Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In bilateral sequential NAION, do you expect any progressive worsening of OCT/VF years from the ischemic event and when would you have these patients evaluated for another progressive optic neuropathy?
One should not see progressive loss of vision years after the initial insult with NAION. One may see variability in the automated field testing, but it should not be steady progression. OCT should be at its lowest nadir for both rNFL and GCL by 6 months, without further loss beyond age-appropriate c...
Do you feel there is value to getting endothelial cell counts in the absence of frank edema/visual significance in your management endothelial dystrophies?
I would, yes, mostly for patient understanding of their condition and following up on it objectively. There is a clinical benefit, but it is limited. Clinically, I use it to give the patients an assessment about their risks of edema post cataract surgeries or to push for early cataract surgeries in...
How do you manage Cancer-Associated Retinopathy (CAR) in a patient who doesn’t have a known cancer diagnosis, given the difficulty in finding the underlying cancer and the risks of using immunosuppressive treatments to preserve vision?
Auto-immune retinopathy, whether paraneoplastic or non-paraneoplastic, can be a very difficult condition to diagnose and manage. There are a few features that raise suspicion for a paraneoplastic cause particularly, such as rapid progression and more significant intraocular inflammation (anterior ch...
Do you still obtain Tensilon (edrophonium) testing for myasthenia gravis, and what do you feel is the added value over serum testing?
Edrophonium has not been available commercially for years. Neostigmine can be used intramuscularly instead, given with atropine, and the effect assessed 30-45 minutes later. Some seronegative patients will have a positive test, so it can be helpful when you still suspect myasthenia and want further ...
What options would you consider for removing dense fibrin deposits from an IOL in a patient with chronic uveitis?
Pre-treat with a steroid and nonsteroid drop, use a low-power YAG laser anterior offset to remove, and post op continue with pre op regimen for as long as recurrence is necessary, then slowly taper off.
In which cases of post-injection endophthalmitis should early vitrectomy be considered if there is little to no improvement 48 hours after a tap and inject and there is no organism isolated?
Prompt vitrectomy should be considered in all patients with post-injection endophthalmitis (PIE) if there is no improvement 48 hrs after a tap and inject. The initial tap did not identify the organism. Non-infectious endophthalmitis can be included in the differential diagnosis of persistent inflamm...
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...
What is the role of bilateral same-day cataract surgery in your practice?
Like many things in medicine, sometimes there are mental hurdles to jump over that are more challenging than operational or evidence-based hurdles. We perform many invasive procedures, bilateral same day: laser vision correction, intravitreal injections, phakic IOLs, etc. Yet many of us, myself incl...
In patients with sicca symptoms and positive SSA/SSB how often do you perform other diagnostic testing such as salivary gland ultrasound, biopsy, Shirmers, ocular staining, stimulated salivary flow, etc?
In patients with sicca symptoms and positive SSA antibodies, I always try to confirm that they have objective evidence of dryness/gland involvement. This is because patients can say they have dry eye and/or dry mouth yet not have this bear out on objective testing (Bezzina et al., PMID 27992710, Rip...
In patients with a history of retinal vein occlusion, how should the risk of recurrent thromboembolic events influence the selection of osteoporosis therapies?
The FDA-approved prescribing information for raloxifene explicitly lists retinal vein thrombosis alongside deep vein thrombosis and pulmonary embolism as contraindications.