Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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...
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?
Reason for the suprachoroidal hemorrhage, size, duration, nature of the retinal detachment, and other coexisting conditions are some factors to consider. A therapeutic level of coumadin, use of antiplatelet medications are fine; clearly a greatly elevated INR is a contraindication. Some surgeons mig...
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 ...
How has using a chandelier for scleral buckling impacted your teaching or surgical outcomes?
Chandelier buckles are valuable in teaching primary scleral buckle to fellows early in their training, but do not offer significant benefits beyond this application. The reason is that management of the chandelier itself (in the eye for marking breaks and cryo, out of the eye for placement of the ba...
In patients with preexisting vitreous prolapse undergoing glaucoma drainage implant surgery, what is the optimal surgical timing for performing an anterior vitrectomy to minimize complications and ensure successful tube placement?
Prior to tube insertion.
When do you decide to proceed with cataract or glaucoma surgery in patients with non-quiescent herpetic stromal keratitis?
Cataract surgery should wait until quiescent for at least 3 months. Glaucoma surgery, if emergent, may be unavoidable, but that has to be decided on a case-by-case basis.
In light of the voluntary recall of the Bausch & Lomb enVista IOL, what has been your experience regarding patient satisfaction and visual outcomes with other monofocal IOL options?
Excellent results with the PanOptic IOL and even better with the PanOptics Pro.