Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?
The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward. There are ...
In phacomorphic glaucoma with limited view, how do you approach surgical management (i.e., staged or combined surgery, temporize with LPI)?
In true phacomorphic glaucoma, the definitive treatment is cataract extraction. I first focus on medically lowering the IOP, and if the cornea is hazy, I do everything possible to clear it to obtain a safe surgical view. If the view remains limited, I’m comfortable using the biometry from the fellow...
How do you balance empiric therapy and diagnostic testing in severe pediatric conjunctivitis presentations?
It depends on the meaning of "severe pediatric conjunctivitis." There are 3 main types of pediatric conjunctivitis that being bacterial, viral, and allergic. Viral needs to be broken down into viral and herpes viral, in the way they are treated. For routine pediatric conjunctivitis, which does not i...
How should Dato-DXd be managed in the absence of necessary resources for ocular exams and referrals?
We typically send patients for baseline slit-lamp exams prior to the start of Dato-DXd. If these resources are not available, telemedicine with slit-lamp biomicroscopic photography, as well as community screening resources, can be considered. Patients should still be educated on symptoms that would ...
When do you consider performing laser refractive surgery on corneal transplants?
This can be somewhat dependent on the tools you have available. In general, if the astigmatism is regular after a corneal transplant, depending on the corneal thickness and overall refractive error, you can consider photorefractive keratectomy in a transplantation patient. If the astigmatism is irre...
In patients with early Fuchs’ endothelial dystrophy, how do you determine whether to proceed with cataract surgery alone versus a combined endothelial keratoplasty?
If Corneal thickness is >640 or specular microscopy is lower than 1,000, those are indicative of poor outcome after cataract surgery and patients may benefit from combined procedure. However, some patients with Fuchs can be misleading as having a low corneal thickness but a dense central guttae that...
In patients with corneal edema and a glaucoma drainage tube placed in the AC, under what circumstances would you consider repositioning the tube in the sulcus first versus proceeding directly with endothelial keratoplasty alone?
I have a pretty low threshold to just move these tubes to the sulcus as soon as my cornea colleagues are contemplating an EK. I am not a cornea specialist, but my impression is that first grafts almost always do better than second grafts, so I want to give that first one the best chance of survival....
What has been your experience using sutureless Müller’s Muscle-Conjunctival Resection (MMCR) for ptosis repair?
Personally, I get the desire to be less interventional, but if you are going to do this and it is 'less aggressive' than a levator resection, just put in a suture; it is not so hard.
Which IOL do you prefer for patients with a history of hyperopic LASIK to minimize the risk of inducing spherical aberration?
I prefer an IOL without any induced spherical aberration, such as the enVista monofocal, in my post-hyperopic LASIK patients. Other standard monofocal lenses (such as clareon monofocal, J&J monofocal, etc.) have a built-in negative spherical aberration that is intended to offset the standard positiv...
How do you determine whether to switch to a different anti-VEGF agent or to Ozurdex after a patient with diabetic macular edema fails a series of Avastin?
For my practice, macular oedema (CSME) is based on three factors. Ischemia, inflammation, and traction: the three factors which lead to persistent oedema. IVFA will show the level of non-perfusion in the far periphery, which is a major producer of VEGF, and laser (PRP) is the treatment. IV anti-VEGF...