Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What factors influence your decision to use femtosecond laser-assisted cataract surgery in complex cases?
For complex cataracts with patients having shallow anterior chambers, weak zonules (pseudoX), and dense cataract, Femtosecond may be more beneficial than the standard technique in reducing energy and AC manipulation for these cases. However, it would be risky to perform the laser under these complex...
Under what circumstances would CPC be considered the primary intervention for severe glaucoma with preserved central vision?
I would consider CPC as a primary intervention in the following circumstances: old age (>80), no social support, inability to keep appointments, unable to instill glaucoma drops, or intolerance to systemic CAIs. Karanjit
How do you approach the timing of surgical intervention in intermittent exotropia?
If the child alternates fairly well and there is no amblyopia, I monitor the strabismus every six months. There is no urgency to operate in these cases, and multiple measurements of the angle over time are beneficial. The frequency helps with the decision. If the eyes are exotropic more than 40% of ...
How do you decide between performing an ECP versus a MIGS procedure in a patient undergoing cataract surgery?
If a patient would benefit from a concurrent IOP-lowering procedure at the time of cataract surgery, there are many options. Some glaucoma specialists will choose ECP in the setting of angle closure, with the thought that ECP will shrink the ciliary processes and allow more opening of the angle. ECP...
How does CTAK compare to conventional keratoplasty techniques (PK/ALK) in patients with corneal ectasia?
Over the past 10 years, with long-term follow-up, I’ve seen that CTAK grafts remain clear and stable. Additionally, in comparison to conventional keratoplasty, I have not seen any episodes of graft rejection during this time period. In comparison to INTACs, I have not seen any episodes of corneal me...
What guides reoperation versus observation in managing macular folds after retinal detachment surgery?
The decision between reoperation and observation for macular folds after retinal detachment surgery depends on several factors. Is the patient symptomatic? If not, then observation is likely the best decision. Location is also a major consideration. Full-thickness folds involving the fovea generally...
What is your preferred method for suprachoroidal drainage?
Presumably suprachoroidal drainage. For technique, I have previously found this video very helpful: How to drain a choroidal hemorrhage. I prefer to make a paracentesis at the beginning, to make it easier to restore the IOP. I also like to pre-place an AC maintainer. For draining suprachoroidal hemo...
What factors influence your evaluation of surgical candidacy for persistent fetal vasculature, and how do you approach operative management?
I believe all these babies need a very good EUA. First of all, you need to be sure it is not RB and it is not FEVR. By doing this, you make sure the "good" eye is perfect. You need to know the difference in axial length between eyes (Sisk et al., PMID 20619897) because it can help in educating paren...
How do you monitor glaucoma progression in highly myopic patients with unreliable visual fields and atypical RNFL scans?
Monitoring glaucoma in highly myopic eyes with unreliable tests is a well-known challenge. Careful clinical examination of the optic nerve, supported by stereo disc photos, remains essential. Myopic discs are often tilted with shallow cupping, making glaucomatous change easy to miss. However, featur...
How much with-the-rule astigmatism would you intentionally leave in patients under 40 undergoing cataract surgery, considering the expected age-related shift toward against-the-rule astigmatism?
IOL selection and expectations are hugely important in this conversation. Will leave less for a multifocal, and more with a standard IOL. A sharpshooter, I might correct all the cyl with a standard IOL, but with the expectation they will need touch-ups. A good place to start is their topo and their ...