Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you individualize treatment choices for progressive myopia in children?
For all patients, I recommend at least 14 hours/week (on average 2 hours/day) of bright sunlight exposure to slow myopia progression. I also recommend limiting near work to academic work as much as possible. If playing video games or watching shows, better to use a TV at a distance rather than phone...
What are the most effective strategies for managing post-operative complications such as scarring in pediatric oculoplastics surgeries?
Massage, topical steroids.
What techniques do you use to minimize the risk of buckle extrusion or infection, especially in younger or highly myopic patients?
No different techniques. Make sure you soak the elements in saline with an antibiotic. Do not touch the buckle with your hands. Do not use instruments that can damage the silicone. Extrusions and infections are not common. Kids have a healthy Tenon that will keep buckles from extruding. Also, buckle...
How would you approach choosing a MIGS procedure for a patient with mild glaucoma with progressively worsening PAS undergoing cataract surgery?
In a patient with mild glaucoma and progressive PAS undergoing cataract surgery, I first assess whether the mechanism is primary or secondary angle closure, such as from uveitis. Context is important here. Given that the angle is at least partially compromised, I generally avoid angle-based MIGS at ...
In which cases of post-injection endophthalmitis should early vitrectomy be considered if there is little to no improvement 48 hours after a tap and inject and there is no organism isolated?
Prompt vitrectomy should be considered in all patients with post-injection endophthalmitis (PIE) if there is no improvement 48 hrs after a tap and inject. The initial tap did not identify the organism. Non-infectious endophthalmitis can be included in the differential diagnosis of persistent inflamm...
What are the clinical indications for performing a second laser peripheral iridotomy (LPI) instead of proceeding directly with cataract surgery?
The only reason for a second LPI in CACGL or occludable angle is if sector iris bombe develops due to posterior synechiae formation. Otherwise, one LPI will normalize the pressures between the posterior and anterior chambers. If you still see progressive angle closure after LPI, you are dealing with...
In eyes with lamellar macular holes, what clinical or OCT features push you toward recommending surgery versus continued observation?
Most published papers and my personal surgical experience suggest that surgery on eyes with a lamellar hole alone (i.e., without a significant associated ERM) RARELY yields visual improvement. For this reason, I generally discuss the surgical option only in patients with progressive expansion of lam...
How has your use of SLT changed given the 6-year results of the LiGHT trial?
I offer primary SLT to almost all of my treatment-naive patients with OHTN or POAG, and most patients with mild-moderate disease who have never received SLT. I counsel patients that with primary SLT, they are less likely to show disease progression at 6 years and less likely to require incisional gl...
In clinical practice, how can AMD imaging biomarkers guide risk stratification and shape discussions with patients regarding prognosis and monitoring?
When I see a patient with intermediate AMD, if I see biomarkers on OCT such as hyperreflective foci (HRF), drusen that have hyporeflective cores, lots of drusenoid deposits, acquired vitelliform lesions, or areas of thick basal laminar deposit, I realize that patient is at higher risk for progressio...
What is your preferred regimen for treating recalcitrant and recurrent macula-threatening ocular toxoplasmosis?
Treatment options for ocular toxoplasmosis include: Trimethoprim/sulfamethoxazole (Bactrim) Azithromycin Pyrimethamine + sulfadiazine + folinic acid Atovaquone Oral clindamycin Intravitreal clindamycin I usually start with Bactrim DS PO BID. If a patient is sulfa allergic or pregnant, I start with a...