Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Which method do you prefer to assess for stigmata of old optic neuropathy?
If I'm not convinced based on my history and exam, I will typically refer to ophthalmology and at our institution, they tend to gravitate towards OCT rather than VEPs. There are a number of findings on examination to complement the history, including afferent pupillary response to light, errors on i...
Would you consider utilizing a TNF-inhibitor in a patient with RA/SLE overlap who has already tried methotrexate, hydroxychloroquine, and abatacept?
I would not hesitate to use a TNFi in this situation. For my rationale, see a previous post I answered with a similar question that includes the references for my answer: https://www.themednet.org/question/16121. However, as others have answered in this post, alternatives should also be considered.I...
What is your approach to the workup for an underlying systemic condition in a patient presenting with retinal vasculitis?
Retinal vasculitis is a frequently misunderstood condition. My colleagues and I have written about it on several occasions such as in Current Opinion in Rheumatology, 2016. Retinal vasculitis is often diagnosed by an ophthalmologist on the basis of vascular leakage in a test called a fluorescein ang...
How do you manage occlusive bilateral retinal vasculitis with isolated lupus anticoagulant positivity?
Although I consider myself an expert on retinal vasculitis, I would often solicit help from a physician with expertise in coagulation, especially if that expertise is related specifically to the lupus anticoagulant. A tremendous part of the treatment strategy depends on the location and severity of ...
Is thyrotropin receptor antibody a good biomarker to predict development of thyroid eye disease?
Patients with thyroid eye disease usually have positive TRAb or TSI but in patients with Graves' hyperthyroidism it does not help predict the development of eye disease which is much less common than hyperthyroidism.
Is it safe to use quinacrine in SLE patients with a history of hydroxychloroquine-associated retinopathy?
To my knowledge, quinacrine, an anti-malarial, is not FDA-approved for use in the US. It may be obtained from compounding pharmacies but the FDA makes no assertions regarding either its safety or its efficacy. For lupus, it has been used primarily as adjunctive therapy for cutaneous disease, e.g. ad...
What is the risk of uveitis flare in patients with JIA and uveitis, who are in remission, when tapering medications?
The ADJUST Trial is in progress and is trying to answer precisely this question for those currently receiving adalimumab. I am not aware currently of a large database to provide a reliable answer to this question. My approach is to require no evidence for active uveitis for at least 12 months, and t...
What would be your approach to a patient with Scleroderma/Myositis overlap syndrome (+anti-Ku) and active inflammatory eye disease despite high dose mycophenolate?
This is a challenging question but impossible to answer without more information. Inflammatory eye disease includes uveitis, scleritis, corneal melt, and orbital inflammation. Just as scleroderma itself has a range of manifestations that drive the treatment, the various eye inflammations would requi...
How do you approach the use of hydroxychloroquine in patients with a history of visual field defect from another cause such as macular degeneration or diabetic retinopathy?
As Dr. @Dr. First Last noted, close collaboration with an ophthalmologist is critical, as the findings of HCQ-toxicity on advanced imaging with modalities such as an OCT can often be distinguished from other causes, and hence there is not an absolute contraindication in most cases. A few considerati...
Do you routinely obtain baseline vascular imaging (CTA, MRA, PET) in patients with suspected GCA, but negative temporal artery biopsy?
Vascular imaging is particularly helpful in patients with large vessel giant cell arteritis. This patient subset may present with persistent constitutional symptoms, refractory polymyalgia rheumatica, fever of unknown origin, or with vascular signs/symptoms (for example arm claudication). These pati...