Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What are the pros and cons of Multifocal IOLs vs. EDOF IOLs?
Multifocal IOLs provide excellent near, intermediate, and distance vision with high spectacle independence, making them attractive for patients who prioritize reading and near tasks, but they achieve this via light-splitting diffractive optics that reduce contrast sensitivity and can cause significa...
What factors do you take into consideration when deciding between enucleation and evisceration?
Almost always I perform an eviceration unless there’s a suspected or known tumor. Endophthalomitis is variable. If at surgery there’s no posterior involvement I’ll still do an eviceration. Typically most endophthalmitis has been aggressively treated and gives one the option of doing the procedure wi...
What is the most appropriate next step for a patient experiencing prolonged hypotony following Ahmed glaucoma valve implantation and unsuccessful medical management?
To reduce aqueous flow through the tube, a less invasive approach involves occluding the tube lumen using a 2-0 or 3-0 Prolene suture via an ab interno technique. For complete occlusion, a Supramid suture may be used instead of Prolene. The ab interno approach minimizes conjunctival disruption. Alte...
In quiescent patients with history of herpetic keratouveitis with uncontrolled IOP on topicals, do you prescribe PGAs?
The evidence on prostaglandin analogues (PGAs) in the setting of herpetic anterior uveitis is nuanced. Traditionally, we have been taught to avoid PGAs in the setting of herpetic disease, given the theoretical concerns that these drugs could compromise the host's interferon defense system. But, more...
How do you approach a patient with idiopathic anterior uveitis who has ongoing disease despite adalimumab every two weeks?
This is a style question, I think. I thought it would be useful to note the choice here might depend on testing for anti-adalimumab antibodies as there is some suggestion that changing to once weekly adalimumab in the presence of anti-adalimumab antibodies might not be efficacious. (Ismayilova et al...
What operative techniques do you use to minimize the risk of postoperative ectropion in a patient with pre-existing lower eyelid laxity undergoing lower eyelid blepharoplasty?
I favor a transconjunctival approach for the fat excision or transposition, combined with either pinch skin excision or CO2 laser resurfacing, and horizontal tightening either by canthopexy (in milder laxity patients) or a full tarsal strip procedure in severe laxity or frankly ectropic patients.
How do you decide when to give or defer intracameral antibiotics for endophthalmitis prophylaxis during routine cataract surgery?
I give intracameral antibiotics at the conclusion of all my cataract surgeries, and this practice is heavily supported by evidence.In particular, I use non-diluted moxifloxacin 0.05-0.1 cc, from a Vigamox brand bottle or a bottle of generic moxifloxacin from a few select manufacturers that are known...
How often do you recommend ophthalmologic screening exams for patients with sarcoidosis?
The American Academy of Ophthalmology has guidelines for routine eye exams for an asymptomatic, healthy individual (not someone with sarcoidosis). These guidelines include a complete, dilated eye exam at age 40, interim exams at the discretion of the patient and one's ophthalmologist, and an exam ev...
How do you differentiate between macular schisis vs. macular edema vs. optically empty spaces (from macular telangiectasia) on OCT?
When trying to differentiate between these identities, I begin by looking at the morphology of the intraretinal fluid-filled spaces on OCT imaging. The cystoid spaces in macular edema caused by vascular leakage or medications (e.g., niacin) are typically round in shape and increase in size toward th...
How do you approach treatment of eyelid sarcoma?
I have not personally treated eyelid sarcoma but have treated SCC and adenexal carcinoma both definitively and in adjuvant settings. I have used 60 and 66 Gy in 2 Gy per fraction for adjuvant and definitive patients, respectively, with electrons using appropriate eye shielding.