Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Are there any important considerations when initiating orbital radiation therapy for TED in a patient with diabetic retinopathy?
Recent research would suggest that the risk of radiation retinopathy in patients with DM undergoing orbital radiation therapy for TED is low (Makhoul et al., PMID 41450582). However, my personal preference is to explore all other medical options (Tepezza, EUGOGO protocol, Actemra, etc.) prior to tre...
Are there any special considerations when approaching ptosis repair in a patient with a prior trabeculectomy?
I have two main concerns with trabeculectomy patients (or any glaucoma filtering procedure). The first is avoiding overcorrection of ptosis, which can expose the bleb and increase the risk of blebitis. The second is respecting the conjunctiva. I generally avoid posterior ptosis repair (MMCR or Fasan...
For patients with evidence of prior bilateral uveitis (PS, pupillary membranes, inactive KP, no view posteriorly) who reports no prior symptoms and who has had negative lab work-up, when do you consider repeat work-up and which labs would you repeat?
This is a difficult question to answer succinctly, as so much information is missing to provide a complete response. However, it does raise some important points that are worth mentioning:There is a prevailing tenet, which I was taught as a resident and hear often from residents today, that 1st epis...
When do you use GLP-1 receptor agonists for the management of patients with idiopathic intracranial hypertension (IIH)?
I would use GLP-1 agonists in all overweight IIH patients who did not have a contraindication if it wasn't for the cost. In the IIH treatment trial, 6% weight loss over 6 months lowered intracranial pressure by about 50 mm (acetazolamide also lowered ICP by about 50 mm, but of course, it did it much...
How do you approach treatment in patients with pachychoroid disease who show fluctuating subretinal fluid without visual decline?
What is described has often been called chronic CS(C)R. I do not believe there is any proven treatment better than observation for these patients at this time, so observation it is.
What are the toxic effects of a small amount of intraocular perfluoron on the retina and cornea?
I have seen small amounts of PFO retained in the posterior pole and no inflammation was associated with it. But in some patients, particularly those with any subretinal PFO, retinal atrophy and chronic choroiditis can be seen. This will require surgical removal, especially if the PFO is trapped near...
How do you approach re-treatment in a patient with chronic central serous chorioretinopathy who has residual subretinal fluid after their first half-dose?
If the fovea is dry and the residual fluid is outside the fovea, I usually observe without additional treatment. If the residual SRF is subfoveal in location and decreasing compared with pre-treatment, I typically observe, hoping for continued improvement to a dry fovea. If there is residual subfove...
Has the CONDOR trial changed your first-line approach to treatment-naive proliferative diabetic retinopathy in a patient with good visual acuity who is able to attend regular follow-up visits?
No. In the US, we stopped using brolucizumab (Beovu) because of the risk of retinal vasculitis. So I don’t even think I can get that medicine anymore. For those who don’t know about it, CONDOR was a trial that studied the use of Beovu vs. PRP (panretinal photocoagulation) for proliferative diabetic ...
What is the standard of care for timing of a mac-off retinal detachment repair?
The literature on this topic is mixed and at times contradictory. My own synthesis of the literature, which I believe coincides with the consensus standard of care, suggests that repair of macula-involving rhegmatogenous retinal detachment is relatively time sensitive: urgent but not emergent. The c...
How effective is weight loss in improving visual function in IIH and how much weight loss/what strategies (i.e., formal exercise program, weight loss medications) do you recommend/counsel patients on?
Weight loss is a cornerstone of IIH management because it lowers intracranial pressure (ICP), which in turn improves papilledema and visual function. It works but should not be used alone for cases with moderate or progressive visual loss. In the IIH Weight Trial,[1] the magnitude of weight loss cor...