Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach the decision to escalate from conservative medical therapy to surgical intervention in a patient with EBMD-related recurrent corneal erosions who has not responded to several months of nighttime lubricating ointment?
In the case of recurrent erosion in the setting of EBMD, we first attempt to optimize the conditions for a pristine and smooth ocular surface. This includes non-preserved lubricants, hypertonic saline to avoid swelling and sloughing at night, and treatment of any dry eye and meibomian gland dysfunct...
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 ...
Are there clinical situations where you would advise removal of the LASIK flap and how do you determine if it is clinically necessary?
I had a patient who had recurrent and persistent epi in-growth into the flap interface, and eventually all of that Epi in-growth caused the flap to sectorally melt. I decided to amputate the flap and let the interface just grow over woth epithelium. Surprisingly, the patient did quite well and once ...
What is your approach to offering PRK for 1 diopter of myopia in patients over 45 with a corneal thickness of 450 microns and no keratoconus?
I am not sure why you would treat this patient?. One diopter of myopia over 45 years old. The patient probably has pretty good reading and distance vision without glasses. What is the patient’s visual goal? They want 20/20 distance without correction and now lose all ability to read?
Is there benefit for anterior chamber washouts for the treatment of infectious keratitis extending into the anterior chamber and when do you consider utilizing it?
When it comes to corneal infections, there is no evidence that an 'anterior chamber washout' and putting antibiotics in the AC does anything. In ophthalmology, we can 'carpet bomb' the cornea with antibiotics. Fungal infections and acanthamoeba are much harder to treat, but still not clear than doin...
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 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 patients with Stickler syndrome, would you recommend prophylactic laser to areas of lattice?
There is a growing body of evidence that laser retinopexy in patients with Stickler syndrome significantly reduces the risk of retinal detachment. Up to 60% of patients with Stickler syndrome develop retinal detachment, with those with type 1 and type 2 Stickler syndrome at the highest risk. Extende...
How do you go about assessing a patient that has had refractive surprise following cataract surgery when determining the cause for surprise and in preparation for the other eye?
Pretty simple, if at the visit at 1 week BEFORE the second eye is done, if the vision is NOT good and they are refracted and there is a surprise, then look again. If necessary, DON'T do the 2nd eye until you know what is going on with the first surgery!
How do you approach IOL calculations and selection in patients with keratoconus based on disease severity?
Lens selection assuming stable KCN and no plan for a transplant: Symmetrical astigmatism and they don't want to wear CL after surgery? Can consider a toric lens. Symmetrical astigmatism and they are okay with continuing RGP/sclerals? Monofocal aberration-free lens. Asymmetrical astigmatism and want...