Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach management of GLP-1 receptor agonist therapy in patients who develop NAION?
Short answer is I recommend stopping the GLP-1 agonist if one eye has already developed NAION, for the sake of protecting the fellow eye. The fact is, our knowledge is still growing in this matter. While some studies indicate links between GLP-1 agonists and NAION, there are so many discussions arou...
What options would you consider for removing dense fibrin deposits from an IOL in a patient with chronic uveitis?
First, to ensure uveitis is adequately controlled before intervention, ongoing or recurrent intraocular inflammation increases postoperative inflammatory risk. If I am to do a YAG, I would want the patient to have no inflammation for 1-2 months. If I am to do a surgery, you would need to wait longer...
What is your approach to atropine dosing for myopia in children and when do you consider higher concentrations?
I have little experience with this. From what I understand, it offers inconsistent results at best.
What has been your experience with occluder contact lenses for intractable diplopia?
Poor, I’ve had better luck with scotch tape on one glasses lens placed in the center. It usually only needs a piece about an inch by an inch. This allows peripheral vision. Unfortunately, many don’t want to do this.
Which patients are good candidates for micropulse CPC?
Micropulse CPC is a suitable option for treating elevated IOP in a number of scenarios: advanced VF loss resulting in a small central or temporal island, intolerant to topical/oral glaucoma meds, poor general health limiting interventional surgery, no social support, and non-compliance.
What supportive care measures do you prioritize to manage or prevent toxicity in patients receiving Dato-DXd?
My supportive care approach is centered around early identification and management of interstitial lung disease (ILD) and mucositis, both of which were observed in the TROPION-Breast01 trial. Twelve patients (3.3%) in the Dato-DXd arm had adjudicated drug-related ILD/pneumonitis. I routinely obtain ...
What strategies do you use to manage refractory cystoid macular edema in uveitis patients who have already received ocular steroids and systemic immunosuppression?
For this clinical situation, especially if the CME is bilateral, systemic peg-interferon alpha is an excellent option. Commence with peg-interferon 180 mcg injected subcutaneously weekly. Check baseline CBC/diff and complete metabolic panel prior to starting treatment and at least weekly initially (...
How do you modify CPC (i.e., parameters, location of probe) in high myopes that may have thin sclera or more posterior ciliary bodies?
I often illuminate the eye to help visualize the ciliary processes. If I am worried about a thin sclera, I may start with a slightly lower energy and titrate up as needed.
In patients with Stickler syndrome, would you recommend prophylactic laser to areas of lattice?
There is a growing body of evidence that laser retinopexy in patients with Stickler syndrome significantly reduces the risk of retinal detachment. Up to 60% of patients with Stickler syndrome develop retinal detachment, with those with type 1 and type 2 Stickler syndrome at the highest risk. Extende...
What recommendations do you provide to patients who develop ocular side effects with Dupixent?
I would start with over-the-counter artificial tears without preservative and then refer to an ophthalmologist, ideally a corneal specialist who is experienced in the nuances of treating this condition. I have also had success switching from Dupixent to Adbry, although JAK inhibitors are a better o...