Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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.
How would you advise a younger patient with residual/recurrent optic nerve meningioma, proceeding with radiotherapy, about the risks of malignant transformation or induction of other brain malignancies because of radiation?
The risk of malignant transformation of an optic nerve sheath meningioma (ONSM) after RT appears to be remarkably low, much lower than the risk of blindness from an untreated, progressive ONSM. In a younger patient, I would lean toward RT for patients with imaging progression or early visual loss, ...
Do you feel there is benefit to canaloplasty at the time of trabecular meshwork stent insertion in terms of ease of implantation or IOP lowering?
Although there is no high-quality data on this question, I think there is a benefit to canaloplasty when inserting Hydrus; I feel that they go in more smoothly and are less likely to dive into the suprachoroidal space when a viscocanaloplasty has been performed in the region of insertion. I don't th...
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.
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 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...
What is your preferred approach to managing a patient with tube exposure?
I typically put the patient immediately on a topical antibiotic until I can find OR time to surgically fix. I have seen others try Prokera or amniotic membrane grafts in the clinic if patients are very opposed to surgical correction, though these haven't worked well in my experience. I find that mov...
Do you feel there are medical advantages to FLACS and if so, what are they and how often are you offering FLACS to patients?
That's a question that's sure to trigger contentious responses!Personally, I think the capability of making toric marks on the cornea or lens capsule to line up toric lenses (and using iris registration to do so), as well as the ability to do LRIs, does offer some advantage for accuracy in astigmati...
Do you utilize thrombolytic therapy in patients with CRAO?
Yes. The previous trial was negative because patients with CRAO were included after 4.5 hours. There are trials underway in Europe for both tPA and TNK to address that. The retina will irreversibly infarct if the blood flow is not restored within 240 minutes (this is from basic science studies with ...
How do you approach cataract surgery in a patient with a history of radial keratotomy (RK) who desires postoperative independence from glasses?
Carefully. I would say I'm abrupt and dispel the notion they will be spectacle independent at all, given they are not candidates for MTF lenses and, even EDoF lenses, would have issues of aberrations in the visual system caused by the RK incisions. I literally hang the "black drape." That sort of sh...