Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
When do you consider performing laser refractive surgery on corneal transplants?
This can be somewhat dependent on the tools you have available. In general, if the astigmatism is regular after a corneal transplant, depending on the corneal thickness and overall refractive error, you can consider photorefractive keratectomy in a transplantation patient. If the astigmatism is irre...
What is your approach to offering PRK for 1 diopter of myopia in patients over 45 with a corneal thickness of 450 microns and no keratoconus?
I am not sure why you would treat this patient?. One diopter of myopia over 45 years old. The patient probably has pretty good reading and distance vision without glasses. What is the patient’s visual goal? They want 20/20 distance without correction and now lose all ability to read?
How do you adjust postoperative refraction targets for LAL in patients with altered corneal anatomy?
I don't adjust any postoperative refraction targets based on prior refractive surgery or previous EK, but modify the approach to adjustments. In patients with a history of PRK/LASIK, we wait at least 6 weeks to initiate adjustments. In patients with a history of RK, we wait 8+ weeks to start adjustm...
In patients with early Fuchs’ endothelial dystrophy, how do you determine whether to proceed with cataract surgery alone versus a combined endothelial keratoplasty?
If Corneal thickness is >640 or specular microscopy is lower than 1,000, those are indicative of poor outcome after cataract surgery and patients may benefit from combined procedure. However, some patients with Fuchs can be misleading as having a low corneal thickness but a dense central guttae that...
In patients with corneal edema and a glaucoma drainage tube placed in the AC, under what circumstances would you consider repositioning the tube in the sulcus first versus proceeding directly with endothelial keratoplasty alone?
I have a pretty low threshold to just move these tubes to the sulcus as soon as my cornea colleagues are contemplating an EK. I am not a cornea specialist, but my impression is that first grafts almost always do better than second grafts, so I want to give that first one the best chance of survival....
How does LAL+ compare with other EDOF lenses?
The LAL+ combines an EDOF optical profile with the unique ability to fine-tune the refractive target postoperatively, offering a level of customization that goes beyond standard EDOF lenses. It provides a smoother range of vision with less anisometropia compared to traditional LAL monovision strateg...
What has been your experience using sutureless Müller’s Muscle-Conjunctival Resection (MMCR) for ptosis repair?
Personally, I get the desire to be less interventional, but if you are going to do this and it is 'less aggressive' than a levator resection, just put in a suture; it is not so hard.
How do you adjust your glaucoma management strategy for pregnant patients who require IOP lowering?
Managing glaucoma during pregnancy is challenging and requires a multidisciplinary approach in collaboration with the patient’s OB-GYN team. Several management strategies can be considered. Initially, close observation with frequent intraocular pressure monitoring and visual function/nerve assessmen...
Which IOL do you prefer for patients with a history of hyperopic LASIK to minimize the risk of inducing spherical aberration?
I prefer an IOL without any induced spherical aberration, such as the enVista monofocal, in my post-hyperopic LASIK patients. Other standard monofocal lenses (such as clareon monofocal, J&J monofocal, etc.) have a built-in negative spherical aberration that is intended to offset the standard positiv...
How do you determine whether to switch to a different anti-VEGF agent or to Ozurdex after a patient with diabetic macular edema fails a series of Avastin?
For my practice, macular oedema (CSME) is based on three factors. Ischemia, inflammation, and traction: the three factors which lead to persistent oedema. IVFA will show the level of non-perfusion in the far periphery, which is a major producer of VEGF, and laser (PRP) is the treatment. IV anti-VEGF...