Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What clinical and diagnostic factors best predict who will benefit from intervention versus observation for patients with visually significant floaters?
There are no clinical or diagnostic factors that predict who will benefit from an intervention for vitreous floaters. Symptomatology from vitreous floaters is subjective. Patient-reported outcome measures after floaterectomy are also subjective. The improvement in symptoms following vitrectomy (I do...
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 is the PFO is trapped neat ...
How do you determine when to discontinue anti-complement therapy in patients with geographic atrophy who already have center-involving disease given the minimal likelihood of central vision improvement but the potential for more rapid scotoma expansion if treatment is withdrawn?
Since these drugs have a significant risk and a marginal benefit, not to mention the significant treatment burden and their outrageous cost, it begs the question of how often they should be used altogether.
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 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...
What are some methods to deal with IOP elevations with intravitreal injections in a patient without glaucomatous damage that does not want to have AC taps with each injection?
In this situation, depending on the elevated IOP, use the standard medical approach: Iopidine1%, Cosopt, Alphagan 0.2%, and in some cases, Diamox 250 mg. Wait for half an hour and repeat if necessary, or send the patient home with one or more drugs. Of course, make sure of drug selective contraindic...
How do you approach tube shunt placement in very high myopes with thin sclera?
Due to decreased scleral rigidity in highly myopic eyes, there is a higher risk of hypotony and hypotony maculopathy with filtering surgeries, including tube shunts. In choosing the type of tube shunts, I would favor a valved tube shunt in high myopes. For surgical technique, I take great care when ...
How do you optimize retinopathy screening schedules for patients on hydroxychloroquine while also prioritizing cost-effectiveness?
I'll approach this from the cost-effectiveness standpoint as I agree with Drs. @Dr. First Last and @Dr. First Last on their excellent points.Patients with SLE have remarkably high costs when you add up copays, medications, imaging studies, travel, missing work, etc. Anything we can do to help reduce...
How do you approach the treatment of "normal tension glaucoma" and how do you discuss this with patients?
It highlights that glaucoma is probably not an eye pressure disease, but rather a vascular disease. As noted above, there is a genetic component clearly, but vasculopaths (DM, Sleep apnea, CVD, etc.) increase that risk with the same IOP.
For patients with xanthelasma, aside from a lipid panel, do you perform any additional lab workup or send referrals?
It is reasonable to get a lipid panel and screening thyroid dysfunction labs (tsh, t4, and t3). Since xanthelasma are benign but often recur, I think an important aspect here is managing expectations. Let the patient know that recurrence is common and not associated with poor surgical techniques.