Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How would you approach a patient who is unable to undergo the recommended ophthalmologic examinations during treatment with mirvetuximab soravtansine?
Until more data are available regarding the ocular safety and reviewed by the agency, I follow the recommendations. I feel there is a decent chance real-world experience may change this but officially I follow the recommendations as stated. Having said this, the testing recommended (“Conduct an opht...
What work-up do you recommend for optic nerve edema in a patient who is immunocompromised?
Symptoms (is visual loss present or not?) and time of onset/pace help to direct the workup. For unilateral optic nerve edema with vision loss, optic neuritis and NAION are always high on the differential. In immunocompromised patients, an infectious cause such as herpes zoster, syphilis, TB, and art...
What is your approach to using multifocal or extended depth of focus IOLs in patients with preperimetric glaucoma?
As a glaucoma specialist, my approach may be viewed as more conservative. I completely avoid multifocal lenses in anyone with glaucoma and am very hesitant to recommend EDOF lenses unless there is a compelling argument in favor (patient wants to maximize spectacle independence for distance and inter...
When would you consider using selective laser trabeculoplasty (SLT) for managing uveitic glaucoma?
Definitely not during an active flare. Only if completely quiet for at least 6 months off of steroids, with no history of recurrence. For those with a history of recurrence, needs to be quiet of at least 5 years off of steroids. It is useful to determine whether pressure elevation is a result of tr...
Does using a heads-up display for surgery improve ergonomics and surgical performance compared to a traditional microscope, or does the need to alternate between views reduce its long-term usability?
Disclaimer: I have only tried it in lab/demo sessions. The display is off to the side, which is NOT ergonomic. Then, there is the nearly imperceptible time lag, which I am told I am imagining. Finally, there is the ever-present hardware and especially software reliability problem. Even a relatively ...
What factors should be considered when deciding the best timing for choroidal drainage in a monocular patient with a suprachoroidal hemorrhage and a concurrent retinal detachment?
In these cases, the most important and sometimes most difficult thing is determining whether the retinal detachment is exudative or rhegmatogenous. This will affect the decision-making process regarding when to operate. If it's rhegmatogenous, you may need to operate sooner than would be optimal for...
What’s your approach to managing postoperative inflammation and CME in high-risk patients after cataract surgery?
As a retinal specialist, I often receive referrals from my cataract surgery colleagues for patients with cystoid macular edema (CME) post-cataract surgery. My initial approach involves topical steroids combined with a topical NSAID. I re-evaluate these patients in two to four weeks to assess for ana...
How do you manage a patient with giant cell arteritis treated with weekly tocilizumab and low dose glucocorticoid who develops sudden vision loss?
Fortunately, this scenario is a rare event, as most patients treated with ongoing tocilizumab (TCZ) and prednisone are at a far lower risk for developing new visual loss due to giant cell arteritis (GCA). A recent paper by Amsler et al., PMID 33752737 reviewing the risk for visual loss in patients b...
What factors influence the decision to initiate anti-VEGF injections to prevent radiation retinopathy after plaque brachytherapy?
A great and timely question! There is increasing evidence, based on several retrospective series, that prophylactic use of anti-VEGF agents (particularly bevacizumab) may provide better visual and structural (avoiding neovascular complications) in post-plaque melanoma patients. This is with injectio...
How often do you monitor asymptomatic atrophic holes and lattice in pediatric patients?
I do it annually unless there’s traction on the hole, in which case I would laser it. When young people have formed vitreous, it’s very, very uncommon for them to detach from an asymptomatic hole. That’s why we see adult patients with scarred holes who never had a laser. The body eventually figures ...