Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What factors guide your decision to test for or start empiric treatment for Acanthamoeba keratitis in cases of corneal ulcers?
I can't say that I've ever started empiric treatment for acanthamoeba keratitis prior to other workup/testing/culture results, although I suppose if you have a slam dunk case with a known acanthamoeba exposure, I would do so. The question of whether to test for AK is far more interesting. New-onset ...
What has been your experience with dSLT?
Overall positive. The procedure is quick and the interface is intuitive. We have to warn the patients that they are going to feel it, and oh man, if you look at the anterior chamber about 20 minutes after the dSLT, you are going to see a lot of cells floating around there. I have been able to perfor...
What criteria do you use to decide the duration of IV steroids in patients with optic neuritis?
This question has long gone unanswered because it is complicated. Short optic nerve segment enhancement (MS):In this situation, I do not routinely recommend steroid treatment. For the optic neuritis of multiple sclerosis, the Optic Neuritis Treatment Trial (Beck and Gal, PMID 18625951) clearly showe...
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...
What factors guide the decision to treat with ROP laser treatment versus a repeat anti-VEGF injection in a child who has previously received anti-VEGF therapy for retinopathy of prematurity (ROP)?
In patients who have a recurrence of stage 3 neovascular ROP following anti-VEGF injection, I will typically perform laser unless the patient is systemically unstable and cannot tolerate sedation or anesthesia, or unless the patient still has very posterior disease (zone 1 or posterior zone 2). In p...
Has the CONDOR trial changed your first-line approach to treatment-naive proliferative diabetic retinopathy in a patient with good visual acuity who is able to attend regular follow-up visits?
No. In the US, we stopped using brolucizumab (Beovu) because of the risk of retinal vasculitis. So I don’t even think I can get that medicine anymore. For those who don’t know about it, CONDOR was a trial that studied the use of Beovu vs. PRP (panretinal photocoagulation) for proliferative diabetic ...
When would you offer neoadjuvant immunotherapy prior to Mohs surgery in a locally advanced squamous cell carcinoma for which clearance may require enucleation?
I would flip this question around and answer that radiotherapy is often a terrific option around the eyes, and it should always be considered in this area, especially when a radical surgical procedure is being entertained. Between en face therapy with a shield (superficial, electrons) and IMRT/VMAT,...
How do you approach the use of Cequa in eyes with severe corneal thinning from a prior, healed corneal ulcer?
The use of Cequa or other cyclosporins has not been associated with an increased risk of thinning. Cequa prescribing information lists no contraindications and reports instillation site pain and conjunctival hyperemia as the main adverse reactions. Corneal thinning, impaired healing, and perforation...
How do you approach a patient who has anterior uveitis and is referred for evaluation of ocular TB with a positive Quantiferon gold (as part of their workup) in countries with low TB incidence?
It is a frustrating problem and is expected to increase without solid evidence. Until then, management should involve an interdisciplinary collaborative approach and a shared decision-making process.I see the following issues. I feel ophthalmologists follow the diagnostic criteria for TB uveitis us...
For patients with Light Adjustable Lenses, what has been your approach regarding YAG capsulotomy timing?
It is best to avoid performing a YAG capsulotomy before or during the light-adjustment period unless the posterior capsule opacification (PCO) is visually significant and functionally limiting. Although the YAG laser itself is safe and effective regardless of its timing relative to lens lock-in, sev...