Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What factors guide the decision to proceed with trabeculectomy in a patient with advanced glaucoma who retains good central vision?
You have to ask yourself, what is your IOP goal? What is the superior conjunctival status? What is your experience with trabeculotomy surgery? Axial myopia or hyperopia, age, and race of the patient will all affect the outcome of the filtration procedure. If your IOP goal is single digits, trab with...
When should surgical resection be considered for vasoproliferative tumors?
Ideally, vasoproliferative tumors should be treated when they are small and receptive to local treatment. This prevents them from growing and proliferating to the point where surgical resection might need to be considered. Tumors can usually be controlled when they are small using direct thermal las...
What factors guide the choice between early versus delayed vitrectomy after an open globe injury?
The vitrectomy should be performed as early as possible in the presence of endophthalmitis or a posterior segment IOFB. The timing of retinal detachment repair (RDR) after open globe injury is controversial. The biggest risk of delaying RDR is the progressive development of proliferative vitreoretin...
How do you decide between escalating treatment with additional IOP-lowering medications versus surgical options for patients with normal tension glaucoma and progressive visual field loss despite well-controlled IOP?
Consider the number of drops the patient needs to control their IOP. Are there any local side effects other than allergy—tearing, redness, dry eye, etc.? All of these can affect compliance and efficacy. A patient using more than two bottles of eyedrops is most likely going to be poorly controlled ov...
What is your approach to eyelid reconstruction in children with severe congenital or acquired eyelid defects?
While fixing the "problem" can be extremely important for ocular health and for social ramifications, the most important things to consider first in newborns are the protection of the cornea and concern for amblyopia. Many conditions may not require emergent ocular repair as long as the family can a...
How would you approach the management of dry corneal melt in a patient requiring high dose systemic steroids and no apparent underlying systemic autoimmune disease?
A corneal melt is a rare condition in which the cornea thins, usually at its periphery, which is the junction between the cornea and the sclera. A healthy cornea is avascular, but an array of antigen-presenting cells (APCs) is present at the corneal-scleral junction, presumably acting like guards to...
What is the best course of treatment for limbal stem cell deficiency with a perforated corneal ulcer?
Tough situation! I would tend to favor stabilizing the eye with an emergent PKP, sutured AMT, and temporary tarsorrhaphy if a glue application is not successful or possible. Once the eye has epithelialized, an SLET can be performed if the other eye is normal.
How do you approach the management of bilateral non-infectious uveitis in the pediatric population?
Fortunately, it’s rare. Depending on the severity and symptoms, topical steroids work well. Interestingly, children can develop increased pressure quickly, so you have to be careful. The iCare IOP tool is great to get pressures without doing an EUA. A Rheumatologist can also help you. If symptoms ar...
What strategies have you found effective in overcoming socioeconomic and cultural barriers to amblyopia treatment adherence?
My approach is to assess the caregiver's knowledge and understanding of the treatment first. Then I provide an explanation for why I’m recommending the treatment, and why it is important to do it within a certain timeframe due to the critical period of visual development. I stress that LASIK or wear...
In a patient with active spondylarthritis and uveitis who cannot take TNF inhibitors, what is your next agent of choice?
Uveitis and typically acute anterior uveitis is commonly associated with Axial spondyloarthritides (SpA) but also other spondyloarthritides and is usually recurrent with exacerbation and resolution. The approach to the management of uveitis in my opinion is similar to patients without an underlying ...