Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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 approach management of GLP-1 receptor agonist therapy in patients who develop NAION?
Short answer is I recommend stopping the GLP-1 agonist if one eye has already developed NAION, for the sake of protecting the fellow eye. The fact is, our knowledge is still growing in this matter. While some studies indicate links between GLP-1 agonists and NAION, there are so many discussions arou...
How do you approach cataract surgery in a patient with a history of radial keratotomy (RK) who desires postoperative independence from glasses?
Carefully. I would say I'm abrupt and dispel the notion they will be spectacle independent at all, given they are not candidates for MTF lenses and, even EDoF lenses, would have issues of aberrations in the visual system caused by the RK incisions. I literally hang the "black drape." That sort of sh...
In what cases do you consider mannitol for cataract surgery?
I have found IV mannitol VERY helpful for dehydrating vitreous for short axial length, especially around 20.5 or less. Otherwise, in short eyes, there is less working space and a greater tendency for the iris to want to prolapse out, even in the absence of typical IFIS-type medications. I’ve typical...
How do you counsel patients with GCA on the benefits of steroids who have already experienced vision loss?
I first tell the patient they are at considerable risk for further visual loss in the same eye or the other eye over the next 1-2 weeks. I also let them know that, even though their risk of visual loss has been reduced, their best option for preventing further visual loss is immediately starting hig...
How do you approach cases of zonular dehisence/weakness noticed intra-op?
For dehiscence of less than 90 degrees, placing CTR seems the safest and easiest way. Published studies suggest CTR use in zonular dialysis or weak zonules can improve postoperative visual or refractive outcomes in many cases. For 180 degrees of zonular loss, I try to preserve the anatomy if possibl...
When do you consider initiating zoster prophylaxis in patients?
I do this when more than one episode of keratitis or uveitis per year; If a planned surgery, would start treatment doses one week before surgery and for 14 days after. Nothing worse than reactivation of zoster.
Should teprotumumab be used in patients with active, moderate Graves thyroid eye disease in the absence of proptosis?
Teprotumumab is NOT a benign therapy with multiple serious side effects and complications. In the setting of acute TED with significant disease, it has a place. For the average patient, there are multiple other treatments and other Biologics with fewer complications.
What are some methods to deal with IOP elevations with intravitreal injections in a patient without glaucomatous damage that does not want to have AC taps with each injection?
In this situation, depending on the elevated IOP, use the standard medical approach: Iopidine1%, Cosopt, Alphagan 0.2%, and in some cases, Diamox 250 mg. Wait for half an hour and repeat if necessary, or send the patient home with one or more drugs. Of course, make sure of drug selective contraindic...
In extensive basal cell carcinoma involving both upper and lower eyelids and the lacrimal gland, is radiotherapy poorly tolerated (especially to doses up to 50-60 Gy) and/or is orbital exenteration preferred?
For advanced basal cell carcinoma with orbital invasion, I would treat with hedgehog inhibitors. If there is an inadequate clinical response, exenteration is usually recommended. Radiation is not particularly effective for BCC and can have significant ocular side effects.