Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach IOL calculations and selection in patients with keratoconus based on disease severity?
Lens selection assuming stable KCN and no plan for a transplant: Symmetrical astigmatism and they don't want to wear CL after surgery? Can consider a toric lens. Symmetrical astigmatism and they are okay with continuing RGP/sclerals? Monofocal aberration-free lens. Asymmetrical astigmatism and want...
How do you approach the management of epithelial ingrowth in a patient who underwent LASIK 20 years ago and developed epithelial ingrowth following recent cataract surgery?
If it’s a small area in the periphery, not causing any issue, then it would be reasonable to monitor it as it may not progress. If it is progressing or starting to cause issues, you can either try YAG, which may take more than one round, or simply lift the flap and scrape both the bed and underside ...
How do you decide the best way to treat glaucoma in patients with ICE syndrome given their higher risk of surgical failure and corneal complications?
In general, patients with ICE syndrome have unilateral refractory disease that often requires surgical management. MIGS procedures are not typically effective given the angle anatomy and progressive nature of the disease, and I usually perform tube shunt surgery in these cases. Placing the tube deep...
How should ectasia risk be triaged using RSB, PTA, and tomography?
Randleman ectasia risk score is very helpful in assessing the risks. It takes into consideration RSB PTA topography, CT, and age. Randleman Ectasia Risk Factor Score System
What is your preferred method of secondary IOL placement (Yamane vs. scleral sutured) and why?
I think the real answer here depends on what is most reliable and repeatable in your hands. When I started years ago, like many retina surgeons then, all I did for secondary IOLs was an ACIOL. Easy, quick, and with few things that could go wrong (but not zero!). For a variety of reasons, I learned t...
How important are retinal fluid fluctuations for long-term vision and how do you factor them in when making treatment decisions for conditions like nAMD and DME?
I think the question has been asked in a different form here. As I have commented on Mednet previously, it depends on a lot of factors, primarily: Are you treating the OCT or the patient? I'd also say the answer is very different for nARMD (or any CNVM) DME or edema from RVO. People: this is not a o...
Do you re-load with monthly doses when switching a patient with DME from aflibercept to faricimab, or do you transition directly to a treat-and-extend schedule?
When I switch from one anti-VEGF agent to another, I start with the same treatment interval I was using with the previous agent, so I can assess the comparative efficacy of the two agents. Once I have determined the new agent is more effective, I proceed immediately to a treat-and-extend dosing regi...
For those using 5% Betadine as a single-use prep, how are you handling the associated costs or aliquoting?
Very difficult legal question. Other countries make 5 or 10 cc bottles produced by Allergan and other generics for 1 dollar. They are multi-use and sterile. Not legal to import into the USA. By FDA law, for patient use, 10 percent has been used in the USA for 20 years without a significant problem. ...
What has been your experience with dSLT?
Overall positive. The procedure is quick and the interface is intuitive. We have to warn the patients that they are going to feel it, and oh man, if you look at the anterior chamber about 20 minutes after the dSLT, you are going to see a lot of cells floating around there. I have been able to perfor...
What concentration/dose of mitomycin C do you use for trabeculectomies and XENs and how do you titrate based on patient factors?
I use the mitosol kit and reconstitute at 0.2 mg/ml (0.02%). I inject the mitomycin at the end of the case, after ensuring watertight conjunctiva closure by raising a bleb via a corneal paracentesis. My standard dose then is 60 ug injected (0.3ml of 0.2 mg/ml), but I may titrate that dose/volume up ...