Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
After evisceration for endophthalmitis, when is secondary implant placement reasonable?
While there is definitely a theoretical concern for implant infection in the setting of endophthalmitis, I actually routinely place primary implants and have not had any issues. After eviscerating the globe, I irrigate the socket copiously with antibiotic solution and place a silicone implant in the...
How does LAL+ compare with other EDOF lenses?
Customizable: The LAL+ provides a *customizable depth of focus*. Typically, patients achieve excellent distance and intermediate vision, with some functional near vision depending on postoperative adjustments. Surgeons can create mini-monovision or slightly blended vision to extend range as desired...
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...
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 is your experience with intraocular tPA for blood clots in the AC folowing GDD surgery?
It works great - but hard to get if you're not in a hospital-based practice. The tube needs to be open (valved or the ligature has opened); otherwise, there won’t be anywhere for the blood to go.
What is your approach to eyelid reconstruction in children with severe congenital or acquired eyelid defects?
While fixing the "problem" can be extremely important for ocular health and for social ramifications, the most important things to consider first in newborns are the protection of the cornea and concern for amblyopia. Many conditions may not require emergent ocular repair as long as the family can a...
Which MIGS do you feel has the most durable IOP lowering effect?
Consider the results of this poll itself to be a bit flawed. People are going to answer based on the options they themselves are familiar with. If they are not using some of these options, they will elect for ones they believe, in their hands, have the most durable lowering effect.
How do you manage bothersome diplopia due to metastatic disease affecting occipital lobe?
An isolated occipital lobe lesion should not result in strabismic diplopia (relating to misalignment of the eyes) unless a resulting loss of peripheral field reduces the drive for fusion and decompensates an underlying strabismus. The fact that it does not go away with monocular occlusion suggests i...
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.
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.