Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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 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.
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...
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.
In patients with corneal edema and a glaucoma drainage tube placed in the AC, under what circumstances would you consider repositioning the tube in the sulcus first versus proceeding directly with endothelial keratoplasty alone?
I have a pretty low threshold to just move these tubes to the sulcus as soon as my cornea colleagues are contemplating an EK. I am not a cornea specialist, but my impression is that first grafts almost always do better than second grafts, so I want to give that first one the best chance of survival....
What factors guide the choice between early versus delayed vitrectomy after an open globe injury?
The vitrectomy should be performed as early as possible in the presence of endophthalmitis or a posterior segment IOFB. The timing of retinal detachment repair (RDR) after open globe injury is controversial. The biggest risk of delaying RDR is the progressive development of proliferative vitreoretin...
In quiescent patients with history of herpetic keratouveitis with uncontrolled IOP on topicals, do you prescribe PGAs?
The evidence on prostaglandin analogues (PGAs) in the setting of herpetic anterior uveitis is nuanced. Traditionally, we have been taught to avoid PGAs in the setting of herpetic disease, given the theoretical concerns that these drugs could compromise the host's interferon defense system. But, more...
How do you manage macular-threatening toxoplasma chorioretinitis in pregnancy?
When contemplating treatment in a pregnant woman, it's always advisable to coordinate care with the managing OB/GYN to ensure the health of both the mother and the fetus. One could consider a treatment course of clindamycin for toxoplasma chorioretinitis, administered systemically with oral pills or...
What do you feel are some of the advantages and disadvantages of dropless cataract surgery and what are your preferred agents?
A clear advantage of dropless surgery is that the patient no longer needs to use post-op drops. This may not necessarily present as an advantage to the surgeon, as any additional techniques will add time and cost to the cataract surgery, especially if a particular technique is not covered by insuran...
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.