Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you decide which secondary IOL to place in an aphakic eye?
I am a fan of scleral fixated IOLs as they can be inserted through a smaller corneal incision than ACIOLs, they present less risk when it comes to corneal decompensation and glaucoma, and have predictable refractive outcomes. I personally use a modified needle-assisted Yamane technique for my second...
How do you decide whether to continue hydroxychloroquine in a young patient who develops subretinal neovascularization with no other risk factors?
Hydroxychloroquine (HCQ), an anti-inflammatory and immunomodulatory agent, is used to treat autoimmune diseases (rheumatoid arthritis, lupus, Sjogren’s disease, etc.) and malarial prophylaxis. Vision problems can ensue resulting from these deleterious irreversible effects of HCQ on retina if the cum...
When should amblyopia treatment be initiated in patients being treated for retinoblastoma?
There is decent data (small numbers) that amblyopia therapy is beneficial in RB patients, even those with macular/foveal involvement if this is unilateral. The timing for initiation is not clear, however. Treatment initiation is probably most effective once tumor burden is under control enough to ha...
How do you manage dry eye syndrome due to lacrimal or meiobian gland dysfunction after external beam radiotherapy?
I have also found autologous serum (AS) or platelet-rich plasma (PRP) eye drops/tears to be extremely useful (provided by an ophthalmologist). Dry eye can also be exacerbated by graft vs. host disease, which I have anecdotally seen worsened within radiation fields and is characterized by a lasting m...
What dose would you use for a plaque brachytherapy for a melanoma involving the iris?
The following isotopes have been used for radioactive plaque therapy to treat choroidal melanomas: 125I, 103Pd, and 131Cs as low-energy seeds, and 106Ru as β emitter. The dose used for uveal melanomas is between 80-90Gy with most studies reporting doses ~85 Shields et al., PMID 10980767. In this lar...
How should diabetic retinopathy surveillance be adjusted for patients starting GLP-1 agonists?
As with traditional anti-hyperglycemic medications, GLP-1 agonists may cause transient worsening of diabetic retinopathy due to the initial rapid control of blood glucose. Therefore, if a patient has existing retinopathy and is about to start GLP-1 agonist therapy, I recommend closer monitoring. For...
How do you determine the timing of surgical intervention for traumatic cataracts in children?
When it is visually significant or blocking the view to the posterior pole.
How do you manage a twice-recurrent mucinous adenocarcinoma of the lower eyelid with direct involvement of the lateral rectus muscle and lacrimal duct?
These are difficult cases. In the past, I have successfully treated a couple of these tumors with neoadjuvant immunotherapy, which allows for reduction in tumor volume to allow for an eye-sparing surgery. Because the orbit is involved, radiation should not be given due to the profound complications ...
What factors guide the decision to treat with ROP laser treatment versus a repeat anti-VEGF injection in a child who has previously received anti-VEGF therapy for retinopathy of prematurity (ROP)?
In patients who have a recurrence of stage 3 neovascular ROP following anti-VEGF injection, I will typically perform laser unless the patient is systemically unstable and cannot tolerate sedation or anesthesia, or unless the patient still has very posterior disease (zone 1 or posterior zone 2). In p...
How do you determine whether to proceed with topography-guided PRK, lamellar keratoplasty, or a full-thickness transplant in patients with irregular astigmatism and corneal scarring?
Start with a rigid gas permeable refraction. If the vision can be improved to a satisfactory level, then something like topography-guided PRK could be considered, or simply fit the patient in a RGP/Scleral lens. If the vision is still not adequate, a lamellar keratoplasty can be considered. Although...