Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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...
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.
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...
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...
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 approach recommending ocular exams for asymptomatic candidemic patients considering the discordance between the IDSA and American Academy of Ophthalmology guidelines?
Endogenous endophthalmitis due to Candida sp. occurs in <1% of patients with candidemia. The IDSA 2016 guidelines for management of candidiasis outline evaluation and treatment of patients with endophthalmitis, with recommendations to perform a dilated ophthalmologic exam on all patients with candid...