Pupil Pod
A case-based podcast hosted by Sila Bal, MD, MPH, covering all stages of the journey through ophthalmology, from first-year residents to leading experts. The show focuses on learning by sharing clinical cases and experiences in the field.
Episodes
Case Review: White Dot Syndromes (Part 2)
Maura Di Nicola, MD, joins Ogul Uner, MD, to talk about white dot syndromes, a group of inflammatory chorioretinopathies. They begin with a case of a 32-year-old woman who presents with blurry vision in the right eye for 2 weeks, with new onset floaters with mild pain and photophobia. Examination showed 2+ vitreous cells and multiple yellow-white chorioretinal lesions in both eyes. Dr. Di Nicola s
Case Review: Signs and Symptoms of Thyroid Eye Disease
Ogul Uner, MD, invites Amina Malik, MD, to review a case of suspected thyroid eye disease (TED) in a 44-year-old female patient who presents with eye redness and diplopia. The patient reported no recent illnesses or medications, and external examination showed upper eyelid retraction, edema, erythema, and mild chemosis. Dr. Malik shares her initial thoughts on the case and describes the diagnostic
Case Review: Uveitic Ocular Hypertension and Glaucoma
Erick Rivera Grana, MD, meets with host Ogul Uner, MD, to review a case of a 34-year-old woman who experienced blurred vision and mild discomfort in her right eye with an IOP of 38 mm Hg. The patient also presented with conjunctival injection and posterior synechiae. Dr. Rivera Grana describes his diagnostic approach to this case and explains the management of uveitic ocular hypertension and uveit
Case Review: Arteritic Anterior Ischemic Optic Neuropathy
Neuro-ophthalmologist Amanda Redfern, MD, joins host Ogul Uner, MD, to review a case in which a 70-year-old woman experienced intermittent visual disturbances and headaches. Examination revealed a relative afferent pupillary defect and optic disc inflammation. Dr. Redfern explains her initial diagnosis of arteritic anterior ischemic optic neuropathy (AAION) and outlines the typical demographics of
Case Review: Pars Planitis
Ogul Uner, MD, is joined by vitreoretinal surgeon and uveitis specialist Akshay Thomas, MD, for a comprehensive, case-based discussion on intermediate uveitis and pars planitis. In this case of a young patient presenting with floaters and blurred vision, Dr. Thomas breaks down how to distinguish intermediate uveitis from pars planitis and recognize key exam findings. The conversation highlights th
Case Review: Pediatric Glaucoma Diagnosis
Ogul Uner, MD, invites Ta Chen Peter Chang, MD, a pediatric glaucoma specialist, to review a case of a 9-month-old boy who presented with significant photophobia in both eyes. Examination showed IOP of 32 mm Hg in the right eye and 29 mm Hg in the left eye with moderate optic nerve cupping in both eyes. Dr. Chang shares what additional information he would look for to make a diagnosis of pediatric
Case Review: Acute Anterior Uveitis
Kareem Moussa, MD, speaks with Ogul Uner, MD, about a case in which a 30-year-old man presented with pain, redness, and photophobia in his right eye for 3 days. The patient reports that the pain was sudden, worsening, and similar to a previous instance 1 year prior in his left eye that had been treated with drops. Dr. Moussa explains the information he would need to determine a diagnosis and recom
Astigmatism Management During Cataract Surgery
In this episode, instead of reviewing just one case, Sila Bal, MD, MPH, invites Neda Shamie, MD, to share her insights into challenging cases of astigmatism management during cataract surgery. Dr. Shamie explains how modern patients have higher expectations for optimized refractive outcomes and reviews her preferred techniques for astigmatism management in these cases. They discuss limbal relaxing
Case Review: Retrobulbar Optic Neuritis
In this episode, John Chen, MD, PhD, joins Ogul Uner, MD, to share his experience in neuro-ophthalmology. In the case discussed, a 32-year-old woman presented with decreased vision and pain in her right eye for 1 week, and examination revealed a rapid afferent pupillary defect. The patient also mentioned she had experienced numbness in her right arm 1 year ago. Dr. Chen explains why he would suspe
Case Review: Diagnosing Neovascular AMD
Katherine Talcott, MD, joins Ogul Uner, MD, to review a case of a 70-year-old woman with a history of intermediate dry age-related macular degeneration (AMD). The patient now presented with wavy lines in her vision in the right eye, and dilated exam showed several large drusen in both eyes with no retinal hemorrhages. OCT of the right macula showed fibrovascular pigment epithelial detachments with
Case Review: White Dot Syndromes (Part 1)
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
Case Review: Dermatochalasis, Periorbital Rhytids, and Mid-Face Volume Loss
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 jo
Case Review: SICS for Bilateral Dense Cataracts
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 su
Case Review: Rhegmatogenous Retinal Detachment
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 app
Case Review: Pigment Dispersion Syndrome
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 syndrom
Case Review: Suspected Stevens-Johnson Syndrome
Cohost Ogul 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 diagn
Case Review: Hemifacial Spasm
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.
Case Review: Diagnosing Proliferative and Nonproliferative Diabetic Retinopathy
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
Case Review: Addressing Poor Medication Compliance With Interventional Glaucoma
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
Case Review: Risk Factors for Age-Related Macular Degeneration
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), geograp
Case Review: Elevated IOP and Disc Thinning
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
Case Review: The Six Ps of Orbital History
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 highlig
Case Review: Interstitial Keratitis
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
Case Review: Chronic Bilateral Conjunctivitis
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 findin
Case Review: Retinal Artery Occlusions
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 insight
Case Review: Idiopathic Orbital Inflammation
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 i
Glaucoma Study Review
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
Case Review: Branch Retinal Vein Occlusion
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 dia
Case Review: Assessing an Unhappy Refractive Cataract Surgery Patient
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
Case Review: Pediatric Ocular Toxoplasmosis
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 fo
Case Review: Retinopathy of Prematurity
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 fro
Case Review: Gradual Decreased Vision After Cataract Surgery
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
Case Review: Angle-Closure Glaucoma
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 de
Case Review: Cataract Evaluation With History of Infection and Corneal Scar
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 individ
Case Review: Evaluation of Patients for ICL Implantation
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 the
Case Review: Infectious Retinitis
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
Case Review: Complex Cataract Surgery for a Patient With a History of Refractive Surgery
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
Case Review: Refractive Surgery Consultation
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 co
Case Review: SLT for Pseudoexfoliation Glaucoma
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 trabeculop
Case Review: Progression of Glaucomatous Optic Neuropathy
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
Case Review: Corneal Transplant in Fuchs Endothelial Dystrophy
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 posto
Case Review: Neurotrophic Keratitis and Complex Regional Pain Syndrome
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
Case Review: Surgical Challenges in Global Ophthalmology
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 ext
Case Review: Expert Management of Keratoconus at Each Stage of Disease
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.
Case Review: Managing Patients With Early POAG and Ocular Hypertension
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
Case Review: Take-Home Points and Clinical Applications From Diabetic Retinopathy Studies
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 an
Case Review: Diagnosing and Treating Retinoblastoma
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.
Case Review: Identifying and Treating Pediatric Third Nerve Palsy
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.
Case Review: Finding the Right Lens
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.
Case Review: Defining the Criteria for LASIK Patients
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
Case Review: Screening a Newly Diagnosed Diabetic Patient
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 s
Case Review: Postoperative CME
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.
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