Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Do you combine anti-VEGF with PDT for polypoidal choroidal vasculopathy upfront or reserve PDT for refractory cases?
Having considered EVEREST, EVEREST II, and PLANET, I tend to start with monthly aflibercept, with a low threshold for applying PDT during the first 3 months, before the vessel complex is too established to undergo regression.In practice, I only uncommonly encounter PCV early in its clinical course; ...
How do you decide whether or not to excise a pterygium prior to cataract surgery?
I'll remove a pterygium prior to cataract surgery if I suspect the pterygium will need removal at some point in the future. This could mean: 1.) I have seen evidence of pterygium progression in the recent past (either physical growth onto the cornea as compared to historical measurements/photos, or ...
How do you counsel patients interested in LAL monovision about the possibility of reduced glasses dependence?
One of the main advantages of the LAL is the ability to fine-tune monovision after surgery, allowing patients to experience and adjust their visual balance between distance and near before final lock-in. I explain that this flexibility greatly increases satisfaction and can significantly reduce glas...
In extremely premature infants born at <25 weeks gestational age, how do you individualize the timing and frequency of ROP screening?
Those extremely premature infants with an unstable clinical course or where the accuracy of GA was uncertain may need to be screened prior to 31 weeks PMA (post-menstrual age).Please see our paper: Souverein et al., PMID 38878959.In this study, among infants <=24 weeks gestational age at birth, we f...
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.
How do you predict which patients are most likely to have a positive response to Oxervate?
Works great for peripheral nerve damage. HSV/VZV, burns, chronic dry eye/sicca/gvhd type patients. For central nerve damage from tumor, stroke, or brain/face surgery never found any benefit.
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.