Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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...
How do you approach a patient with idiopathic anterior uveitis who has ongoing disease despite adalimumab every two weeks?
This is a style question, I think. I thought it would be useful to note the choice here might depend on testing for anti-adalimumab antibodies as there is some suggestion that changing to once weekly adalimumab in the presence of anti-adalimumab antibodies might not be efficacious. (Ismayilova et al...
In a patient with isolated HLA B27+ anterior uveitis, how long would you continue immunosuppressive therapy?
Although the majority of patients with Human Leukocyte Antigen B27 (HLA B27)-associated recurrent, acute anterior uveitis have some evidence of spondyloarthropathy, this disease does occur sometimes with clinical disease only in the eye. The disease is not usually chronic (i.e., lasting longer than ...
How do you approach the management of recurrent episcleritis in a patient with RA that is otherwise well-controlled?
The episclera lies on top of the sclera. The majority of patients with episcleritis do not have a systemic disease, although patients with rheumatoid arthritis are more prone to develop episcleritis. Episcleritis must be distinguished from scleritis, which is also associated with rheumatoid arthrit...
Would you consider using a JAK inhibitor for a patient with RA associated scleritis?
Yes, I have used it before with success when with limited options. I recommend speaking to the MSL from one of the JAKi developers and they can provide the data to make an informed decision or to appeal to insurance if denied.
Does a low serofast RPR titer (such as 1:1 or 1:2) in the setting of a remote history of appropriately treated latent syphilis in a patient with now uveitis of yet unknown etiology referred from ophthalmology for possible ocular syphilis make a diagnosis of ocular syphilis less likely?
I err on the side of offering empiric treatment. As syphilis rates have risen over the past 20 years, so has the incidence of syphilitic uveitis (Mir et al., PMID 37991790), and the question posed, therefore, represents a not uncommonly encountered conundrum for infectious disease consultants. Syphi...
When should methotrexate injections be initiated for proliferative vitreoretinopathy?
This is an excellent question with a nuanced answer. Currently, we lack substantial Level 1 evidence to guide precise treatment strategies for off-label use of methotrexate (MTX) in the treatment or proliferative vitreoretinopathy (PVR). Based on animal and human clinical retrospective studies, the ...
What alternative treatments are available for refractory filamentary keratitis in a patient for whom bandage contact lenses provide the only relief and who has failed cyclosporine and N-acetylcysteine drops?
Need to figure out what other eye issues exist that are related to this. Are there lid problems such as various lid malpositions, collagen vascular disease, systemic disease, or medication side effects? Then treat accordingly.
What examination findings are indicative of bilateral optic neuritis or optic neuropathy as the underlying cause of bilateral vision loss?
This is a general question, and the answer is very broad. Also, optic neuropathy and optic neuritis have different meanings. In summary, diagnosis of optic neuropathy is made by general eye exams, including visual acuity, pupillary exams, color vision, visual field, and examination of the anterior a...
How do you determine the most appropriate intraocular lens choice for children/teens based on age and developmental stage?
By intraocular lens (IOL) choice, I presume that you are asking mostly about choosing the appropriate power of the implant in the child who is growing. I now try to personalize that choice for each child. We developed a formula that can predict the future globe axial length of an individual eye usin...