Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Is optimal timing of choroidal drainage in the case of kissing choroidals with hypotony after glaucoma surgery different in a vitrectomized eye?
To answer the question, probably the timing is not different for a vitrectomized eye. One could make the case for more immediate surgery in the sense that there is no vitreous buffer between appositional retina layers, but I doubt there's much data to support that. On the subject of timing in genera...
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...
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.
How do you approach management of GLP-1 receptor agonist therapy in patients who develop NAION?
Short answer is I recommend stopping the GLP-1 agonist if one eye has already developed NAION, for the sake of protecting the fellow eye. The fact is, our knowledge is still growing in this matter. While some studies indicate links between GLP-1 agonists and NAION, there are so many discussions arou...
What is the best next surgical approach to manage severe inferior oblique overaction and superior oblique underaction after inferior oblique myectomy?
Persistent superior oblique (SO) muscle underaction after inferior oblique (IO) myectomy usually indicates an abnormal, loose, and floppy superior oblique tendon. At surgery, the first thing to do is traction testing of both oblique muscles to detect tightness or laxity. Videos of the "exaggerated t...
What is your go-to multifocal lens?
As of today, the Alcon PanOptix for most patients who want a multifocal-type outcome. But more importantly, I think matching the strengths/weaknesses/side effect profile of each lens type with each patient's optical system and expectations. Well-controlled head-to-head studies regarding this would b...
How do you approach cases of transient monocular vision loss when initial carotid imaging and cardiac workup are unrevealing?
As you eluded, it is essential to rule out amaurosis fugax in a case of TMVL, and carotid Doppler and cardiac echo are two essential tests to evaluate the two potential sources of embolization in this setting. I would also recommend an MRI of the brain (to check for possible evidence of other ischem...
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...
What specific exam findings or test changes prompt escalation of care when evaluating pediatric patients with optic disc drusen for possible increased intracranial pressure?
Both pediatric and adult patients with optic disc drusen can develop increased intracranial pressure, including IIH, like normal individuals. This is important to remember, especially if the symptoms and risk factors suggest elevated intracranial hypertension. In the pediatric group, especially youn...
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 if the PFO is trapped near...