Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
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...
Who are good candidates for light adjustable lenses?
Who is a great candidate? The LAL is a great option for a wide range of patients. In general, patients who prioritize quality of vision but want to achieve meaningful freedom from glasses are excellent candidates for LAL technology. The prototype candidate in my experience is a patient with a histor...
What has been your experience with the travoprost intracameral implant (iDose)?
My experience has been positive, but I consider patient selection prior to surgical planning to be crucial. At this time, I am mostly targeting mild to moderate POAG patients who are on 1-3 glaucoma medications (at least one being a PGA). I usually perform the iDose along with cataract surgery and a...
What factors affect/correlate with viral PCR yield in aqueous in a patient with recurrent episodes of uveitis associated with high IOP?
Regarding viral PCR testing of aqueous for patients with recurrent episodes of hypertensive uveitis, I have the following thoughts: For herpetic uveitis specifically, HSV (1 and 2), VZV, and CMV, sampling the aqueous for viral PCR is highly sensitive (upwards of +90%) and comparable to that of vitre...
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...
For patients with xanthelasma, aside from a lipid panel, do you perform any additional lab workup or send referrals?
Agree that recurrence is common, but there are no data that a high cholesterol or increased serum lipid is associated with them.
Have you experienced any significant refractive regression years after the final lock-in for light adjustable lenses?
But to be fair, the people who do these lenses have a vested interest in being positive about them. I would like to see a prospective double blind study.
How do you go about assessing a patient that has had refractive surprise following cataract surgery when determining the cause for surprise and in preparation for the other eye?
Pretty simple, if at the visit at 1 week BEFORE the second eye is done, if the vision is NOT good and they are refracted and there is a surprise, then look again. If necessary, DON'T do the 2nd eye until you know what is going on with the first surgery!
Do you feel there is benefit to subconjunctival steroid or MMC injection at the time of valved tube placement?
In my opinion, there is a lack of compelling clinical evidence and studies to support the injection of subconjunctival MMC at the time of valved tube placement. I consider the injection of a subconjunctival steroid in patients with poorly controlled inflammation and those who I think may be less com...
What are the advantages of using plexitome for treating recurrent corneal erosions compared with traditional methods?
There is no evidence that any surgical technique is better than the others (PTK, burr, or puncturing) in terms of recurrence rate. The Plexitome has the same concept of puncturing. The advantages over needle puncturing are: controlled spike depth, which is very minimal in Plexitome minimal corneal ...