Episodios
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Sila Bal, MD, MPH, welcomes Vivienne Hau, MD, PhD, to review a case of a 56-year-old man with a history of ocular hypertension and type 2 diabetes who presented with mild nuclear sclerotic cataracts and a decrease in vision in both eyes. Dilated examination showed tortuous renal vasculature, scattered hemorrhages, cotton wool spots, and hard exudates in both eyes. Dr. Hau describes these clinical findings and explains next steps for diagnosing and treating this patient.
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Sila Bal, MD, MPH, invites I. Paul Singh, MD, to discuss a recent case in which a 72-year-old pseudophakic patient with open-angle glaucoma inquired about alternatives to topical treatments due to compliance issues. Dr. Singh reviews the benefits of more interventional treatment options such as selective laser trabeculoplasty and drug delivery platforms and explains how he counsels patients about these options.
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¿Faltan episodios?
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Aleksandra Rachitskaya, MD, FASRS, reviews a case of a 70-year-old woman with a history of hypertension and type-2 diabetes who presented with changes to the macula. On dilated exam, small macular drusen was observed in both eyes. Dr. Rachitskaya discusses the additional questions she would consider to better understand the patient’s risk factors for age-related macular degeneration (AMD), geographic atrophy, and more.
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Sila Bal, MD, MPH, invites Rachel Simpson, MD, to review a case of a 56-year-old woman who presented with elevated intraocular pressure with inferior and superior disc thinning. The patient had not undergone an eye examination in 10 years and experienced no other visual symptoms. Dr. Simpson reviews how she would proceed after these findings, describing the questions she would ask regarding family history of glaucoma and potential next steps towards treatment.
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Sarah A. Avila, MD, an oculoplastic and orbital surgeon, joins Sila Bal, MD, MPH, to review a case of an 8-year-old boy who presented with worsening redness and swelling of his left eyelid over 3 days. He had normal findings on dilated examination with full extraocular motility. Dr. Avila reviews her approach to these cases, describes important orbital exam findings and considerations, and highlights the ‘six Ps’ of orbital history: pain, proptosis, progression, palpitation, pulsation, and periocular changes.
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William Trattler, MD, joins Sila Bal, MD, MPH, to discuss a case of a 31-year-old woman who presented with pain and decreased vision in her right eye. Slit lamp examination revealed conjunctival injection and a unifocal area of stromal haze with no epithelial defects. Dr. Trattler explains further diagnostic strategies for this case to help determine the best treatment. He also reviews approaches to suppress inflammation in different forms of keratitis.
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Beeran Meghpara, MD, joins Sila Bal, MD, MPH, to review a case in which a 16-year-old boy with a scaly rash on his elbows also presented with a 1 month history of photophobia and mucoid discharge in both eyes. Dr. Meghpara explains how he would approach a patient with this history, what questions to ask, and what diagnoses he would consider. Drs. Bal and Meghpara discuss further examination findings and relevant treatment approaches.
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Caroline Baumal, MD, joins Sila Bal, MD, MPH, to discuss a case in which a 53-year-old man with a history of hypertension and type 2 diabetes presented with sudden painless loss of vision in his left eye. Dr. Baumal explains that a dilated exam revealed the retina had an opaque appearance with a cherry red spot, causing her to suspect central retinal artery occlusion (CRAO). Listen to gain insights into additional risk factors, pathophysiology, and how to approach patients with presumed CRAO.
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Andrea Tooley, MD, joins Sila Bal, MD, MPH, to review a case of a 33-year-old woman who presented with sudden onset periorbital pain and edema on her left side. On examination, vision was 20/20 with normal IOP and extraocular movements. Dr. Tooley walks through important orbital examination findings that physicians should evaluate in every patient with an orbital concern. Listen to gain insights into the approach to idiopathic orbital inflammation and other potentially concerning orbital inflammatory conditions.
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Brian Shafer, MD, and Sila Bal, MD, MPH, discuss important glaucoma studies that guide clinical practice and provide a deep understanding of how to manage patients. They review the Early Manifest Glaucoma Treatment Trial, the Collaborative Normal-Tension Glaucoma Study, the Advanced Glaucoma Intervention Study, and several others. Listen to gain insights into the benefits, effects, and approaches to lowering IOP.
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Avni P. Finn, MD, MBA, joins Sila Bal, MD, MPH, to discuss a case in which a 47-year-old man with a history of hypertension and type-2 diabetes presented with a sudden decrease in vision in his left eye. After observing tortuous retinal vasculature and intraretinal hemorrhages on dilated examination, Dr. Finn suspected branch retinal vein occlusion (BRVO). Drs. Bal and Finn further discuss the diagnosis and pathophysiology of BRVO and the most effective forms of treatment.
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Nicole R. Fram, MD, joins Sila Bal, MD, MPH, to discuss a case of a 68-year-old woman who presented as unhappy with her quality of vision 2 months after refractive cataract surgery. Dr. Fram reviews her typical preoperative screening process for refractive cataract patients, focusing on the ocular surface, patient lifestyle, and other diagnostic tools. She also describes how she educates patients preoperatively about their lens selection options. Drs. Bal and Fram further review common potential reasons that a refractive cataract patient might be unhappy with his or her vision, and Dr. Fram shares how she postoperatively assesses and manages these patients to improve outcomes.
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In this episode, Ehsan Rahimy, MD, talks to Sila Bal, MD, MPH, about a case of a 13-year-old girl who presented with floaters and decreased visual acuity for 2 weeks. Examination revealed 1+ vitreous cells with a focal area of necrotizing chorioretinitis. Dr. Rahimy outlines his approach to this case and his framework for making a diagnosis. He then explains how to navigate treatment strategies for rare infectious etiologies in the retina.
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Diana Laura, MD, joins Sila Bal, MD, MPH, to share a case in which a 22-week-old gestational infant girl presented to the NICU with respiratory distress and concern about retinopathy of prematurity (ROP). Dr. Laura explains the screening criteria for ROP in premature infants and reviews the identifying factors for ROP stages 0 through 5. Drs. Bal and Laura also discuss information and findings from multiple studies on ROP management and treatment.
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In this case review, Lisa K. Feulner, MD, PhD, describes a case of a 73-year-old woman who presented with gradually decreasing vision 3 years after cataract surgery. Host Sila Bal, MD, MPH, and Dr. Feulner discuss how to approach these patients and review the potential conditions that could influence decreased vision, such as ocular surface disease, glaucoma history, medications, etc. Dr. Feulner explains the diagnosis, treatment, and outcome for this specific patient and shares pearls for how to avoid common postoperative complications following cataract surgery.
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Sahar Bedrood, MD, PhD, joins Sila Bal, MD, MPH, to present a case of a 45-year-old woman who came to the emergency room reporting headache, nausea, blurred vision, and rainbow halos. Upon initial examination the patient’s visual acuity was 20/100 and had an acutely elevated IOP of 51 mm Hg OD. Dr. Bedrood discusses how she initially approached this patient and stresses the value of obtaining a detailed medical history. She outlines her examination and treatment process and shares insight into how she might have managed this patient with earlier intervention.
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In this episode, P. Dee G. Stephenson, MD, joins Sila Bal, MD, MPH, to review a case of cataract surgery evaluation for a 72-year-old patient with a history of an unknown eye infection, astigmatism, and an anterior stromal scar. Dr. Stephenson outlines her approach to preoperative planning and evaluation for all patients and describes how she counsels them about lens options based on their individual needs.
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Robert Melendez, MD, MBA, sits down with Sila Bal, MD, MPH, to discuss the case of a 32-year-old woman with a history of high myopia who came to the office for evaluation for refractive surgery. Dr. Melendez discusses which patients make good candidates for the EVO ICL (STAAR Surgical) versus traditional corneal refractive surgery. The two surgeons discuss the preoperative workups required for these cases and how to educate patients about the procedure. Dr. Melendez also shares surgical pearls he has gained from implanting these lenses.
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Jayanth Sridhar, MD, joins Sila Bal, MD, MPH, to discuss a case in which a 32-year-old man presented with floaters and decreased visual acuity for 2 weeks. Upon examination, imaging revealed peripheral whitening of the retina and opacification with areas of hemorrhages. Dr. Sridhar explains his approach in cases of infectious retinitis, outlines treatment strategies, and highlights the importance of working with an infectious disease uveitis specialist.
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In this episode, Morgan Micheletti, MD, joins Sila Bal, MD, MPH, to review a case of a 65-year-old woman with a history of high myopia and radial keratotomy who presented with pseudoexfoliation, a poorly dilated pupil, and a 3+ nuclear sclerotic cataract. Dr. Micheletti describes how he manages IOL calculations and preoperative assessments for patients with previous refractive surgery and outlines surgical insights in this case. He also explains considerations for patients with pseudoexfoliation syndrome and how to manage patients’ expectations of postoperative outcomes and recovery.
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