Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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...
What has been your experience both intra-op and post-op with different non-valved implants (Baerveldt vs. Clearpath)?
In general, all 3 non-valved implant styles available in the US (Baerveldt, Clearpath, and Molteno) work quite similarly, and utilize similar techniques regarding ligation, tube modifications to create early flow anterior to the capsule, and postoperative course. The Molteno implants are slightly na...
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...
In what scenarios do you consider using an amniotic membrane graft for macular hole closure?
Given that the success rate of closing macular holes is excellent when the hole is worth closing, and that there are no studies demonstrating the benefit to the patient of amniotic membranes for (presumably) very large and chronic holes, I can't recommend this approach. Having said that, I have no e...
Would you recommend observation or laser retinopexy in a young myope with asymptomatic lattice degeneration with retinal holes within lattice in each eye?
This is a difficult question to answer. I take into consideration many factors such as: activity/sports, family history of RDs, genetic results, location of lattice and traction around lattice, can they see me every 6 months, can they be imaged easily, disability, etc. It’s a discussion to have with...
How do you decide between repeat surgical correction vs. botulinum toxin injections for recurrent intermittent exotropia after previous surgery?
If the lateral rectus muscle has been recessed, it would be very challenging to get Botox accurately administered. Bilateral medial rectus resection would be easier and is very effective.
What has been your experience incorporating the Port Delivery System (PDS) into clinical practice?
My initial exposure was as a study surgeon, and the first patient I saw in the study had had the port system placed 9 months before. When I saw her, the port injection surface had become exposed with breakdown of the surrounding conjunctiva and tenons. This required urgent surgery and a conjunctival...
How do you approach diagnosis and management of orbital myositis?
Orbital myositis is an umbrella diagnosis that includes a wide range of potential underlying conditions. Patients with this presentation are often first evaluated by neuro-ophthalmology to exclude causes such as isolated orbital myositis, myasthenia gravis, thyroid eye disease, infection, and diabet...
Is there any role for topical corticosteroids in the treatment of photokeratitis?
Typically not, as this is not an inflammatory condition. The goal is to provide supportive care with aggressive lubrication and pain control with topical cycloplegics until epithelial regeneration occurs.