Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Is it safe to continue azathioprine in a patient with severe bilateral panuveitis (thought to be related to sarcoidosis) and benign ethnic neutropenia, given worsening neutropenia since starting the medication, or should an alternative immunosuppressive agent be considered?
In this case, I would consider stopping azathioprine and switching to an alternative medication, such as an anti-TNF agent. Although not a large drop in the PMN, azathioprine is known to cause leukopenia, and in a patient with known neutropenia, extra precaution should be taken. In the case of uveit...
What baseline visual testing, if any, do you recommend at diagnosis for patients with multiple sclerosis who deny visual complaints?
I do a baseline eye exam with visual acuity, OCT RNFL, and fundus photos yearly. If I see any abnormalities, then I might consider a repeat exam in six months. If all is normal and there's no history of optic neuritis, I do yearly appointments. If they are on DMTs that have eye side effects, then I ...
How do you manage macular-threatening toxoplasma chorioretinitis in pregnancy?
When contemplating treatment in a pregnant woman, it's always advisable to coordinate care with the managing OB/GYN to ensure the health of both the mother and the fetus. One could consider a treatment course of clindamycin for toxoplasma chorioretinitis, administered systemically with oral pills or...
How do you decide which secondary IOL to place in an aphakic eye?
I am a fan of scleral fixated IOLs as they can be inserted through a smaller corneal incision than ACIOLs, they present less risk when it comes to corneal decompensation and glaucoma, and have predictable refractive outcomes. I personally use a modified needle-assisted Yamane technique for my second...
When should amblyopia treatment be initiated in patients being treated for retinoblastoma?
There is decent data (small numbers) that amblyopia therapy is beneficial in RB patients, even those with macular/foveal involvement if this is unilateral. The timing for initiation is not clear, however. Treatment initiation is probably most effective once tumor burden is under control enough to ha...
What dose would you use for a plaque brachytherapy for a melanoma involving the iris?
The following isotopes have been used for radioactive plaque therapy to treat choroidal melanomas: 125I, 103Pd, and 131Cs as low-energy seeds, and 106Ru as β emitter. The dose used for uveal melanomas is between 80-90Gy with most studies reporting doses ~85 Shields et al., PMID 10980767. In this lar...
How should diabetic retinopathy surveillance be adjusted for patients starting GLP-1 agonists?
As with traditional anti-hyperglycemic medications, GLP-1 agonists may cause transient worsening of diabetic retinopathy due to the initial rapid control of blood glucose. Therefore, if a patient has existing retinopathy and is about to start GLP-1 agonist therapy, I recommend closer monitoring. For...
How do you determine the timing of surgical intervention for traumatic cataracts in children?
When it is visually significant or blocking the view to the posterior pole.
How do you manage a twice-recurrent mucinous adenocarcinoma of the lower eyelid with direct involvement of the lateral rectus muscle and lacrimal duct?
These are difficult cases. In the past, I have successfully treated a couple of these tumors with neoadjuvant immunotherapy, which allows for reduction in tumor volume to allow for an eye-sparing surgery. Because the orbit is involved, radiation should not be given due to the profound complications ...
What factors guide the decision to treat with ROP laser treatment versus a repeat anti-VEGF injection in a child who has previously received anti-VEGF therapy for retinopathy of prematurity (ROP)?
In patients who have a recurrence of stage 3 neovascular ROP following anti-VEGF injection, I will typically perform laser unless the patient is systemically unstable and cannot tolerate sedation or anesthesia, or unless the patient still has very posterior disease (zone 1 or posterior zone 2). In p...