Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your follow-up protocol with the light adjustable lenses?
I did all my own adjustments for my LAL patients for 2+ years before deciding to delegate these adjustments to my extender OD (not the referring OD). I have not seen any change in outcomes with this shift, but I find myself being more willing to offer LAL to patients now because I don't dread the po...
How do you optimize retinopathy screening schedules for patients on hydroxychloroquine while also prioritizing cost-effectiveness?
I'll approach this from the cost-effectiveness standpoint as I agree with Drs. @Dr. First Last and @Dr. First Last on their excellent points.Patients with SLE have remarkably high costs when you add up copays, medications, imaging studies, travel, missing work, etc. Anything we can do to help reduce...
What is your go-to multifocal lens?
As of today, the Alcon PanOptix for most patients who want a multifocal-type outcome. But more importantly, I think matching the strengths/weaknesses/side effect profile of each lens type with each patient's optical system and expectations. Well-controlled head-to-head studies regarding this would b...
Would you recommend observation or laser retinopexy in a young myope with asymptomatic lattice degeneration with retinal holes within lattice in each eye?
This is a difficult question to answer. I take into consideration many factors such as: activity/sports, family history of RDs, genetic results, location of lattice and traction around lattice, can they see me every 6 months, can they be imaged easily, disability, etc. It’s a discussion to have with...
In patients with myopic traction maculopathy, what clinical and imaging thresholds prompt you to intervene surgically rather than continue observation?
Given the risk of surgery, I typically follow patients conservatively as long as they feel the involved eye (when the other eye is covered) has visual function sufficient for important daily visual tasks such as reading, driving, working, etc. Many eyes continue to have functional vision even with v...
When should you seek hyperbaric oxygen therapy for patients with CRAO?
I usually pursue hyperbaric oxygen therapy within the 24-hour window from symptom onset for CRAO. This can be performed following TNK if given. In reality, though, there are multiple barriers to achieving this, including: Few centers offer hyperbaric oxygen therapy Labor intensive Difficulty with i...
Is optimal timing of choroidal drainage in the case of kissing choroidals with hypotony after glaucoma surgery different in a vitrectomized eye?
To answer the question, probably the timing is not different for a vitrectomized eye. One could make the case for more immediate surgery in the sense that there is no vitreous buffer between appositional retina layers, but I doubt there's much data to support that. On the subject of timing in genera...
How do you approach tube shunt placement in very high myopes with thin sclera?
Due to decreased scleral rigidity in highly myopic eyes, there is a higher risk of hypotony and hypotony maculopathy with filtering surgeries, including tube shunts. In choosing the type of tube shunts, I would favor a valved tube shunt in high myopes. For surgical technique, I take great care when ...
How do you utilize Diamox in patients with cerebral venous sinus thrombosis and vision symptoms who do not undergo thrombectomy/recanalization?
Diamox (acetazolamide) is often used to treat papilledema with associated visual loss in cases of CVST. While there is a theoretical risk of dehydration from acetazolamide with potential worsening of the thrombosis, 1) acetazolamide is a weak diuretic and 2) the risk of blinding visual loss usually ...
How do visual outcomes differ among scleral lenses, refractive surgery, and phakic IOLs in keratoconus patients with irregular astigmatism following cross-linking?
These are three distinct avenues of treatment for KC. The visual disability in keratoconus is secondary to perturbation of the corneal optics. This manifests itself in changes in sphere, cylinder, and optical aberrations. Scleral contact lenses, for the most part, correct all three and often give ex...