Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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...
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 re-treatment in a patient with chronic central serous chorioretinopathy who has residual subretinal fluid after their first half-dose?
If the fovea is dry and the residual fluid is outside the fovea, I usually observe without additional treatment. If the residual SRF is subfoveal in location and decreasing compared with pre-treatment, I typically observe, hoping for continued improvement to a dry fovea. If there is residual subfove...
For those using 5% Betadine as a single-use prep, how are you handling the associated costs or aliquoting?
Very difficult legal question. Other countries make 5 or 10 cc bottles produced by Allergan and other generics for 1 dollar. They are multi-use and sterile. Not legal to import into the USA. By FDA law, for patient use, 10 percent has been used in the USA for 20 years without a significant problem. ...
Would you recommend observation or laser retinopexy in a young myope with asymptomatic lattice degeneration with retinal holes within lattice in each eye?
This is a difficult question to answer. I take into consideration many factors such as: activity/sports, family history of RDs, genetic results, location of lattice and traction around lattice, can they see me every 6 months, can they be imaged easily, disability, etc. It’s a discussion to have with...
Are there any special considerations for cataract surgery in a patient with ICE syndrome (Chandler) with a relatively clear cornea?
It is important to try and get a cell count before surgery to manage patient expectations in case of increased risk of endothelial failure. The cataract surgery should be straightforward unless there is a correctopia needing a pupillary dilator. To note that MIGS are usually not successful when comb...
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...
How do you approach treatment in patients with pachychoroid disease who show fluctuating subretinal fluid without visual decline?
What is described has often been called chronic CS(C)R. I do not believe there is any proven treatment better than observation for these patients at this time, so observation it is.
In patients with myopic traction maculopathy, what clinical and imaging thresholds prompt you to intervene surgically rather than continue observation?
Given the risk of surgery, I typically follow patients conservatively as long as they feel the involved eye (when the other eye is covered) has visual function sufficient for important daily visual tasks such as reading, driving, working, etc. Many eyes continue to have functional vision even with v...
When should you seek hyperbaric oxygen therapy for patients with CRAO?
I usually pursue hyperbaric oxygen therapy within the 24-hour window from symptom onset for CRAO. This can be performed following TNK if given. In reality, though, there are multiple barriers to achieving this, including: Few centers offer hyperbaric oxygen therapy Labor intensive Difficulty with i...