Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What are the pros and cons of Multifocal IOLs vs. EDOF IOLs?
Multifocal IOLs provide excellent near, intermediate, and distance vision with high spectacle independence, making them attractive for patients who prioritize reading and near tasks, but they achieve this via light-splitting diffractive optics that reduce contrast sensitivity and can cause significa...
How do you approach a patient with idiopathic anterior uveitis who has ongoing disease despite adalimumab every two weeks?
This is a style question, I think. I thought it would be useful to note the choice here might depend on testing for anti-adalimumab antibodies as there is some suggestion that changing to once weekly adalimumab in the presence of anti-adalimumab antibodies might not be efficacious. (Ismayilova et al...
How do you sequence IV steroids and IGF-1R blockade when inflammatory activity and proptosis coexist in a patient with active thyroid eye disease (TED)?
I don't find that steroids are actually necessary for patients who are receiving IGF1R inhibitors. The inflammation typically responds quite well to Teprotumumab (haven't tried Veligrotug yet), so steroids don't really add any benefit. These days, I only use IV steroids for patients who can't get IG...
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...
What operative techniques do you use to minimize the risk of postoperative ectropion in a patient with pre-existing lower eyelid laxity undergoing lower eyelid blepharoplasty?
I favor a transconjunctival approach for the fat excision or transposition, combined with either pinch skin excision or CO2 laser resurfacing, and horizontal tightening either by canthopexy (in milder laxity patients) or a full tarsal strip procedure in severe laxity or frankly ectropic patients.
For bilateral cataract surgery, what first-eye events trigger aborting the second-eye surgery that day?
For my immediate sequential bilateral cataract surgeries (ISBCS), any event that could increase the risk of second-eye intraoperative or postoperative complications will trigger the aborting of the second-eye surgery. Additionally, any situation that would require a breach of ISBCS protocol leads to...
How do you decide when to give or defer intracameral antibiotics for endophthalmitis prophylaxis during routine cataract surgery?
I give intracameral antibiotics at the conclusion of all my cataract surgeries, and this practice is heavily supported by evidence.In particular, I use non-diluted moxifloxacin 0.05-0.1 cc, from a Vigamox brand bottle or a bottle of generic moxifloxacin from a few select manufacturers that are known...
How often do you recommend ophthalmologic screening exams for patients with sarcoidosis?
The American Academy of Ophthalmology has guidelines for routine eye exams for an asymptomatic, healthy individual (not someone with sarcoidosis). These guidelines include a complete, dilated eye exam at age 40, interim exams at the discretion of the patient and one's ophthalmologist, and an exam ev...
How do you differentiate between macular schisis vs. macular edema vs. optically empty spaces (from macular telangiectasia) on OCT?
When trying to differentiate between these identities, I begin by looking at the morphology of the intraretinal fluid-filled spaces on OCT imaging. The cystoid spaces in macular edema caused by vascular leakage or medications (e.g., niacin) are typically round in shape and increase in size toward th...
How do you approach treatment of eyelid sarcoma?
I have not personally treated eyelid sarcoma but have treated SCC and adenexal carcinoma both definitively and in adjuvant settings. I have used 60 and 66 Gy in 2 Gy per fraction for adjuvant and definitive patients, respectively, with electrons using appropriate eye shielding.