Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
For a patient with orbital sarcoidosis who has achieved sustained clinical remission on adalimumab in combination with mycophenolate mofetil, how long would you recommend continuing mycophenolate before considering a gradual taper and discontinuation?
In patients with sarcoidosis who achieve remission, I generally favor considering a gradual taper of immunosuppressive therapy after sustained disease control, rather than discontinuing treatment immediately once clinical remission is achieved.There is no universally accepted duration of remission o...
What has been your experience adopting office-based surgery and has it meaningfully improved patient access or practice efficiency?
We have demeaned and minimized what we do, and in response, Medicare and insurance companies have decreased our reimbursements. We (ophthalmologists) have advertised how easy cataract surgery is, and in general, what we do, and we are our own worst enemies.
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...
Which MIGS do you feel has the most durable IOP lowering effect?
Consider the results of this poll itself to be a bit flawed. People are going to answer based on the options they themselves are familiar with. If they are not using some of these options, they will elect for ones they believe, in their hands, have the most durable lowering effect.
What has been your experience with Xdemvy?
Expensive - most drug plans won't cover without prior authorization and documentation of failure of other therapies. So far, I have found that if patients discontinue early, they end up coming back and have to restart a full course of therapy.
How do you differentiate between macular schisis vs. macular edema vs. optically empty spaces (from macular telangiectasia) on OCT?
When trying to differentiate between these identities, I begin by looking at the morphology of the intraretinal fluid-filled spaces on OCT imaging. The cystoid spaces in macular edema caused by vascular leakage or medications (e.g., niacin) are typically round in shape and increase in size toward th...
In patients with a history of retinal vein occlusion, how should the risk of recurrent thromboembolic events influence the selection of osteoporosis therapies?
The FDA-approved prescribing information for raloxifene explicitly lists retinal vein thrombosis alongside deep vein thrombosis and pulmonary embolism as contraindications.
How do you approach the management of recurrent episcleritis in a patient with RA that is otherwise well-controlled?
The episclera lies on top of the sclera. The majority of patients with episcleritis do not have a systemic disease, although patients with rheumatoid arthritis are more prone to develop episcleritis. Episcleritis must be distinguished from scleritis, which is also associated with rheumatoid arthrit...
In primary angle closure suspects without cataracts, how do you approach the discussion about LPIs, given the relatively low risk of an acute angle closure attack?
In primary angle closure suspects without cataracts, I will have a discussion about aqueous humor dynamics and outflow mechanisms of the eye, and how that relates to risk stratification in the patient's case. We are fortunate in glaucoma to have a fair bit of evidence to guide us in our clinical dec...
What guides reoperation versus observation in managing macular folds after retinal detachment surgery?
The decision between reoperation and observation for macular folds after retinal detachment surgery depends on several factors. Is the patient symptomatic? If not, then observation is likely the best decision. Location is also a major consideration. Full-thickness folds involving the fovea generally...