Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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 do you determine the duration and taper of systemic corticosteroids when you add them alongside antibiotics for orbital cellulitis?
There is no 'standard of care' answer for this. My personal preference is the following: Pediatric patients -- 0.25 to 0.5 mg/kg dexamethasone daily (given in AM) for up to 3 days, starting the day after source control/cultures from surgery. Higher dose/longer duration if very inflamed, and lower d...
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 pre-operative features in pseudoexfoliation patients do you feel correlate with intra-op zonulopathy?
This is an excellent question. Several factors play a role in the extent of zonulopathy that one may expect during pseudoexfoliation cases. A history of zonulopathy in the other eye or other factors that could contribute (trauma, falls, prior surgeries like retina procedures) would be one thing to l...
Who are good candidates for light adjustable lenses?
Who is a great candidate? The LAL is a great option for a wide range of patients. In general, patients who prioritize quality of vision but want to achieve meaningful freedom from glasses are excellent candidates for LAL technology. The prototype candidate in my experience is a patient with a histor...
How do you approach the use of Cequa in eyes with severe corneal thinning from a prior, healed corneal ulcer?
The use of Cequa or other cyclosporins has not been associated with an increased risk of thinning. Cequa prescribing information lists no contraindications and reports instillation site pain and conjunctival hyperemia as the main adverse reactions. Corneal thinning, impaired healing, and perforation...
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...
What is the standard of care for timing of a mac-off retinal detachment repair?
The literature on this topic is mixed and at times contradictory. My own synthesis of the literature, which I believe coincides with the consensus standard of care, suggests that repair of macula-involving rhegmatogenous retinal detachment is relatively time sensitive: urgent but not emergent. The c...
What follow-up monitoring would you recommend for an adult with self-resolved idiopathic acute pupil-sparing third nerve palsy?
Pupil-sparing third nerve palsy is a relatively common presentation for neuro-ophthalmologists. They typically resolve completely by 12 weeks, and I will typically follow them until they are fully resolved, watching them once a month. The most common are microvascular and associated with a variety o...