Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What pre-operative features in pseudoexfoliation patients do you feel correlate with intra-op zonulopathy?
Unfortunately, the presence or amount of fibrillar material in the anterior segment (e.g., lens capsule, pupillary border, or TM) really does not seem to correlate with zonular status in my experience. That said, phacodonesis obviously is a big red flag, but also apposition of the anterior lens caps...
What options would you consider for removing dense fibrin deposits from an IOL in a patient with chronic uveitis?
Pre-treat with a steroid and nonsteroid drop, use a low-power YAG laser anterior offset to remove, and post op continue with pre op regimen for as long as recurrence is necessary, then slowly taper off.
What follow-up monitoring would you recommend for a patient with self-resolved idiopathic pupil-sparing third nerve palsy?
I have only seen this with diabetics and it’s rare even then. I don’t have any specific follow-up if the tests are all negative.
What is the role of femtosecond laser–assisted techniques in pediatric cataracts?
Theoretically, FLACS would be a great tool for pediatric cataracts because the anterior capsule in children is elastic and can be quite unpredictable, making the capsulorhexis step one of the most challenging in the procedure. FLACS would potentially minimize the complication rate in this step. Pati...
Do you feel there are medical advantages to FLACS and if so, what are they and how often are you offering FLACS to patients?
That's a question that's sure to trigger contentious responses!Personally, I think the capability of making toric marks on the cornea or lens capsule to line up toric lenses (and using iris registration to do so), as well as the ability to do LRIs, does offer some advantage for accuracy in astigmati...
What has been your experience adopting office-based surgery and has it meaningfully improved patient access or practice efficiency?
NONE (on purpose) as the legal and cost of implementation in office surgery, staffing, and equipment costs, as well as ever-changing regulatory nightmares, may push over the limits of actual benefits on the cost/benefit ratio.
In a patient with prior cataract surgery in one eye with an unknown monofocal lens, how do you approach selection of a monofocal in the second eye?
The choice is completely dependent on the patient and the physician's discretion and discussion. No one choice for everyone.
What strategies do you use to optimize cataract surgery outcomes in patients with anterior basement membrane dystrophy (ABMD)?
For the preoperative period, surface dryness should be well controlled; usually, artificial tears, punctal plugs, and Restasis are enough. Then, if the topography shows central irregular reading, I usually prefer to remove the epithelium and let it heal for a month before considering cataract surger...
In what cases do you consider mannitol for cataract surgery?
I have found IV mannitol VERY helpful for dehydrating vitreous for short axial length, especially around 20.5 or less. Otherwise, in short eyes, there is less working space and a greater tendency for the iris to want to prolapse out, even in the absence of typical IFIS-type medications. I’ve typical...
What is your approach to atropine dosing for myopia in children and when do you consider higher concentrations?
I have little experience with this. From what I understand, it offers inconsistent results at best.