is the superior conjunctival status? What is your experience with trabeculotomy surgery? Axial myopia or hyperopia, age, and race of the patient will all affect the outcome of the filtration procedure. If your IOP goal is single digits, trab with...
When should surgical resection be considered for vasoproliferative tumors?
Ideally, vasoproliferative tumors should be treated when they are small and receptive to local treatment. This prevents them from growing and proliferating to the point where surgical resection might need to be considered. Tumors can usually be controlled when they are small using direct thermal las...
What factors guide the choice between early versus delayed vitrectomy after an open globe injury?
The vitrectomy should be performed as early as possible in the presence of endophthalmitis or a posterior segment IOFB. The timing of retinal detachment repair (RDR) after open globe injury is controversial. The biggest risk of delaying RDR is the progressive development of proliferative vitreoretin...
How do you decide between escalating treatment with additional IOP-lowering medications versus surgical options for patients with normal tension glaucoma and progressive visual field loss despite well-controlled IOP?
Consider the number of drops the patient needs to control their IOP. Are there any local side effects other than allergy—tearing, redness, dry eye, etc.? All of these can affect compliance and efficacy. A patient using more than two bottles of eyedrops is most likely going to be poorly controlled ov...