Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
In patients with glaucoma who are not ideal candidates for goniotomy, angle stenting, tubes, or trabeculectomy, does the use of AlloFlo provide safe and predictable IOP control compared to other surgical options?
I have used it on one patient with severe glaucoma and a poor filtration bleb candidate. Bilateral implants. Pre-surgery IOP mid 20’s 4 meds. Now on latanoprost OU, IOP 15 OU. Now PO 3-4 months. Alloflo literature I believe shows a 40% reduction in IOP with a 40% reduction in medications at the 2-3 ...
What is your approach to intralesional steroid injection for chalazia (in terms of dosage, approach, timing)?
I offer the option of intralesional steroid to all patients with chalazia, particularly if there is significant inflammation present. I give up to 1 cc of a 10 mg/mL solution of dexamethasone. I have approached this by both transconjunctival as well as transcutaneous. I think transconjunctival hurts...
What is an effective technique for obtaining tissue for pathological analysis from a broad-based luminal punctal/canalicular mass?
If there is enough representative tissue outside of the punctum/canaliculus proper, then it can be incised sharply like any other marginal lesion (I prefer a 15-blade and Westcott scissors). If the pathology is limited to the lumen, then a modified punctoplasty could be considered. Dilate the punctu...
What treatment strategies do you use to reduce the risk of post-herpetic neuralgia after herpes zoster ophthalmicus?
For prevention, our best tool is the VZV vaccine (Shingrix). I recommend that all patients over age 50 consider receiving it. However, if an individual develops VZO and has persistent pain, I begin with antiviral therapy to assess whether subclinical viral activation is contributing to the pain (dur...
What is your perspective on using AI with OCTA to assess optic nerve blood flow in glaucoma management?
OCTA provides quick, reliable 3D scans that reveal both structural (NFLA, ON rim, cupping, GCC thickness, FAZ) and vascular (VD retina and ONH) information. Thus, it fulfills the requirements of both the mechanical and vascular theories. However, the busy ophthalmologist must scan through over 30 va...
How do you determine the appropriate toric IOL when there is a discrepancy in axis or cylinder power between optical biometry and corneal tomography during preoperative evaluation?
Always difficult. Always re-measure when discrepancies occur. For axis discrepancies, Auto Ks, topography, biometry, and past refraction. Past refraction is where the patient lived their entire life before their cataract surgery. Which of these tests aligns the most? Past refraction, especially pre-...
How soon do you consider repeating external diode (CPC) for a patient who's IOP remains relatively unchanged and uncontrolled post-op after initial CPC?
My experience is that a reduction is usually apparent by 6-8 weeks. If not at target level IOP, repeat the procedure and adjust parameters of treatment accordingly (duration on, cycle frequencies/duty cycle).
What is your algorithm for transitioning a patient with chronic noninfectious posterior uveitis from corticosteroids to immunosuppressive therapy?
There are some forms of noninfectious posterior/panuveitis where it is known from the time of uveitis diagnosis that steroid-sparing immunosuppression (IMT) will be needed. For example, in birdshot retinochoroiditis or serpiginous choroidopathy, IMT is often initiated in concert with oral corticoste...
How do you approach IOL calculations and selection in patients with keratoconus based on disease severity?
Lens selection assuming stable KCN and no plan for a transplant: Symmetrical astigmatism and they don't want to wear CL after surgery? Can consider a toric lens. Symmetrical astigmatism and they are okay with continuing RGP/sclerals? Monofocal aberration-free lens. Asymmetrical astigmatism and want...
What is your approach to audiometric monitoring for patients on Teprotumumab and how do you discuss the possibility of irreversible hearing loss with your patients?
I have set up a connection with our institution’s ENT and audiometry service to do a baseline test for any patient who is a candidate for teprotumumab. If the patient already has abnormalities in the high and ultrahigh frequencies, would not proceed to treatment. Would also repeat the test if the pa...