Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Given concerns about cooperation, anesthesia, and predictability, under what circumstances do you use adjustable sutures in pediatric strabismus surgery?
With only a few exceptions, I usually do adjustable sutures for patients with double vision (a little older, able to report diplopia well, and when diplopia makes sense and they fuse with prisms in the clinic) or unusual strabismus, where results might be less predictable, and I want to avoid any un...
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.
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?
I don't think you can predict which patients are most likely to have a positive response, unfortunately. I think Stage 1 or early Stage 2 neurotrophic ulcers are the best scenarios to use this treatment.
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 eyes with lamellar macular holes, what clinical or OCT features push you toward recommending surgery versus continued observation?
Most published papers and my personal surgical experience suggest that surgery on eyes with a lamellar hole alone (i.e., without a significant associated ERM) RARELY yields visual improvement. For this reason, I generally discuss the surgical option only in patients with progressive expansion of lam...
How has your use of SLT changed given the 6-year results of the LiGHT trial?
I offer primary SLT to almost all of my treatment-naive patients with OHTN or POAG, and most patients with mild-moderate disease who have never received SLT. I counsel patients that with primary SLT, they are less likely to show disease progression at 6 years and less likely to require incisional gl...