Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
When do you use GLP-1 receptor agonists for the management of patients with idiopathic intracranial hypertension (IIH)?
I would use GLP-1 agonists in all overweight IIH patients who did not have a contraindication if it wasn't for the cost. In the IIH treatment trial, 6% weight loss over 6 months lowered intracranial pressure by about 50 mm (acetazolamide also lowered ICP by about 50 mm, but of course, it did it much...
How do you approach treatment in patients with pachychoroid disease who show fluctuating subretinal fluid without visual decline?
What is described has often been called chronic CS(C)R. I do not believe there is any proven treatment better than observation for these patients at this time, so observation it is.
What are the toxic effects of a small amount of intraocular perfluoron on the retina and cornea?
I have seen small amounts of PFO retained in the posterior pole and no inflammation was associated with it. But in some patients, particularly those with any subretinal PFO, retinal atrophy and chronic choroiditis can be seen. This will require surgical removal, especially if the PFO is trapped near...
How do you approach re-treatment in a patient with chronic central serous chorioretinopathy who has residual subretinal fluid after their first half-dose?
If the fovea is dry and the residual fluid is outside the fovea, I usually observe without additional treatment. If the residual SRF is subfoveal in location and decreasing compared with pre-treatment, I typically observe, hoping for continued improvement to a dry fovea. If there is residual subfove...
Has the CONDOR trial changed your first-line approach to treatment-naive proliferative diabetic retinopathy in a patient with good visual acuity who is able to attend regular follow-up visits?
No. In the US, we stopped using brolucizumab (Beovu) because of the risk of retinal vasculitis. So I don’t even think I can get that medicine anymore. For those who don’t know about it, CONDOR was a trial that studied the use of Beovu vs. PRP (panretinal photocoagulation) for proliferative diabetic ...
How effective is weight loss in improving visual function in IIH and how much weight loss/what strategies (i.e., formal exercise program, weight loss medications) do you recommend/counsel patients on?
Weight loss is a cornerstone of IIH management because it lowers intracranial pressure (ICP), which in turn improves papilledema and visual function. It works but should not be used alone for cases with moderate or progressive visual loss. In the IIH Weight Trial,[1] the magnitude of weight loss cor...
What has been your experience with the travoprost intracameral implant (iDose)?
My experience has been positive, but I consider patient selection prior to surgical planning to be crucial. At this time, I am mostly targeting mild to moderate POAG patients who are on 1-3 glaucoma medications (at least one being a PGA). I usually perform the iDose along with cataract surgery and a...
What factors affect/correlate with viral PCR yield in aqueous in a patient with recurrent episodes of uveitis associated with high IOP?
Regarding viral PCR testing of aqueous for patients with recurrent episodes of hypertensive uveitis, I have the following thoughts: For herpetic uveitis specifically, HSV (1 and 2), VZV, and CMV, sampling the aqueous for viral PCR is highly sensitive (upwards of +90%) and comparable to that of vitre...
How do you decide whether to continue hydroxychloroquine in a young patient who develops subretinal neovascularization with no other risk factors?
Hydroxychloroquine (HCQ), an anti-inflammatory and immunomodulatory agent, is used to treat autoimmune diseases (rheumatoid arthritis, lupus, Sjogren’s disease, etc.) and malarial prophylaxis. Vision problems can ensue resulting from these deleterious irreversible effects of HCQ on retina if the cum...
For patients with xanthelasma, aside from a lipid panel, do you perform any additional lab workup or send referrals?
Agree that recurrence is common, but there are no data that a high cholesterol or increased serum lipid is associated with them.