Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What surgical strategies do you recommend for managing isolated skew deviation after stroke?
Skew deviation is a tough matter to diagnose and treat, but as a general fact the most cases of skew deviations occur along with an acute stroke or as a consequence of demyelinating disorders. Thankfully, most of them tend to disappear after a few weeks and rarely require treatment. Between the chro...
In cases of failed endothelial keratoplasty with concurrent cataract, do you favor repeat keratoplasty plus lens extraction in the same setting or sequential surgeries?
I tend to favor combining the two into one surgery. If the view is not clear enough or the patient is interested in a more accurate refractive outcome, the surgery can, of course, be staged with the endothelial keratoplasty first, followed by cataract surgery about 3 months or so later. With the use...
What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?
The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward. There are ...
In phacomorphic glaucoma with limited view, how do you approach surgical management (i.e., staged or combined surgery, temporize with LPI)?
In true phacomorphic glaucoma, the definitive treatment is cataract extraction. I first focus on medically lowering the IOP, and if the cornea is hazy, I do everything possible to clear it to obtain a safe surgical view. If the view remains limited, I’m comfortable using the biometry from the fellow...
How do you decide when to stop anti-VEGF injections for patients with exudative AMD?
The ongoing anti-VEGF injections are usually withdrawn when the clinical status of nAMD stabilizes with the absence of clinical activity for an extended period of time or, rarely, when the visual acuity improves to 20/20. I usually use the treat and extend protocol for the treatment of exudative AMD...
How do you balance empiric therapy and diagnostic testing in severe pediatric conjunctivitis presentations?
It depends on the meaning of "severe pediatric conjunctivitis." There are 3 main types of pediatric conjunctivitis that being bacterial, viral, and allergic. Viral needs to be broken down into viral and herpes viral, in the way they are treated. For routine pediatric conjunctivitis, which does not i...
How should Dato-DXd be managed in the absence of necessary resources for ocular exams and referrals?
We typically send patients for baseline slit-lamp exams prior to the start of Dato-DXd. If these resources are not available, telemedicine with slit-lamp biomicroscopic photography, as well as community screening resources, can be considered. Patients should still be educated on symptoms that would ...
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...
How do you decide the threshold and duration of subretinal fluid that can be safely tolerated in exudative AMD when adjusting treat-and-extend intervals?
There are so many other factors at play here. The very nature of this question begs the question of whether you are treating the patient or the OCT. Sadly, it appears the preponderance of patients I have seen are treated at fixed intervals of 1-2 months and no treat and extend, even from physicians ...
For patients with nAMD who are developing GA in the same eye, do you consider adding anti-complement therapy?
My personal perspective, shared by many colleagues around the country, is that the minimal anatomic and functional benefit of anti-complement therapy does not outweigh the aggregate risks and costs of perpetual treatment with these agents. I discuss these issues with my GA patients (including those ...