Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Is there benefit for anterior chamber washouts for the treatment of infectious keratitis extending into the anterior chamber and when do you consider utilizing it?
Regarding bacterial infections, I have never felt the need to perform an anterior chamber washout, as vancomycin and tobramycin drops have good intraocular penetration. You do not want to go do a washout on a reactive hypopyon, and many times it is hard to differentiate a reactive hypopyon from an e...
When do you use GLP-1 receptor agonists for the management of patients with idiopathic intracranial hypertension (IIH)?
I would use GLP-1 agonists in all overweight IIH patients who did not have a contraindication if it wasn't for the cost. In the IIH treatment trial, 6% weight loss over 6 months lowered intracranial pressure by about 50 mm (acetazolamide also lowered ICP by about 50 mm, but of course, it did it much...
In your experience, what factors prompt you to switch a patient with diabetic macular edema to Eylea HD?
In my practice, it isn’t switching to longer acting anti-VEGF, it is the treatment of the peripheral retinal ischemia. I often initially treat CSME with Avastin, but I use an IVFA to evaluate and treat the non-perfused retina with laser. It is the PRP that treats the VEGF production driving the diab...
What strategies do you use to improve Jones tube tolerability in patients who require CPAP therapy?
I have seen infections from CPAP in a patient who has never had surgery. Lower lid punctum plugs helped considerably. I’ve not seen this in a Jones tube patient. I’m sure any patient manipulating the tube would be unsuccessful. Plugging the tube with anything physical is unlikely to be possible. The...
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 incorporate intravitreal methotrexate injections into the management of traumatic retinal detachment repairs?
I do not use intravitreal methotrexate after ocular trauma. I assume the question is directed at the prevention and/or treatment of PVR. Multiple studies have shown this medication is not effective in the treatment or prevention of PVR.
In cases where placing an IOL in the bag/sulcus is not possible, how do you decide between leaving a patient aphakic for a scleral-fixated IOL (assuming this can't be done immediately) vs. placing an ACIOL?
In 2 situations, I would leave a patient aphakic even without an IOL: highly myopic patients where the actual IOL power is minimal +\- 3 D, in that case, glasses can correct residual refraction, supposing that the patient does not develop anisometropia monocular patients with up to 5 D residual ref...
How do you decide on when to start or continue anti-VEGF injections during pregnancy?
The safety of anti-VEGF medications in pregnant women hasn't been adequately evaluated with regard to fetal safety. If at all possible, I don't initiate anti-VEGF injections during pregnancy. If a patient is currently on anti-VEGF therapy and then becomes pregnant, I hold treatment at that point. Id...
How do you approach offering multifocal IOLs to patients with prior retinal pathology and surgery (i.e., mac-off RD) who have had relatively good recovery of vision?
As a retina specialist, I have seen a significant increase, over recent years, in patients doing badly because someone inserted a multifocal IOL in the context of prior or impending retinal disease. In most of these cases, the patients seemed naive to the implications, reporting that they were told ...
How do you approach patient selection for starting intravitreal complement inhibitors?
Because complement inhibition seems to have only a modest effect on GA progression, no clear functional benefit in pivotal trials, and a not-insignificant risk of CNV and optic neuropathy, I tend toward a conservative view when deciding whether to recommend it to patients. A good candidate, in my v...