Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How has the ADVISE trial changed your approach to steroid sparing agents for non-infectious uveitis?
The ADVISE trial was a well-designed, multinational trial that compared adalimumab therapy for non-infectious intermediate, posterior, or panuveitis versus conventional immunosuppressive therapy or CID. Two hundred twenty-seven subjects were enrolled over four years, and a fifth year was required to...
For an anterior capsular tear that has not extended posteriorly, what lens options (i.e., 1-piece monofocal, toric, multifocal, and 3-piece) and placement options would you still consider?
I have found the single piece acrylic lenses unfold so gently that they don't extend the tear. I have experienced this about 3 times, and none have needed any other procedures, IOL exchange, or the like. I did a YAG capsulotomy on one of them without issue.
How do you approach recommending ocular exams for asymptomatic candidemic patients considering the discordance between the IDSA and American Academy of Ophthalmology guidelines?
Endogenous endophthalmitis due to Candida sp. occurs in <1% of patients with candidemia. The IDSA 2016 guidelines for management of candidiasis outline evaluation and treatment of patients with endophthalmitis, with recommendations to perform a dilated ophthalmologic exam on all patients with candid...
How do you approach cataract surgery in a patient with a history of radial keratotomy (RK) who desires postoperative independence from glasses?
Carefully. I would say I'm abrupt and dispel the notion they will be spectacle independent at all, given they are not candidates for MTF lenses and, even EDoF lenses, would have issues of aberrations in the visual system caused by the RK incisions. I literally hang the "black drape." That sort of sh...
How do you sequence IV steroids and IGF-1R blockade when inflammatory activity and proptosis coexist in a patient with active thyroid eye disease (TED)?
I don't find that steroids are actually necessary for patients who are receiving IGF1R inhibitors. The inflammation typically responds quite well to Teprotumumab (haven't tried Veligrotug yet), so steroids don't really add any benefit. These days, I only use IV steroids for patients who can't get IG...
What has been your experience with CP250 vs. CP350 in terms of ease of implantation, post-operative course, and efficacy in IOP lowering?
We did look at this in our study from Wills (Shalaby et al., PMID 38158079) and did not find a difference in IOP control or medication use between CP250 or CP350. However, the CP350 cohort was small and this was a retrospective study. Similar findings have been published earlier regarding the BGI 25...
Who are good candidates for light adjustable lenses?
Ideal Candidates Desire for spectacle independence, especially those motivated to fine-tune vision after surgery. High expectations for visual precision — e.g., engineers, pilots, or patients highly sensitive to small refractive errors. Previous refractive surgery (LASIK, PRK, RK)** — where IOL pow...
For bilateral cataract surgery, what first-eye events trigger aborting the second-eye surgery that day?
This is a very challenging question that has a few reasonable answers. To speak to my experience, I perform multiple bilateral sequential same-day cataract surgeries a year, usually one every few months. My patients that I deem eligible for this are almost exclusively adults with developmental delay...
What’s your approach to managing postoperative inflammation and CME in high-risk patients after cataract surgery?
As a retinal specialist, I often receive referrals from my cataract surgery colleagues for patients with cystoid macular edema (CME) post-cataract surgery. My initial approach involves topical steroids combined with a topical NSAID. I re-evaluate these patients in two to four weeks to assess for ana...
What is your preferred method of secondary IOL placement (Yamane vs. scleral sutured) and why?
I think the real answer here depends on what is most reliable and repeatable in your hands. When I started years ago, like many retina surgeons then, all I did for secondary IOLs was an ACIOL. Easy, quick, and with few things that could go wrong (but not zero!). For a variety of reasons, I learned t...