Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Is there any role for topical corticosteroids in the treatment of photokeratitis?
Typically not, as this is not an inflammatory condition. The goal is to provide supportive care with aggressive lubrication and pain control with topical cycloplegics until epithelial regeneration occurs.
Do you stop netarsudil or brimonidine for patients with very injected conjunctiva prior to trabeculectomy, and what do you feel is the benefit?
I find Rhopressa helpful in lowering IOP pre-op surgery, but it can cause inflamed conjunctiva, so I stop 1 week prior to surgery and prefer brimonidine 0.15% (Alphagan P), and it may have neuroprotective value as well.
How would you approach a patient with vitreoretinal lymphoma without CNS or systemic involvement?
The optimal treatment approach for primary intraocular lymphoma is debated. This is a rare disease with only small retrospective series guiding therapy. There is no clear superior treatment approach in the literature. In clinical practice, younger patients are often treated initially with high-dose ...
What has been your experience both intra-op and post-op with different non-valved implants (Baerveldt vs. Clearpath)?
In general, all 3 non-valved implant styles available in the US (Baerveldt, Clearpath, and Molteno) work quite similarly, and utilize similar techniques regarding ligation, tube modifications to create early flow anterior to the capsule, and postoperative course. The Molteno implants are slightly na...
Would you recommend observation or laser retinopexy in a young myope with asymptomatic lattice degeneration with retinal holes within lattice in each eye?
This is a difficult question to answer. I take into consideration many factors such as: activity/sports, family history of RDs, genetic results, location of lattice and traction around lattice, can they see me every 6 months, can they be imaged easily, disability, etc. It’s a discussion to have with...
In patients with myopic traction maculopathy, what clinical and imaging thresholds prompt you to intervene surgically rather than continue observation?
Given the risk of surgery, I typically follow patients conservatively as long as they feel the involved eye (when the other eye is covered) has visual function sufficient for important daily visual tasks such as reading, driving, working, etc. Many eyes continue to have functional vision even with v...
How do you utilize Diamox in patients with cerebral venous sinus thrombosis and vision symptoms who do not undergo thrombectomy/recanalization?
Diamox (acetazolamide) is often used to treat papilledema with associated visual loss in cases of CVST. While there is a theoretical risk of dehydration from acetazolamide with potential worsening of the thrombosis, 1) acetazolamide is a weak diuretic and 2) the risk of blinding visual loss usually ...
How do visual outcomes differ among scleral lenses, refractive surgery, and phakic IOLs in keratoconus patients with irregular astigmatism following cross-linking?
These are three distinct avenues of treatment for KC. The visual disability in keratoconus is secondary to perturbation of the corneal optics. This manifests itself in changes in sphere, cylinder, and optical aberrations. Scleral contact lenses, for the most part, correct all three and often give ex...
How do you approach cases of transient monocular vision loss when initial carotid imaging and cardiac workup are unrevealing?
As you eluded, it is essential to rule out amaurosis fugax in a case of TMVL, and carotid Doppler and cardiac echo are two essential tests to evaluate the two potential sources of embolization in this setting. I would also recommend an MRI of the brain (to check for possible evidence of other ischem...
In patients with progressive AZOOR who demonstrate enlarging zones of outer retinal loss despite corticosteroid therapy, how do you determine when to escalate to steroid-sparing immunomodulatory agents?
We should first be sure this is not a "masquerade" syndrome such as vitreoretinal lymphoma, infectious uveitis, or IRD. If these are considered unlikely, then at this point in the course, where there is documented progression of a presumed inflammatory process, systemic IMT should be considered. Som...