Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How often and in what way do you monitor patients who are receiving teprotumumab (Tepezza) for thyroid eye disease?
A week or two after completion unless having an issue.
What is your approach to the diagnosis and management of optic chiasmitis in systemic lupus erythematosus?
Optic nerve involvement occurs in SLE but not commonly. I am aware of two case reports about 20 years apart describing inflammation of the optic chiasm in lupus. Both appeared the Neuroophthalmology and the most recent was 16:117, 2020. I would be cautious about making the diagnosis of lupus if sero...
How do you approach the planning of oculoplastic surgery for pediatric patients with craniofacial syndromes?
Those are very challenging patients because of the risk of amblyopia, from early keratopathy, and in more severe cases, even permanent corneal scarring. Then there is refractive amblyopia if not addressed early, and difficulty fitting with spectacles. Focus on early intervention, meticulous follow-u...
How do you integrate ophthalmic exam and surveillance into routine visits for cervical cancer patients receiving tisotumab vedotin?
The key is to identify and intervene early; in my practice, I personally see patients each cycle (q3 weeks) and do office ophthalmic exams. Look for eye redness, irritation, corneal lesions. Key to avoiding tox is prevention with the vasoconstrictor, steroid, and lubricating drops as well as cool pa...
When should you consider performing an AC tap in patients with suspected herpetic uveitis?
Anterior chamber paracentesis is a relatively low-risk procedure that can confirm a diagnosis of viral uveitis. In the setting of anterior uveitis, however, the false negative rate is relatively high, especially in comparison to positivity rates in viral retinitis/acute retinal necrosis. The benefit...
What factors should be considered when deciding whether to perform corneal crosslinking (CXL) in mild cases of keratoconus?
When deciding whether to perform corneal cross-linking (CXL) in mild cases of keratoconus, the most important factors to consider are age and evidence of progression. The presence of keratoconus in any pediatric patient is considered a high risk for progression to advanced disease. Therefore, any pe...
How do you manage Cancer-Associated Retinopathy (CAR) in a patient who doesn’t have a known cancer diagnosis, given the difficulty in finding the underlying cancer and the risks of using immunosuppressive treatments to preserve vision?
Auto-immune retinopathy, whether paraneoplastic or non-paraneoplastic, can be a very difficult condition to diagnose and manage. There are a few features that raise suspicion for a paraneoplastic cause particularly, such as rapid progression and more significant intraocular inflammation (anterior ch...
How do you differentiate between ocular involvement due to active tuberculosis versus latent infection in a patient with uveitis and suspected tuberculosis?
The type of ocular involvement (phenotype) is important to determine if the uveitis is related to active tuberculosis [like the presence of a single choroidal granuloma, serpiginous-like choroidopathy or choroiditis (unifocal or multifocal)] vs. a patient with recurrent unilateral anterior uveitis. ...
How do you approach the management of a patient with a small, indeterminate choroidal mass with no obvious primary malignancy?
First a careful history is obtained regarding the lesion itself. When was it first detected? Are there historical images to be obtained and reviewed? Are there symptoms associated with the lesion? When did they begin? Then a personal medical history regarding cancer and auto-immune disease is taken....
In patients with sicca symptoms and positive SSA/SSB how often do you perform other diagnostic testing such as salivary gland ultrasound, biopsy, Shirmers, ocular staining, stimulated salivary flow, etc?
In patients with sicca symptoms and positive SSA antibodies, I always try to confirm that they have objective evidence of dryness/gland involvement. This is because patients can say they have dry eye and/or dry mouth yet not have this bear out on objective testing (Bezzina et al., PMID 27992710, Rip...