Pupil Pod

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.