Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Have you experienced any significant refractive regression years after the final lock-in for light adjustable lenses?
We have patients 18-24 months out. And the vast majority has no change in Mrx. No more than you would have with a multifocal or any other lens.
What is your preferred method of secondary IOL placement (Yamane vs. scleral sutured) and why?
I think the real answer here depends on what is most reliable and repeatable in your hands. When I started years ago, like many retina surgeons then, all I did for secondary IOLs was an ACIOL. Easy, quick, and with few things that could go wrong (but not zero!). For a variety of reasons, I learned t...
Do you feel there are medical advantages to FLACS and if so, what are they and how often are you offering FLACS to patients?
That's a question that's sure to trigger contentious responses!Personally, I think the capability of making toric marks on the cornea or lens capsule to line up toric lenses (and using iris registration to do so), as well as the ability to do LRIs, does offer some advantage for accuracy in astigmati...
In eyes with chronic DME despite frequent anti-VEGF, what is your threshold to add or switch to intravitreal steroid therapy?
I’m quick to add steroids to anti-VEGF treatment. If there is little to no response to 3 anti-VEGF injections, adding a dexamethasone implant (Ozurdex) can help a lot. I will usually do that before switching in class. I usually switch to a different anti-VEGF if there is good but incomplete response...
How does a history of malignant glaucoma in one eye influence your surgical approach to the fellow eye, particularly regarding prophylactic/intra-operative measures (i.e., iridotomy, IZH)?
Although this is not a common occurrence, a history of malignant glaucoma in one eye will affect my surgical planning in the fellow eye. I have performed a prophylactic IZH in the fellow eye during cataract surgery. Additionally, I make sure that when appropriate, all fellow eyes have received a las...
What surgical strategies do you recommend for managing isolated skew deviation after stroke?
Skew deviation is a tough matter to diagnose and treat, but as a general fact the most cases of skew deviations occur along with an acute stroke or as a consequence of demyelinating disorders. Thankfully, most of them tend to disappear after a few weeks and rarely require treatment. Between the chro...
How important are retinal fluid fluctuations for long-term vision and how do you factor them in when making treatment decisions for conditions like nAMD and DME?
I think the question has been asked in a different form here. As I have commented on Mednet previously, it depends on a lot of factors, primarily: Are you treating the OCT or the patient? I'd also say the answer is very different for nARMD (or any CNVM) DME or edema from RVO. People: this is not a o...
How do you decide the best way to treat glaucoma in patients with ICE syndrome given their higher risk of surgical failure and corneal complications?
In general, patients with ICE syndrome have unilateral refractory disease that often requires surgical management. MIGS procedures are not typically effective given the angle anatomy and progressive nature of the disease, and I usually perform tube shunt surgery in these cases. Placing the tube deep...
In cases of failed endothelial keratoplasty with concurrent cataract, do you favor repeat keratoplasty plus lens extraction in the same setting or sequential surgeries?
I tend to favor combining the two into one surgery. If the view is not clear enough or the patient is interested in a more accurate refractive outcome, the surgery can, of course, be staged with the endothelial keratoplasty first, followed by cataract surgery about 3 months or so later. With the use...
For patients with evidence of prior bilateral uveitis (PS, pupillary membranes, inactive KP, no view posteriorly) who reports no prior symptoms and who has had negative lab work-up, when do you consider repeat work-up and which labs would you repeat?
This is a difficult question to answer succinctly, as so much information is missing to provide a complete response. However, it does raise some important points that are worth mentioning:There is a prevailing tenet, which I was taught as a resident and hear often from residents today, that 1st epis...