Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you determine the duration and taper of systemic corticosteroids when you add them alongside antibiotics for orbital cellulitis?
There is no 'standard of care' answer for this. My personal preference is the following: Pediatric patients -- 0.25 to 0.5 mg/kg dexamethasone daily (given in AM) for up to 3 days, starting the day after source control/cultures from surgery. Higher dose/longer duration if very inflamed, and lower d...
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...
What are some methods to deal with IOP elevations with intravitreal injections in a patient without glaucomatous damage that does not want to have AC taps with each injection?
In this situation, depending on the elevated IOP, use the standard medical approach: Iopidine1%, Cosopt, Alphagan 0.2%, and in some cases, Diamox 250 mg. Wait for half an hour and repeat if necessary, or send the patient home with one or more drugs. Of course, make sure of drug selective contraindic...
What pre-operative features in pseudoexfoliation patients do you feel correlate with intra-op zonulopathy?
This is an excellent question. Several factors play a role in the extent of zonulopathy that one may expect during pseudoexfoliation cases. A history of zonulopathy in the other eye or other factors that could contribute (trauma, falls, prior surgeries like retina procedures) would be one thing to l...
How often and in what way do you monitor patients who are receiving teprotumumab (Tepezza) for thyroid eye disease?
A week or two after completion unless having an issue.
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?
What has been your impression of the clinical outcomes for photobiomodulation for dry AMD?
I’m not impressed by a 2.4-letter improvement over placebo after 27 treatments. It sounds like noise and can be compared to a drop of preservative-free artificial tears. It’s not like we have tons of clinic availability to spend our time on such trivial improvements. We need a better assay to find t...
Do you feel there is benefit to subconjunctival steroid or MMC injection at the time of valved tube placement?
In my opinion, there is a lack of compelling clinical evidence and studies to support the injection of subconjunctival MMC at the time of valved tube placement. I consider the injection of a subconjunctival steroid in patients with poorly controlled inflammation and those who I think may be less com...
How has OCT and OCT-A technology impacted your use of FA in the evaluation of retinal diseases?
Over the course of my practice, OCT Angiography (OCT-A) has become my primary daily scan, dramatically reducing my reliance on fluorescein angiography (FA). The OCT-A image is accompanied by a structural OCT image and minimal additional time is required for its acquisition. High-resolution OCT-A fre...
How do you adjust your glaucoma management strategy for pregnant patients who require IOP lowering?
Managing glaucoma during pregnancy is challenging and requires a multidisciplinary approach in collaboration with the patient’s OB-GYN team. Several management strategies can be considered. Initially, close observation with frequent intraocular pressure monitoring and visual function/nerve assessmen...