Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you counsel patients on the use of AREDS 3 vitamins (developed by B&L) without the support of clinical trials?
I make it clear that there are currently no prospective clinical trial data that demonstrate increased efficacy of the commercial AREDS3 formulation compared to AREDS2. I further explain that AREDS3 includes all of the AREDS2 components (but with a smaller dose of zinc) plus the addition of several ...
How do you disinfect reusable Goldmann applanation tonometer tips?
We use a dilute bleach solution to store the tips. We have a culture plate with a lid that has holes to support the tips while they soak. The tip is rinsed well with water prior to use. We do not use them in patients with active infection; instead, we use disposable products like the iCare tonometer...
What are some methods to deal with IOP elevations with intravitreal injections in a patient without glaucomatous damage that does not want to have AC taps with each injection?
In this situation, depending on the elevated IOP, use the standard medical approach: Iopidine1%, Cosopt, Alphagan 0.2%, and in some cases, Diamox 250 mg. Wait for half an hour and repeat if necessary, or send the patient home with one or more drugs. Of course, make sure of drug selective contraindic...
When should delayed removal of an intraocular foreign body be considered?
If you are deciding whether to close the globe first and then remove the IOFB with a later surgery, then first consider the type of IOFB and its potential to incite infection or inflammation. No matter what type of IOFB it is, the team repairing the ruptured globe should inject intravitreal broad-sp...
What intra-op and post-op strategies maximize the longevity of a functional bleb in younger patients?
Great question, and one which I hope others will chime in on. Intraoperatively, I really want to ensure a broad dissection of Tenon's capsule from the underlying sclera to allow diffuse flow of aqueous into the subconjunctival space. I inject MMC (0.2mg/ml) rather than use sponges, so I like to ensu...
In quiescent patients with history of herpetic keratouveitis with uncontrolled IOP on topicals, do you prescribe PGAs?
The evidence on prostaglandin analogues (PGAs) in the setting of herpetic anterior uveitis is nuanced. Traditionally, we have been taught to avoid PGAs in the setting of herpetic disease, given the theoretical concerns that these drugs could compromise the host's interferon defense system. But, more...
How soon do you consider repeating external diode (CPC) for a patient who's IOP remains relatively unchanged and uncontrolled post-op after initial CPC?
My experience is that a reduction is usually apparent by 6-8 weeks. If not at target level IOP, repeat the procedure and adjust parameters of treatment accordingly (duration on, cycle frequencies/duty cycle).
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 has immediate patient access to their medical records changed your documentation?
Interesting question. Complex to answer. I was taught always to write notes as if the patient would/could have access to them, so patient access has not significantly modified my approach over many years. Notes are primarily for documentation for ourselves and our colleagues; patient education can b...
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...