Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach cataract surgery in a patient with a history of radial keratotomy (RK) who desires postoperative independence from glasses?
Carefully. I would say I'm abrupt and dispel the notion they will be spectacle independent at all, given they are not candidates for MTF lenses and, even EDoF lenses, would have issues of aberrations in the visual system caused by the RK incisions. I literally hang the "black drape." That sort of sh...
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. ...
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 ...
For patients with nAMD who are developing GA in the same eye, do you consider adding anti-complement therapy?
My personal perspective, shared by many colleagues around the country, is that the minimal anatomic and functional benefit of anti-complement therapy does not outweigh the aggregate risks and costs of perpetual treatment with these agents. I discuss these issues with my GA patients (including those ...
For very low cylinder that does not qualify for a toric lens and no access to femto, do you ever consider LRIs or slightly adjusting your main wound placement (if possible)?
I personally don't do manual LRIs as they can be somewhat unpredictable. Adjusting the main wound to the steep axis can treat 0.1 to 0.3 D due to SIA, so that might be the safest plan if femto is not available. B&L's Envista toric does treat as low as 1.25D, so that may also be an option.
How do you go about assessing a patient that has had refractive surprise following cataract surgery when determining the cause for surprise and in preparation for the other eye?
Pretty simple, if at the visit at 1 week BEFORE the second eye is done, if the vision is NOT good and they are refracted and there is a surprise, then look again. If necessary, DON'T do the 2nd eye until you know what is going on with the first surgery!
When do you consider performing laser refractive surgery on corneal transplants?
This can be somewhat dependent on the tools you have available. In general, if the astigmatism is regular after a corneal transplant, depending on the corneal thickness and overall refractive error, you can consider photorefractive keratectomy in a transplantation patient. If the astigmatism is irre...
What is your approach to offering PRK for 1 diopter of myopia in patients over 45 with a corneal thickness of 450 microns and no keratoconus?
I am not sure why you would treat this patient?. One diopter of myopia over 45 years old. The patient probably has pretty good reading and distance vision without glasses. What is the patient’s visual goal? They want 20/20 distance without correction and now lose all ability to read?
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...
How do you adjust postoperative refraction targets for LAL in patients with altered corneal anatomy?
I don't adjust any postoperative refraction targets based on prior refractive surgery or previous EK, but modify the approach to adjustments. In patients with a history of PRK/LASIK, we wait at least 6 weeks to initiate adjustments. In patients with a history of RK, we wait 8+ weeks to start adjustm...