Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What do you feel are some of the advantages and disadvantages of dropless cataract surgery and what are your preferred agents?
A clear advantage of dropless surgery is that the patient no longer needs to use post-op drops. This may not necessarily present as an advantage to the surgeon, as any additional techniques will add time and cost to the cataract surgery, especially if a particular technique is not covered by insuran...
For patients with xanthelasma, aside from a lipid panel, do you perform any additional lab workup or send referrals?
Agree that recurrence is common, but there are no data that a high cholesterol or increased serum lipid is associated with them.
Do you re-load with monthly doses when switching a patient with DME from aflibercept to faricimab, or do you transition directly to a treat-and-extend schedule?
When I switch from one anti-VEGF agent to another, I start with the same treatment interval I was using with the previous agent, so I can assess the comparative efficacy of the two agents. Once I have determined the new agent is more effective, I proceed immediately to a treat-and-extend dosing regi...
Are there clinical situations where you would advise removal of the LASIK flap and how do you determine if it is clinically necessary?
I had a patient who had recurrent and persistent epi ingrowth into the flap interface, and eventually all of that epi ingrowth caused the flap to sectorally melt. I decided to amputate the flap and let the interface just grow over with epithelium. Surprisingly, the patient did quite well and, once h...
How do you manage a twice-recurrent mucinous adenocarcinoma of the lower eyelid with direct involvement of the lateral rectus muscle and lacrimal duct?
These are difficult cases. In the past, I have successfully treated a couple of these tumors with neoadjuvant immunotherapy, which allows for reduction in tumor volume to allow for an eye-sparing surgery. Because the orbit is involved, radiation should not be given due to the profound complications ...
How would you manage a patient who develops a 1 mm abscess at the internal os of the paracentesis tract following an AC tap after an Izervay injection with eye pain but no vitreous cell or retinal involvement?
It sounds like a very specific question! Never having seen a paracentesis ulcer after 30 years of surgeries with paracenteses from iris hooks, and >10s of thousands of injections (albeit mostly without paracenteses), I'd have to say this is rarer than endophthalmitis. Treat it like a corneal ulcer. ...
When is the ideal time for cataract surgery in a patient with visually significant cataract just beginning anti-VEGF treatment for DME?
There are several important factors in the optimal timing of cataract extraction in patients receiving anti-vascular endothelial growth factor intravitreal injections (IVI) for diabetic macular edema (DME), including the severity of diabetic retinopathy, amount of macular edema, and extent of catara...
How do you optimize retinopathy screening schedules for patients on hydroxychloroquine while also prioritizing cost-effectiveness?
I'll approach this from the cost-effectiveness standpoint as I agree with Drs. @Dr. First Last and @Dr. First Last on their excellent points.Patients with SLE have remarkably high costs when you add up copays, medications, imaging studies, travel, missing work, etc. Anything we can do to help reduce...
Is there benefit for anterior chamber washouts for the treatment of infectious keratitis extending into the anterior chamber and when do you consider utilizing it?
When it comes to corneal infections, there is no evidence that an 'anterior chamber washout' and putting antibiotics in the AC does anything. In ophthalmology, we can 'carpet bomb' the cornea with antibiotics. Fungal infections and acanthamoeba are much harder to treat, but still not clear than doin...
What is the role of bilateral same-day cataract surgery in your practice?
Like many things in medicine, sometimes there are mental hurdles to jump over that are more challenging than operational or evidence-based hurdles. We perform many invasive procedures, bilateral same day: laser vision correction, intravitreal injections, phakic IOLs, etc. Yet many of us, myself incl...