Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What strategies do you use to optimize cataract surgery outcomes in patients with anterior basement membrane dystrophy (ABMD)?
For the preoperative period, surface dryness should be well controlled; usually, artificial tears, punctal plugs, and Restasis are enough. Then, if the topography shows central irregular reading, I usually prefer to remove the epithelium and let it heal for a month before considering cataract surger...
Have you found a successful treatment option for fixed Descemet's folds following prolonged hypotony (after hypotony has been treated/resolved) or Descemet's striae from a surgical incision?
These are difficult situations. The best success I have had is doing DSEKs and suturing the graft in 4 quadrants with 10-0 nylon to prevent detachment. It takes longer to clear but prevents detachment, and the sutures can be removed once the edema is clear. The lifespan of these transplants is inher...
What has been your experience using Dextenza for postoperative inflammation and pain control?
Dextenza has been an extremely useful tool for reducing the postoperative eyedrop burden in managing inflammation after cataract surgery. I typically reserve Dextenza for patients who may have difficulty adhering to a topical drop regimen. This may include those with limited dexterity, cognitive im...
In your experience, what factors prompt you to switch a patient with diabetic macular edema to Eylea HD?
In my practice, it isn’t switching to longer acting anti-VEGF, it is the treatment of the peripheral retinal ischemia. I often initially treat CSME with Avastin, but I use an IVFA to evaluate and treat the non-perfused retina with laser. It is the PRP that treats the VEGF production driving the diab...
What is your approach to atropine dosing for myopia in children and when do you consider higher concentrations?
I have little experience with this. From what I understand, it offers inconsistent results at best.
Which patients are good candidates for micropulse CPC?
Micropulse CPC is a suitable option for treating elevated IOP in a number of scenarios: advanced VF loss resulting in a small central or temporal island, intolerant to topical/oral glaucoma meds, poor general health limiting interventional surgery, no social support, and non-compliance.
What supportive care measures do you prioritize to manage or prevent toxicity in patients receiving Dato-DXd?
My supportive care approach is centered around early identification and management of interstitial lung disease (ILD) and mucositis, both of which were observed in the TROPION-Breast01 trial. Twelve patients (3.3%) in the Dato-DXd arm had adjudicated drug-related ILD/pneumonitis. I routinely obtain ...
How do you modify CPC (i.e., parameters, location of probe) in high myopes that may have thin sclera or more posterior ciliary bodies?
I often illuminate the eye to help visualize the ciliary processes. If I am worried about a thin sclera, I may start with a slightly lower energy and titrate up as needed.
What recommendations do you provide to patients who develop ocular side effects with Dupixent?
I would start with over-the-counter artificial tears without preservative and then refer to an ophthalmologist, ideally a corneal specialist who is experienced in the nuances of treating this condition. I have also had success switching from Dupixent to Adbry, although JAK inhibitors are a better o...
What is the role of femtosecond laser–assisted techniques in pediatric cataracts?
Theoretically, FLACS would be a great tool for pediatric cataracts because the anterior capsule in children is elastic and can be quite unpredictable, making the capsulorhexis step one of the most challenging in the procedure. FLACS would potentially minimize the complication rate in this step. Pati...