Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
When do you consider initiating zoster prophylaxis in patients?
I do this when more than one episode of keratitis or uveitis per year; If a planned surgery, would start treatment doses one week before surgery and for 14 days after. Nothing worse than reactivation of zoster.
Has adopting a 3D heads-up digital visualization system changed your approach to anterior segment surgical teaching of residents or fellows?
We have been using NGENUITY to teach our cornea fellows, residents, and med students for the last 3-4 years. It has been a tremendous addition because it allows multiple people to have a real-world view, not just one surgical assistant. In addition, visiting students who may not be approved to scrub...
What is your approach to treatment for recalcitrant MGD?
Recalcitrant MGD is a frequently seen clinical problem, especially in older patients. Standard treatment encompasses warm compresses and lid hygiene. The latter can be performed with over-the-counter lid wipes or simply with baby shampoo. Tropical antibiotics such as Polytrim drops and bacitracin/po...
How do you approach perioperative steroids for a quiescent uveitis patient undergoing cataract surgery?
Preop: If the patient is using topical steroids chronically, I increased the dose of the drops to four times a day the week prior to surgery. If the patient is using chronic oral prednisone, I will increase the prednisone to 0.5 mg/kg, 3 days prior to surgery, followed by a quick taper every 3 days...
What follow-up monitoring would you recommend for an adult with self-resolved idiopathic acute pupil-sparing third nerve palsy?
Pupil-sparing third nerve palsy is a relatively common presentation for neuro-ophthalmologists. They typically resolve completely by 12 weeks, and I will typically follow them until they are fully resolved, watching them once a month. The most common are microvascular and associated with a variety o...
In patients with Stickler syndrome, would you recommend prophylactic laser to areas of lattice?
There is a growing body of evidence that laser retinopexy in patients with Stickler syndrome significantly reduces the risk of retinal detachment. Up to 60% of patients with Stickler syndrome develop retinal detachment, with those with type 1 and type 2 Stickler syndrome at the highest risk. Extende...
What is your preferred surgical intervention for lagophthalmos secondary to a facial paralysis and signs of exposure keratopathy?
If temporary or early in the recovery, consider stick-on external eyelid weights. If it has been several months without any improvement, I like to do gold or platinum permanent weights sutured to the tarsus, in addition to a lower lid tightening as Dr. @Dr. First Last mentioned.
What has been your experience adopting office-based surgery and has it meaningfully improved patient access or practice efficiency?
We have demeaned and minimized what we do, and in response, Medicare and insurance companies have decreased our reimbursements. We (ophthalmologists) have advertised how easy cataract surgery is, and in general, what we do, and we are our own worst enemies.
Do you feel there is value to Schirmer testing in clinic prior to starting dry eye treatment?
Schirmer's testing is a low-cost, readily available test for a majority of ophthalmologists. It has several limitations and can be quite variable in its results. Consistently low Schrimers I results suggest an aqueous tear film deficiency and can be a clue toward the mechanisms of dry eye problems, ...
How do you counsel patients with GCA on the benefits of steroids who have already experienced vision loss?
I first tell the patient they are at considerable risk for further visual loss in the same eye or the other eye over the next 1-2 weeks. I also let them know that, even though their risk of visual loss has been reduced, their best option for preventing further visual loss is immediately starting hig...