Experts InSight

Drs. Chris Conrady and Akbar Shakoor join host Dr. Ben Young to teach us about why intraocular inflammation (IOI) sometimes occurs after intravitreal injections, how to differentiate these cases from endophthalmitis, and how to manage this potentially blinding condition. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Advocacy and policy leaders Dr. Michael Repka and Rebecca Hyder join host Dr. Andrew Pouw to share their experiences and perspectives about the Academy's work engaging with policy stakeholders. The conversation reviews recent government healthcare funding debates that may affect Medicaid and the Children's Health Insurance Program (CHIP). For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

In today's episode, host Dr. Amanda Redfern invites Dr. Nancy Newman to share updates in the treatment of Leber hereditary optic neuropathy (LHON), covering several clinical trials underway that involve idebenone and gene therapy.  For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

In today's episode, host Dr. Jay Sridhar is joined by Dr. Bobeck Modjtahedi to discuss the American Academy of Ophthalmology's new guidelines on autoimmune retinopathy (AIR), recently published in Ophthalmology Retina. A member of the Academy's task force on AIR and lead author, Dr. Modjtahedi discusses a new diagnostic framework for categorizing AIR as probable, possible, or unlikely based on specific clinical criteria. The guidelines address the challenges in diagnosing this rare condition that mimics inherited retinal diseases, and outline a standardized approach to classification for both clinical practice and research. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Davinder Grover and Ronald Fellman join host Dr. Andrew Pouw to discuss their latest innovative surgical advancement: interventional valve-enhancing trabeculotomy (iVEnT), an angle-based minimally invasive glaucoma surgery (MIGS) procedure. Compared with a traditional goniotomy, this alternative approach may be less invasive, sparing tissue and offering faster visual recovery for glaucoma patients. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Dr. Michael Puente joins host Dr. Ben Young to share his experience founding the first eye clinic specifically for adult and pediatric patients with intellectual developmental delay. Dr. Puente provides practical tips for all ophthalmologists to improve their care for this vulnerable population. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Louise Mawn and Jonathan Siktberg sit down with host Dr. Amanda Redfern to share their work on a groundbreaking paradigm shift in the treatment of periorbital necrotizing fasciitis with dilute hypochlorous acid. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. M. Ali Khan and Ajay Kuriyan join host Dr. Jay Sridhar to discuss updates in the retina space, including the FDA approval of photobiomodulation for dry age-related macular degeneration (AMD), OCT and OCTA reimbursement changes, and surgical technology advances. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Ashkan Abbey and Ehsan Rahimy join host Dr. Jay Sridhar to discuss recent developments in the medical retina and injectable space, including faricimab versus high-dose aflibercept, biosimilars for ranibizumab and aflibercept, off-label bevacaziumb shortages, dry age-related macular degeneration (AMD) therapies, private equity acquisitions, and the new drug pipeline. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Pediatric ophthalmologists Drs. Michelle Cabrera and Alejandra de Alba join host Dr. Ben Young to discuss the pros and cons of using botulinum toxin (Botox) for treating patients with strabismus, and whether every pediatric ophthalmologist—or even general ophthalmologist—should have this technique in their toolbox. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Medicare Advantage (MA) plans (also known as "Part C") are rapidly increasing in use, and beneficiaries' co-pay and claims denials are becoming more frequent. In today's episode, host Dr. Andrew Pouw talks with Academy billing and advocacy experts Joy Woodke and Brandy Keys to learn more about MA plans and their impact on patients and how ophthalmologists deliver care. To review the requirements put forth by your Medicare Administrative Contractor, visit the Academy's page on local coverage determination policies. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Host Dr. Amanda Redfern welcomes oculoplastic surgeons Drs. Davin Ashraf and Natalie Hoesly to discuss their approaches to postoperative pain management, with the help of a pain and addiction medicine specialist, Dr. Pat Liu. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Leading glaucoma experts Drs. Jamie Brandt and Pradeep Ramulu join host Dr. Andrew Pouw to talk about the burden of overdiagnosis and overtreatment of mild glaucoma, and mitigation strategies both in the clinic and at the policy desk. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Host Dr. Amanda Redfern welcomes Dr. Sravanthi Vegunta, a pediatric and neuro-ophthalmologist, to explain how to select the right radiologic imaging when you suspect a neuro-ophthalmic disorder. Dr. Vegunta breaks down idiopathic intracranial hypertension (IIH), papilledema, optic neuritis, optic atrophy, third and fourth cranial nerve palsies, Horner syndrome, and nystagmus.  For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Himani Goyal and Rahul Tonk sit down with host Dr. Jay Sridhar to discuss various diets (e.g., plant-based and Mediterranean) and nutritional supplements in the context of corneal and retinal disease, focusing on how to advise patients given what we know and what's supported by evidence and other medical specialties. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Dr. Thomas Johnson sits down with host Dr. Andrew Pouw to share exciting developments in regenerative stem cell research that may one day cure glaucoma. Learn more about Dr. Johnson's work in a recent presentation he delivered on behalf of the Glaucoma Foundation, and through the Retinal Ganglion Cell Repopulation, Stem Cell Transplantation, and Optic Nerve Regeneration (RReSTORe) Consortium.  For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Jason Comander and Rachel Huckfeldt join host Dr. Ben Young to review management considerations for patients with retinitis pigmentosa (RP). The discussion highlights the winding story of nutritional supplementation recommendations for vitamin A, and the importance of reanalyzing data behind established care patterns. While the latest findings confirm that vitamin E supplementation should still be avoided, they no longer support any generalized neuroprotective effect of high-dose vitamin A for RP.  For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Dr. Peter Quiros joins host Dr. Amanda Redfern to discuss the recent JAMA Ophthalmology article "The Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide," the first study to report a possible association between semaglutide (Wegovy, Ozempic, Novo Nordisk) and nonarteritic anterior ischemic optic neuropathy (NAION). Dr. Quiros provides an overview of what the study showed and what remains unknown, and how ophthalmologists should discuss these recent findings with their patients. Check out the Semaglutide and NAION patient brochure, courtesy of the North American Neuro-Ophthalmology Society (NANOS), and available from www.nanosweb.org. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Host Dr. Andrew Pouw welcomes Drs. Aakriti Shukla, Mahsaw Mansoor, and Alan Robin to discuss the latest sustainability initiatives in the ophthalmic OR and clinic that reduce waste, economic costs, and environmental impact. The participants gratefully acknowledge the joint support of the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery, the inspiration from physicians at the Aravind Eye Hospital, and the following individuals for their commitments to sustainability in ophthalmology: David Chang, MD, Barbara Erny, MD, Cathleen McCabe, MD, David Palmer, MD, Emily Schehlein, MD, and Cassie Thiel, PhD. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Maura Di Nicola and Basil Williams join host Dr. Jay Sridhar to discuss the latest ongoing ocular oncology clinical trials for the treatment of uveal melanoma and associated complications of radiation therapy. Their review begins with the DRCR Retina Network's Protocol AL, which is studying the use of anti-VEGF agents or corticosteroids to reduce the occurrence of radiation retinopathy and consequent vision loss. Drs. Di Nicola and Williams also offer insights about the use of Belzupacap Sarotalocan (Bel-sar) for early-stage choroidal melanoma (CoMpass trial), as well as adjuvant treatment with darovasertib, a protein kinase C inhibitor. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Emmanuel Chang and Eric Nudleman join host Dr. Ben Young to review Stickler syndrome, when to suspect, and how to diagnose this condition that can lead to significant systemic manifestations and severe vision loss. The panel also discusses the role and evidence for prophylactic treatments to reduce the rate of retinal detachment, which can occur in up to 65% of affected patients. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Host Dr. Jay Sridhar welcomes Dr. Gareth Lema to discuss his group's recent study published in Ophthalmology that quantified the amount of eye drop waste in ophthalmic clinics and the implications for practice. When handled appropriately, argues Dr. Lema, eye drops can be used until the FDA-regulated expiration date, and thus help reduce both their carbon footprint and costs while still providing safe and effective patient care. Read more: Tan JM, Chen B, Vail D et al. Ophthalmic drop waste due to self-imposed use cessation dates. Ophthalmology. 2024, Jul 1:S0161-6420(24)00391-9. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Dr. Tamara Fountain joins host Dr. Ben Young to discuss strategies to avoid medical mistakes, how to recognize cognitive biases that can lead to diagnostic error, and what we can learn from the airline industry to improve patient safety. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

The Centers for Medicare and Medicaid Services (CMS) created the new G2211 add-on code to address the time, intensity, and expense involved in conducting patient visits for the management of those with chronic and complex conditions. Use of this new modifier code can help ophthalmologists build strong long-term relationships with patients to benefit their longitudinal care. Drs. Lee Alward and Young Kwon join host Dr. Andrew Pouw to share their experiences and wisdom for building trust and rapport towards a valuable patient-physician relationship. Factsheet on HCPCS Code G2211 Visit Complexity Add-on Code: www.aao.org/g2211-code For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Spaceflight-associated neuro-ocular syndrome (SANS) is a constellation of findings that often present in astronauts who have undergone long-duration space flight in microgravity environments. Astronauts with SANS may have disc edema, choroidal folds, cotton wool spots, nerve fiber layer thickening on OCT, globe flattening, and hyperopic shift. In today's episode, neuro-ophthalmologist and NASA consultant Dr. Andy Lee shares what we know about SANS and its implications on our terrestrial knowledge, technology, and the future. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Episode Description Drs. Avni Finn and Yoshi Yonekawa join host Dr. Jay Sridhar to discuss the current state of retinal reimbursements and the impact that the cost of certain diagnostic and surgical procedures is having on the delivery of patient care. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

With increasing awareness that a retinal artery occlusion (RAO) is a type of stroke, ophthalmologists must be able to plan the next steps of care when an RAO is identified on exam. Drs. Amanda Henderson and Michael Carper join host Amanda Redfern to guide us through their recommendations and various tricky scenarios, notably whether or not to advise use of tissue plasminogen activator (tPA). For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

How do ChatGPT and other large language models (LLMs) work, and how might ophthalmologists harness their power for use in clinical practice? Drs. Peter Campbell and Travis Redd join host Amanda Redfern to discuss the advent of generative AI and its current and future implications for the practice of ophthalmology.  For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Dr. Chris Leffler, pediatric ophthalmologist and medical historian, joins host Andrew Pouw to discuss his study of the history of ophthalmology, ranging from the origin and use of the term "glaucoma," to the evolution of cataract surgery from antiquity to the modern era. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Annie Wishna and Royce Chen join host Jay Sridhar to discuss their experiences teaching trainees with surgical anxiety. Throughout the episode, our guests share their personal anecdotes, measures to overcome surgical anxiety, and how to foster a culture that supports pscyhological improvement. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Rupa Wong and Dagny Zhu join host Amanda Redfern to share their experience and expertise using social media to successfully promote their ophthalmic practices and enhance their professional careers. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Meghan Berkenstock, Stella Kim, and Lauren Dalvin join the show again to teach us about immune checkpoint inhibitors: game changers in oncology, but with a host of ocular side effects. All eye providers will be seeing more patients on this class of medication, and our panel teaches us what to look for and how to manage it. Additional resources: the National Comprehensive Cancer Network offers a suite of clinical practice guidelines to help clinicians manage immunotherapy ocular adverse events. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Fasika Woreta and Ekjyot Gill join host Jay Sridhar to discuss the literature and their experiences surrounding socioeconomic determinants of corneal pathology, and how social risk factors impact access to necessary corneal treatment and surgery. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Dr. David Huang joins the show to share his story of developing optical coherence tomography (OCT), for which he, Dr. James Fujimoto, and Eric Swanson won the National Medal of Technology, the highest award for innovators in the United States, as well as the 2023 Lasker–DeBakey Clinical Medical Research Award, often called "America's Nobel Prize." For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Host Jay Sridhar invites Drs. Sneha Kannan and Zirui Song to discuss their research group's recent publication in JAMA analyzing the association between private equity ownership and the rate of hospital adverse events, and what the results could indicate for ophthalmologists and other physicians. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Host Andrew Pouw and Dr. Chris Johnson, a leading authority on visual field research, discuss the advent of virtual reality (VR) visual field perimetry, its advantages over conventional bowl perimetry, and how this new diagnostic technology will impact the care for patients with glaucoma. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Natalie Homer and Andrea Tooley share some major can't-miss diagnoses in the lids and orbit that carry significant morbidity and mortality, including sebaceous cell carcinoma, orbital tumors, and infectious processes such as mucormycosis and necrotizing fasciitis. Strategies for imaging, histopathology, and management are also discussed. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

A surgical team from NYU Langone Health recently made history when it performed the world's first whole-eye and partial-face transplant in a patient who survived a high-voltage electrical accident. In today's episode, host Ben Young welcomes Dr. Vaidehi Dedania, a retina specialist and the primary ophthalmologist involved in the case, to discuss the surgery, the patient's progress, and the potential future for similar surgeries. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Adhering to an eye drop regimen can be difficult—especially for elderly patients with glaucoma. Those same patients often face an unexpected additional barrier to care when they run out of their medication and are denied early refills by a pharmacy or coverage by their insurance carrier. In today's episode, Dr. Kevin McKinney talks about how his own advocacy efforts at the state level helped protect early eye drop refills in Oregon. He advises what other US clinicians can do to advocate for their patients and empower them to receive the care they need, while also helping them administer eye drops effectively. Resources  The latest eye drop prescription refill legislation in your state (American Academy of Ophthalmology) Contact your state's department of insurance (Forbes) Sample card for patients to use when requesting early refill of an eye drop prescription (Oregon Academy of Ophthalmology) For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

How do you advise patients who need an intraocular tamponade but also plan to travel into areas of high altitude or by air? When should the surgeon opt for silicone oil instead of gas or air? Drs. Sarah Read and Jack Stringham share their experiences and pearls for managing retinal surgery in these challenging cases. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Where do guide dogs come from? How are they trained, and how do they functionally support patients with visual impairment or blindness? What steps should you follow to "prescribe" a guide dog? Which patients qualify, and how much does it cost? In today's episode, host Ben Young invites Jake Koch and his dog Forli from Guide Dogs for the Blind to share everything the ophthalmologist needs to know about guide dogs. Learn more about the services offered by Guide Dogs for the Blind. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Antibody-drug conjugates (ADCs) are new chemotherapeutic agents that can cause significant ocular side effects. Drs. Meghan Berkenstock, Lauren Dalvin, and Stella Kim review this new class of drugs and how they can affect the eye, providing essential tips for what to look for, when to screen, and how to treat the side effects.  Prescribing information mentioned in this episode: Elahere (mirvetuximab soravtansine-gynx) Tivdak (tisotumab vedotin-tftv) For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Maura Di Nicola and Basil Williams sit down with host Jay Sridhar to review how retinoblastoma treatments have evolved, including discussion of intra-arterial and intravitreal chemotherapy and liquid biopsy using aqueous humor samples. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Dr. Mike Chiang, Dr. Michael Boland, and Kent Mathewson join host Andrew Pouw to discuss the current state of clinical documentation in ophthalmology, the future of the electronic health record (EHR), the use of scribes, and legal considerations for documentation. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Julie Falardeau and Mike Lee discuss guidelines and pearls for the management of idiopathic intracranial hypertension (IIH) during pregnancy and childbirth. They share how pregnancy shifts the evaluation and management of the initial diagnosis of IIH and how it can affect patients who already have a history of the disease. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. M. Ali Khan, Ajay Kuriyan, and Sarah Read join host Jay Sridhar to discuss recent developments in intravitreal injectable drugs, including 8-mg aflibercept not initially approved by the FDA, the upcoming PDUFA date for on-label bevacizumab, and approaching injections for dry age-related macular degeneration (AMD). For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

In June 2023, the regional Medicare Administrative Contractors (MACs) almost uniformly introduced draft policy language indicating cessation of coverage for many minimally invasive glaucoma surgery (MIGS) procedures, including goniotomy and cyclophotocoagulation. In today's episode, host Andrew Pouw is joined by Dr. Alan Robin, the first executive vice president of the American Glaucoma Society, and Dr. Pradeep Ramulu, chief of the Glaucoma Division at the Johns Hopkins Wilmer Eye Institute, to discuss MACs, clinical evidence for MIGS, and advocacy efforts underway to protect patient access to MIGS procedures. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Drs. Anita Kohli and Imran Jivraj discuss the evaluation and management of patients with functional vision loss, also known as nonorganic or nonphysiologic visual loss, a phenomenon in which exam findings do not support an underlying organic etiology. Drs. Kohli and Jivraj offer pearls for how to handle both adult and pediatric patients. Functional vision loss can be challenging to identify and manage, and it's important to diagnose correctly as multiple studies have shown that there can be an association between functional vision loss and psychosocial stressors or other psychiatric diagnoses, especially among children.  For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Cornea specialist Dr. Travis Redd discusses the recent outbreak of extensively drug-resistant corneal infections associated with artificial tears and that has led to cases of permanent vision loss and death. Dr. Redd also reviews the challenges and risks of multi-use eye drop bottles. Since January 2023, the CDC, FDA, and state and local health departments have been investigating a multistate outbreak involving a rare, drug-resistant strain of Pseudomonas aeruginosa bacteria. As a result, the CDC has urged discontinued use of EzriCare Artificial Tears, and in February the FDA issued an additional warning about Delsam Pharma's Artificial Eye Ointment. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Ophthalmic genetic counselor Molly Marra and Dr. Lesley Everett discuss the pearls and pitfalls of genetic testing, especially in cases of suspected inherited retinal dystrophy. As discussed in the episode, the National Society of Genetic Counselors offers great tools to find genetic counselors who can advise you and your patients in the diagnostic journey. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.