Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What has been your experience with CP250 vs. CP350 in terms of ease of implantation, post-operative course, and efficacy in IOP lowering?
We did look at this in our study from Wills (Shalaby et al., PMID 38158079) and did not find a difference in IOP control or medication use between CP250 or CP350. However, the CP350 cohort was small and this was a retrospective study. Similar findings have been published earlier regarding the BGI 25...
Who are good candidates for light adjustable lenses?
Ideal Candidates Desire for spectacle independence, especially those motivated to fine-tune vision after surgery. High expectations for visual precision — e.g., engineers, pilots, or patients highly sensitive to small refractive errors. Previous refractive surgery (LASIK, PRK, RK)** — where IOL pow...
For bilateral cataract surgery, what first-eye events trigger aborting the second-eye surgery that day?
This is a very challenging question that has a few reasonable answers. To speak to my experience, I perform multiple bilateral sequential same-day cataract surgeries a year, usually one every few months. My patients that I deem eligible for this are almost exclusively adults with developmental delay...
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...
What work-up do you recommend for optic nerve edema in a patient who is immunocompromised?
Symptoms (is visual loss present or not?) and time of onset/pace help to direct the workup. For unilateral optic nerve edema with vision loss, optic neuritis and NAION are always high on the differential. In immunocompromised patients, an infectious cause such as herpes zoster, syphilis, TB, and art...
Have you changed your practice in treating CRAO with IV thrombolysis?
The recent THEIA trial had a limited sample size to draw conclusions, even though there was a non-significant trend of improved visual acuity initially in the thrombolysis group. Even the TenCRAOS trial had a small sample size with recruitment challenges, where subtle small differences cannot be acc...
What are the pros and cons of Multifocal IOLs vs. EDOF IOLs?
Multifocal IOLs provide excellent near, intermediate, and distance vision with high spectacle independence, making them attractive for patients who prioritize reading and near tasks, but they achieve this via light-splitting diffractive optics that reduce contrast sensitivity and can cause significa...
What factors do you take into consideration when deciding between enucleation and evisceration?
Almost always I perform an eviceration unless there’s a suspected or known tumor. Endophthalomitis is variable. If at surgery there’s no posterior involvement I’ll still do an eviceration. Typically most endophthalmitis has been aggressively treated and gives one the option of doing the procedure wi...
What is the most appropriate next step for a patient experiencing prolonged hypotony following Ahmed glaucoma valve implantation and unsuccessful medical management?
To reduce aqueous flow through the tube, a less invasive approach involves occluding the tube lumen using a 2-0 or 3-0 Prolene suture via an ab interno technique. For complete occlusion, a Supramid suture may be used instead of Prolene. The ab interno approach minimizes conjunctival disruption. Alte...
How do you approach a patient with idiopathic anterior uveitis who has ongoing disease despite adalimumab every two weeks?
This is a style question, I think. I thought it would be useful to note the choice here might depend on testing for anti-adalimumab antibodies as there is some suggestion that changing to once weekly adalimumab in the presence of anti-adalimumab antibodies might not be efficacious. (Ismayilova et al...