Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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?
Ideal Candidates Desire for spectacle independence, especially those motivated to fine-tune vision after surgery. High expectations for visual precision — e.g., engineers, pilots, or patients highly sensitive to small refractive errors. Previous refractive surgery (LASIK, PRK, RK)** — where IOL pow...
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...
In patients with early Fuchs’ endothelial dystrophy, how do you determine whether to proceed with cataract surgery alone versus a combined endothelial keratoplasty?
If Corneal thickness is >640 or specular microscopy is lower than 1,000, those are indicative of poor outcome after cataract surgery and patients may benefit from combined procedure. However, some patients with Fuchs can be misleading as having a low corneal thickness but a dense central guttae that...
In patients with corneal edema and a glaucoma drainage tube placed in the AC, under what circumstances would you consider repositioning the tube in the sulcus first versus proceeding directly with endothelial keratoplasty alone?
I have a pretty low threshold to just move these tubes to the sulcus as soon as my cornea colleagues are contemplating an EK. I am not a cornea specialist, but my impression is that first grafts almost always do better than second grafts, so I want to give that first one the best chance of survival....
In what clinical scenarios do you incorporate topical insulin drops to treat persistent epithelial defects?
I often use topical insulin drops in lieu of Oxervate for persistent epithelial defects and neurotrophic cornea. It works well and is much more affordable.
How does LAL+ compare with other EDOF lenses?
Customizable: The LAL+ provides a *customizable depth of focus*. Typically, patients achieve excellent distance and intermediate vision, with some functional near vision depending on postoperative adjustments. Surgeons can create mini-monovision or slightly blended vision to extend range as desired...
When do you consider adding steroids alongside intravenous antibiotics for patients with orbital cellulitis?
If the orbital cellulitis is infectious, I never add steroids. There is no literature or proof that they do anything, and decreasing immunity, in my opinion, is simply a bad idea. If it is inflammatory, then absolutely. Most infectious orbital cellulitis is from the sinuses and is more common in chi...
What has been your experience using sutureless Müller’s Muscle-Conjunctival Resection (MMCR) for ptosis repair?
Personally, I get the desire to be less interventional, but if you are going to do this and it is 'less aggressive' than a levator resection, just put in a suture; it is not so hard.