Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What factors will most influence your decision to offer ENCELTO to patients with macular telangiectasia type 2?
Yet another (presumably very expensive) surgical treatment for a chronic macular disease was approved on the basis of OCT measurements without demonstrating visual benefit to the patient in a disease with a slow, variable course. Show me quality of life studies and visual benefit justifying surgical...
In extremely premature infants born at <25 weeks gestational age, how do you individualize the timing and frequency of ROP screening?
Those extremely premature infants with an unstable clinical course or where the accuracy of GA was uncertain may need to be screened prior to 31 weeks PMA (post-menstrual age).Please see our paper: Souverein et al., PMID 38878959.In this study, among infants <=24 weeks gestational age at birth, we f...
Given concerns about cooperation, anesthesia, and predictability, under what circumstances do you use adjustable sutures in pediatric strabismus surgery?
With only a few exceptions, I usually do adjustable sutures for patients with double vision (a little older, able to report diplopia well, and when diplopia makes sense and they fuse with prisms in the clinic) or unusual strabismus, where results might be less predictable, and I want to avoid any un...
For patients with Light Adjustable Lenses, what has been your approach regarding YAG capsulotomy timing?
It is best to avoid performing a YAG capsulotomy before or during the light-adjustment period unless the posterior capsule opacification (PCO) is visually significant and functionally limiting. Although the YAG laser itself is safe and effective regardless of its timing relative to lens lock-in, sev...
What is your perspective on the role of digital binocular therapies in amblyopia management?
Digital binocular therapies are great for children who struggle to cooperate with the gold standard of patching. Digital binocular therapies like Luminopia have been studied on children with no or very small angle strabismus, and they are more appropriate for those with anisometropic amblyopia. Also...
What has been your experience with occluder contact lenses for intractable diplopia?
Poor, I’ve had better luck with scotch tape on one glasses lens placed in the center. It usually only needs a piece about an inch by an inch. This allows peripheral vision. Unfortunately, many don’t want to do this.
What long-term complications have you observed in previously stable preterm infants with incomplete peripheral retinal vascularization who did not undergo ROP laser treatment?
Great question. You can see a range of findings, from absolutely nothing to thinning of the avascular retina, lattice degeneration, abnormal insertion of the vitreous base, and localized staining of the end of the vasculature.
In cataract surgery following penetrating keratoplasty, do you think the use of scleral tunnel incisions versus clear corneal incisions meaningfully influence graft survival or astigmatic stability?
I generally prefer a clear corneal incision for most cataract surgeries following PK. Regarding endothelial safety, there are limited studies directly comparing endothelial cell loss or corneal edema between incision types. In my own experience over the past year, I have not encountered endothelial ...
What has been your experience with netarsudil in the management of corneal edema, particularly concerning its clinical effectiveness and insurance coverage?
I don't use netarsudil to treat corneal edema - I have discontinued it in patients who developed reticular epithelial edema (aka honeycomb edema), which is a rare but reported side effect with unclear mechanism. If elevated IOP is thought to be contributing to corneal edema, I typically use aqueous ...
How do you predict which patients are most likely to have a positive response to Oxervate?
I don't think you can predict which patients are most likely to have a positive response, unfortunately. I think Stage 1 or early Stage 2 neurotrophic ulcers are the best scenarios to use this treatment.