Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
When should you seek hyperbaric oxygen therapy for patients with CRAO?
I usually pursue hyperbaric oxygen therapy within the 24-hour window from symptom onset for CRAO. This can be performed following TNK if given. In reality, though, there are multiple barriers to achieving this, including: Few centers offer hyperbaric oxygen therapy Labor intensive Difficulty with i...
What specific exam findings or test changes prompt escalation of care when evaluating pediatric patients with optic disc drusen for possible increased intracranial pressure?
Both pediatric and adult patients with optic disc drusen can develop increased intracranial pressure, including IIH, like normal individuals. This is important to remember, especially if the symptoms and risk factors suggest elevated intracranial hypertension. In the pediatric group, especially youn...
What is your approach to audiometric monitoring for patients on teprotumumab and how do you discuss the possibility of irreversible hearing loss with your patients?
I have set up a connection with our institution’s ENT and audiometry service to do a baseline test for any patient who is a candidate for teprotumumab. If the patient already has abnormalities in the high and ultrahigh frequencies, would not proceed to treatment. Would also repeat the test if the pa...
How do you incorporate OCT and OCT-A in conjunction with FA in your evaluation of retinal diseases?
There are no clinical or diagnostic factors that predict who will benefit from an intervention for vitreous floaters. Symptomatology from vitreous floaters is subjective. Patient-reported outcome measures after floaterectomy are also subjective. The improvement in symptoms following vitrectomy (I do...
What is the standard of care for timing of a mac-off retinal detachment repair?
The literature on this topic is mixed and at times contradictory. My own synthesis of the literature, which I believe coincides with the consensus standard of care, suggests that repair of macula-involving rhegmatogenous retinal detachment is relatively time sensitive: urgent but not emergent. The c...
How do you manage the severe adverse drug reaction of central serous retinopathy with MEK inhibitors?
Fortunately, the ICSC-like association of subretinal fluid with MEK inhibitor exposure is usually reversible after cessation of the drug. When working with this class of medications, it is important to coordinate care with the treating oncologist. If a patient presents with subretinal fluid and is o...
What is your algorithm for transitioning a patient with chronic noninfectious posterior uveitis from corticosteroids to immunosuppressive therapy?
There are some forms of noninfectious posterior/panuveitis where it is known from the time of uveitis diagnosis that steroid-sparing immunosuppression (IMT) will be needed. For example, in birdshot retinochoroiditis or serpiginous choroidopathy, IMT is often initiated in concert with oral corticoste...
How do you decide the threshold and duration of subretinal fluid that can be safely tolerated in exudative AMD when adjusting treat-and-extend intervals?
There are so many other factors at play here. The very nature of this question begs the question of whether you are treating the patient or the OCT. Sadly, it appears the preponderance of patients I have seen are treated at fixed intervals of 1-2 months and no treat and extend, even from physicians ...
Who are good candidates for light adjustable lenses?
Who is a great candidate? The LAL is a great option for a wide range of patients. In general, patients who prioritize quality of vision but want to achieve meaningful freedom from glasses are excellent candidates for LAL technology. The prototype candidate in my experience is a patient with a histor...
In pediatric RRDs associated with high myopia or Stickler syndrome, how do you decide between scleral buckle alone versus combined vitrectomy and buckle?
Most of the time, a buckle works great. If there is posterior PVR that will not relax with a buckle or there is a GRT, then a vitrectomy will be necessary.