Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
When do you consider adding steroids alongside intravenous antibiotics for patients with orbital cellulitis?
If the orbital cellulitis is infectious, I never add steroids. There is no literature or proof that they do anything, and decreasing immunity, in my opinion, is simply a bad idea. If it is inflammatory, then absolutely. Most infectious orbital cellulitis is from the sinuses and is more common in chi...
How do you manage corneal ectasia after refractive surgery?
Corneal cross-linking should be the first step to halt progression. I would then typically encourage patients to try hard contacts, which help improve the vision in the most conservative way. There are a variety of surgical interventions that can be considered depending on how advanced the ectasia i...
What factors guide your decision to test for or start empiric treatment for acanthamoeba keratitis in cases of corneal ulcers?
I can't say that I've ever started empiric treatment for acanthamoeba keratitis prior to other workup/testing/culture results, although I suppose if you have a slam dunk case with a known acanthamoeba exposure I would do so.The question of whether to test for AK is far more interesting. New onset in...
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 cataract surgery following penetrating keratoplasty, do you think the use of scleral tunnel incisions versus clear corneal incisions meaningfully influence graft survival or astigmatic stability?
I generally prefer a clear corneal incision for most cataract surgeries following PK. Regarding endothelial safety, there are limited studies directly comparing endothelial cell loss or corneal edema between incision types. In my own experience over the past year, I have not encountered endothelial ...
How aggressively do you treat the ocular surface before cataract surgery in a patient with inconsistent K readings and mild dry eye who is otherwise ready for surgery and does this differ based on the type of IOL offered?
It is definitely recommended to manage mild dry eye first, as it may progress into a moderate dry eye in the postoperative period and increase the risks of complications. In patients with mild dry eye who are in a hurry to get surgery, I usually place plugs and plan the surgery shortly. Many times, ...
How should ectasia risk be triaged using RSB, PTA, and tomography?
Randleman ectasia risk score is very helpful in assessing the risks. It takes into consideration RSB PTA topography, CT, and age. Randleman Ectasia Risk Factor Score System
What is your follow-up protocol with the light adjustable lenses?
I did all my own adjustments for my LAL patients for 2+ years before deciding to delegate these adjustments to my extender OD (not the referring OD). I have not seen any change in outcomes with this shift, but I find myself being more willing to offer LAL to patients now because I don't dread the po...
What has been your experience with EDOF lenses in patients with glaucoma?
Multifocal lenses and refractive surgeries require a lot of consideration and discussion with patients. Making sure you provide honest information and setting expectations is crucial to providing the best outcomes we can for patients. Regarding glaucoma, if someone has visual field changes, they hav...
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...