Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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...
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...
What factors affect/correlate with viral PCR yield in aqueous in a patient with recurrent episodes of uveitis associated with high IOP?
Regarding viral PCR testing of aqueous for patients with recurrent episodes of hypertensive uveitis, I have the following thoughts: For herpetic uveitis specifically, HSV (1 and 2), VZV, and CMV, sampling the aqueous for viral PCR is highly sensitive (upwards of +90%) and comparable to that of vitre...
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 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...
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...
Does using a heads-up display for surgery improve ergonomics and surgical performance compared to a traditional microscope, or does the need to alternate between views reduce its long-term usability?
Disclaimer: I have only tried it in lab/demo sessions. The display is off to the side, which is NOT ergonomic. Then, there is the nearly imperceptible time lag, which I am told I am imagining. Finally, there is the ever-present hardware and especially software reliability problem. Even a relatively ...
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.