Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Is optimal timing of choroidal drainage in the case of kissing choroidals with hypotony after glaucoma surgery different in a vitrectomized eye?
To answer the question, probably the timing is not different for a vitrectomized eye. One could make the case for more immediate surgery in the sense that there is no vitreous buffer between appositional retina layers, but I doubt there's much data to support that. On the subject of timing in genera...
How do you approach tube shunt placement in very high myopes with thin sclera?
Due to decreased scleral rigidity in highly myopic eyes, there is a higher risk of hypotony and hypotony maculopathy with filtering surgeries, including tube shunts. In choosing the type of tube shunts, I would favor a valved tube shunt in high myopes. For surgical technique, I take great care when ...
How do you utilize Diamox in patients with cerebral venous sinus thrombosis and vision symptoms who do not undergo thrombectomy/recanalization?
Diamox (acetazolamide) is often used to treat papilledema with associated visual loss in cases of CVST. While there is a theoretical risk of dehydration from acetazolamide with potential worsening of the thrombosis, 1) acetazolamide is a weak diuretic and 2) the risk of blinding visual loss usually ...
How do visual outcomes differ among scleral lenses, refractive surgery, and phakic IOLs in keratoconus patients with irregular astigmatism following cross-linking?
These are three distinct avenues of treatment for KC. The visual disability in keratoconus is secondary to perturbation of the corneal optics. This manifests itself in changes in sphere, cylinder, and optical aberrations. Scleral contact lenses, for the most part, correct all three and often give ex...
For patients with xanthelasma, aside from a lipid panel, do you perform any additional lab workup or send referrals?
Agree that recurrence is common, but there are no data that a high cholesterol or increased serum lipid is associated with them.
What is the best next surgical approach to manage severe inferior oblique overaction and superior oblique underaction after inferior oblique myectomy?
Persistent superior oblique (SO) muscle underaction after inferior oblique (IO) myectomy usually indicates an abnormal, loose, and floppy superior oblique tendon. At surgery, the first thing to do is traction testing of both oblique muscles to detect tightness or laxity. Videos of the "exaggerated t...
How do you approach management of GLP-1 receptor agonist therapy in patients who develop NAION?
Short answer is I recommend stopping the GLP-1 agonist if one eye has already developed NAION, for the sake of protecting the fellow eye. The fact is, our knowledge is still growing in this matter. While some studies indicate links between GLP-1 agonists and NAION, there are so many discussions arou...
How do you approach cases of transient monocular vision loss when initial carotid imaging and cardiac workup are unrevealing?
As you eluded, it is essential to rule out amaurosis fugax in a case of TMVL, and carotid Doppler and cardiac echo are two essential tests to evaluate the two potential sources of embolization in this setting. I would also recommend an MRI of the brain (to check for possible evidence of other ischem...
How do you counsel patients with GCA on the benefits of steroids who have already experienced vision loss?
I first tell the patient they are at considerable risk for further visual loss in the same eye or the other eye over the next 1-2 weeks. I also let them know that, even though their risk of visual loss has been reduced, their best option for preventing further visual loss is immediately starting hig...
What specific exam findings or test changes prompt escalation of care when evaluating pediatric patients with optic disc drusen for possible increased intracranial pressure?
Both pediatric and adult patients with optic disc drusen can develop increased intracranial pressure, including IIH, like normal individuals. This is important to remember, especially if the symptoms and risk factors suggest elevated intracranial hypertension. In the pediatric group, especially youn...