Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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. ...
How do you adjust your glaucoma management strategy for pregnant patients who require IOP lowering?
Managing glaucoma during pregnancy is challenging and requires a multidisciplinary approach in collaboration with the patient’s OB-GYN team. Several management strategies can be considered. Initially, close observation with frequent intraocular pressure monitoring and visual function/nerve assessmen...
What strategies do you use to manage refractory cystoid macular edema in uveitis patients who have already received ocular steroids and systemic immunosuppression?
For this clinical situation, especially if the CME is bilateral, systemic peg-interferon alpha is an excellent option. Commence with peg-interferon 180 mcg injected subcutaneously weekly. Check baseline CBC/diff and complete metabolic panel prior to starting treatment and at least weekly initially (...
Which IOL do you prefer for patients with a history of hyperopic LASIK to minimize the risk of inducing spherical aberration?
I prefer an IOL without any induced spherical aberration, such as the enVista monofocal, in my post-hyperopic LASIK patients. Other standard monofocal lenses (such as clareon monofocal, J&J monofocal, etc.) have a built-in negative spherical aberration that is intended to offset the standard positiv...
How do you determine whether to switch to a different anti-VEGF agent or to Ozurdex after a patient with diabetic macular edema fails a series of Avastin?
For my practice, macular oedema (CSME) is based on three factors. Ischemia, inflammation, and traction: the three factors which lead to persistent oedema. IVFA will show the level of non-perfusion in the far periphery, which is a major producer of VEGF, and laser (PRP) is the treatment. IV anti-VEGF...
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...
How would you approach the management of a patient presenting with bilateral central corneal perforations following treatment with Ipilimumab/Nivolumab?
I am aware of at least one case report describing this situation (Aschauer et al., PMID 36072439).Ideally, the offending medication is halted, but when dealing with life-threatening cancer, this may not be possible, especially if the treatment is working. In the acute setting, trying to stabilize th...
Is there a role for PDT in a young patient with PXE and bilateral CNVM who requires intravitreal anti-VEGF injections every 4 weeks and is beginning to develop atrophy?
I am not a fan of PDT for patients who are developing incipient atrophy. The question says anti-VEGF therapy is being given every 4 weeks, but it is not clear what agent is being used. I would try 2nd generation therapy such as faricimab, 8 mg aflibercept, or possibly brolucizumab (after discussion ...
Do you incorporate diurnal or nocturnal IOP measurements in your management of progression despite seemingly adequate daytime control?
The advent of home-based tonometry can make diurnal or nocturnal IOP measurements more convenient to obtain, though the cost of renting or buying these devices may be prohibitive for some patients. Glaucoma specialists sometimes use diurnal or nocturnal IOP measurements to identify whether there are...
How do you approach recommending ocular exams for asymptomatic candidemic patients considering the discordance between the IDSA and American Academy of Ophthalmology guidelines?
Endogenous endophthalmitis due to Candida sp. occurs in <1% of patients with candidemia. The IDSA 2016 guidelines for management of candidiasis outline evaluation and treatment of patients with endophthalmitis, with recommendations to perform a dilated ophthalmologic exam on all patients with candid...