Pupil Pod

Jordan Deaner, MD, vitreoretinal surgeon and uveitis specialist at Wills Eye Hospital, talks to Ogul Uner, MD, about white dot syndromes, a group of inflammatory chorioretinopathies. In the discussed case, a 35-year-old woman presented with photopsias in both eyes, and dilated examination showed 1+ vitreous cells and gray-white lesions in both eyes. Dr. Deaner explains what additional questions he would ask about this patient's history and how he would start to build a differential diagnosis. Drs. Uner and Deaner further discuss the typical presentations of white dot syndromes, including acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), and others.

Julie Woodward, MD, oculoplastic and orbital surgeon, joins host Sila Bal, MD, MPH, to discuss surgical and nonsurgical treatment options for facial aesthetics and rejuvenation. In the case discussed, a 62-year-old woman presented with complaints of looking tired and was interested in rejuvenation options. Examination revealed mild dermatochalasis, periorbital rhytids, mid-face volume loss, and jowling. Dr. Woodward shares insights into determining the most appropriate treatment approach for patients like this. 

Jeff Pettey, MD, MBA, joins the podcast to review a case of a 75-year-old woman who presented with blurred vision. She had nuclear sclerosis with uniform brunescence in her right eye, an intumescent white cataract in her left eye, and poor red reflex in both eyes. Dr. Pettey reviews this patient's options for cataract removal and explains the indications and key steps of small-incision cataract surgery (SICS). 

Ogul Uner, MD, invites Scott Oliver, MD, to the podcast to review a case of a 60-year-old man who presented with new flashes, floaters, and blurriness in his inferior field of vision in his right eye. The patient is a high myope with a relative afferent pupillary defect and pigmented cells in the anterior vitreous, with OCT imaging showing a macula-off retinal detachment. Dr. Oliver shares his approach to this case, reviews risk factors for retinal detachments, and shares insights into treatment.

In this episode, Kingsley Okafor, MD, joins Ogul Uner, MD, to review a case of a 40-year-old man who presented with intermittent visual changes, pain, and halos in his left eye. On examination, the patient had an IOP of 19 mm Hg, mild myopia, pigment on the corneal endothelium, and midperipheral transillumination iris defects in both eyes. Dr. Okafor reviews findings for pigment dispersion syndrome (PDS) and risk factors for developing pigmentary glaucoma.

Cohost Ogul E. Uner, MD, invites the original host of the podcast, Sila Bal, MD, MPH, to discuss a case of possible Stevens-Johnson syndrome (SJS). The patient is a 55-year-old woman with a recent treatment of ibuprofen and doxycycline for cellulitis on her left foot. She was referred to Dr. Bal due to a concern for SJS. Dr. Bal outlines how patients with SJS typically present and describes her diagnosis and treatment approach in these cases. 

In this case, a 55-year-old man presented with an uncontrollable spasm on the right side of his face. Sila Bal, MD, invites oculofacial surgeon Julie Woodward, MD, to explain how she would approach the examination of this patient, describing the questions she would ask to obtain a detailed family and medical history and determine if the condition is a hemifacial spasm, blepharospasm, or myokymia. She shares insights into distinguishing each condition and outlines diagnostic and treatment approaches.

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.

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.

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.

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. 

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.

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.

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.

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.

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. 

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Sila Bal, MD, MPH, welcomes Dagny Zhu, MD, to the Pupil Pod to discuss a case in which a 37-year-old woman was interested in learning about all options in refractive surgery. Dr. Zhu explains how she approached this consultation and outlines the differences in patient selection, limitations, and potential complications for LASIK, PRK, SMILE, and other refractive procedures. The two also discuss considerations and pearls for performing refractive enhancements.

Sila Bal, MD, MPH, continues her conversation with Iqbal Ike K. Ahmed, MD, FRCSC, regarding surgical options for patients with glaucoma. In this episode, they review a case of a 57-year-old man with pseudoexfoliation glaucoma who inquired about laser therapy as an option over eye drops. Dr. Ahmed explains which types of glaucoma are the most appropriate for treating with selective laser trabeculoplasty (SLT) and comments on the benefits and risks of using SLT as a first-line therapy. Drs. Bal and Ahmed further discuss what outcomes surgeons can expect from SLT and when patients could see results.

Sila Bal, MD, MPH, welcomes Iqbal Ike K. Ahmed, MD, FRCSC, in the first of a two-part episode to review a case of a 68-year-old man with a history of primary open-angle glaucoma who experienced progression of a visual field defect and glaucomatous optic neuropathy. Dr. Ahmed shares insights into when to proceed with incisional surgery in these patients and discusses relative contraindications and potential complications of performing trabeculectomy. He also discusses how earlier intervention with minimally invasive techniques has changed the glaucoma surgery field.

Sila Bal, MD, MPH, welcomes Daniel S. Choi, MD, to discuss the case of a 65-year-old woman with Fuchs endothelial dystrophy who was interested in a corneal transplant. Dr. Choi outlines the surgical steps and indications for penetrating keratoplasty (PKP), Descemet stripping endothelial keratoplasty (DSEK), and Descemet membrane endothelial keratoplasty (DMEK). He also explains the potential postoperative complications one might experience following each procedure and reveals how he would approach this case. Drs. Bal and Choi also touch on newer developments for treating endothelial dystrophy such as Descemet stripping only (DSO).

In this special live episode of Pupil Pod, hosted by YoungMD Connect, Sila Bal, MD, MPH, and Brent Kramer, MD, reviewed the unique case of an 18-year-old woman with decreased vision and recurrent corneal erosion as a manifestation of complex regional pain syndrome (CRPS)—a degenerative nerve condition. Dr. Kramer outlined his approach to the case, including the diagnostic testing he performed, and explained the pathogenesis and causes of neurotrophic keratitis (NK) and the association between NK and CRPS. Further, he describes how he managed this unique condition and the patient's outcome from treatment.

Sila Bal, MD, MPH, invites David Khorram, MD, to discuss his experiences in global ophthalmology and how health care workers in remote regions of low- to middle- income countries treat ophthalmic patients. Dr. Khorram shares insights into the epidemiology of trachoma and how it is transmitted and treated. He also explains the advantages of performing manual small-incision cataract surgery over extracapsular cataract extraction in regions without access to phacoemulsification.

Sila Bal, MD, MPH, is joined by Neda Shamie, MD, to discuss the demographics and risk factors for the development of keratoconus and the genetic predisposition, environmental risk factors, and clinical manifestations of the disease. Dr. Shamie also shares expert insight into treatment approaches for each stage of keratoconus severity.

Sila Bal, MD, MPH, welcomes Amenze Osa Oriaifo, MD, to the Pupil Pod to discuss the potential risk factors for patients with primary open-angle glaucoma (POAG), ocular hypertension, and normal-tension glaucoma. Dr. Osa shares findings from the Early Manifest Glaucoma Trial on the effectiveness of lowering IOP for patients with new POAG and results from the Ocular Hypertension Treatment Study. The two physicians discuss how these findings should apply to patients' cases to prevent glaucoma progression.

Sila Bal, MD, MPH, continues her discussion with guest Elizabeth Shanika Esparaz, MD, in the second of a two-part episode of Pupil Pod's diabetic retinopathy series. In the previous episode, Drs. Bal and Esparaz broke down the risks associated with proliferative diabetic retinopathy (PDR). This episode dives into the take-home points and clinical applications from the Diabetic Retinopathy Study and other research, and Dr. Esparaz shares her approach to treating patients with high-risk PDR and clinically significant diabetic macular edema in her practice.

Sila Bal, MD, MPH, welcomes Jesse L. Berry, MD, to the Pupil Pod to discuss a complicated case of a 14-month-old patient who presents to the clinic with strabismus and leukocoria. Together, Drs. Bal and Berry run down the differences between heritable and nonheritable retinal diseases and provide a deep dive on the methods for identifying, treating, and managing retinoblastoma.

Sila Bal, MD, MPH, and Eric Gaier, MD, PhD, discuss a case of a 4-year-old girl with mydriasis, ocular pain, and vision loss. The physicians provide tips for identifying neuro-ophthalmic diseases that can lead to vision loss before examining treatments for third nerve palsy. 

Sila Bal, MD, MPH, welcomes Neda Shamie, MD, to the Pupil Pod to discuss lens selection for a patient prior to cataract surgery. The pair review the Helmholtz accommodation theory, patient selection for the different types of IOLs, advancements in presbyopia treatment, and more.

Sila Bal, MD, MPH, welcomes Neda Nikpoor, MD, to the Pupil Pod to discuss some of the criteria when screening a patient prior to refractive surgery. Drs. Bal and Nikpoor discuss the most important parts of a patient's social and medical history prior to operation, the risks which may present when operating on patients with preexisting ocular conditions, and other crucial conversations to have with patients before LASIK.

In this first of a two-part episode, Sila Bal, MD, MPH, is joined by Elizabeth Shanika Esparaz, MD, to discuss a 25-year-old newly diagnosed diabetic patient who experienced blurry vision and two episodes of subconjunctival hemorrhages in the 2 months prior. Drs. Bal and Esparaz walk through their initial screening process for patients with both type 1 and type 2 diabetes and provide answers for some of the common questions asked by newly diagnosed diabetic patients. 

In the debut episode of Pupil Pod, Sila Bal, MD, MPH, asks Alison Early, MD, to discuss the case of a patient who presented with a complaint of blurry vision 2 months after uncomplicated cataract surgery. Dr. Early describes the workup she performs in this situation when reassessing a patient and some of the potential diagnoses she considers initially.