Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you counsel patients on the use of AREDS 3 vitamins (developed by B&L) without the support of clinical trials?
I make it clear that there are currently no prospective clinical trial data that demonstrate increased efficacy of the commercial AREDS3 formulation compared to AREDS2. I further explain that AREDS3 includes all of the AREDS2 components (but with a smaller dose of zinc) plus the addition of several ...
What factors influence the decision between anti-VEGF injections and surgical displacement with tPA for treating submacular hemorrhage in AMD patients?
The size, thickness, and location of the heme are factors to consider between anti-VEGF monotherapy and a displacement procedure. If there is sufficient thickness to the heme and it is subfoveal, then I perform an in-office displacement. I usually inject anti-VEGF + intravitreal gas on day 0, and th...
Do you consider the vitrectomy performance of a phaco-only machine adequate for anterior vitrectomy during complicated cataract surgery?
There are no head-to-head comparative studies. However, older phaco machines with a slow cut rate and an inability to adjust the function cut/IA vs. IA cut are likely less efficient and have a higher risk of pulling on the retina. With the newer phaco machines like Centurion, they have better contro...
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...
How do you treat idiopathic acute anterior uveitis that recurs immediately after a course of topical corticosteroids?
Anterior uveitis has many known causes that include HLA-B27-associated (often with ankylosing spondylitis); viral such as herpes simplex, CMV, or zoster; or as part of a syndrome that includes interstitial nephritis; or as a manifestation of juvenile arthritis. Labeling it acute means that it starts...
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 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...
When should delayed removal of an intraocular foreign body be considered?
If you are deciding whether to close the globe first and then remove the IOFB with a later surgery, then first consider the type of IOFB and its potential to incite infection or inflammation. No matter what type of IOFB it is, the team repairing the ruptured globe should inject intravitreal broad-sp...
What intra-op and post-op strategies maximize the longevity of a functional bleb in younger patients?
Great question, and one which I hope others will chime in on. Intraoperatively, I really want to ensure a broad dissection of Tenon's capsule from the underlying sclera to allow diffuse flow of aqueous into the subconjunctival space. I inject MMC (0.2mg/ml) rather than use sponges, so I like to ensu...
How soon do you consider repeating external diode (CPC) for a patient who's IOP remains relatively unchanged and uncontrolled post-op after initial CPC?
My experience is that a reduction is usually apparent by 6-8 weeks. If not at target level IOP, repeat the procedure and adjust parameters of treatment accordingly (duration on, cycle frequencies/duty cycle).