EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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E W GLAUCOMA 1 35 coemulsification with the iStent knowing how safe it is but also knowing that they still might need one or two medicines postop- eratively, Dr. Samuelson said. Additionally, patients with advanced glaucoma could be candidates for the iStent as long as both doctor and p atient understand that there will be an ongoing need for medications in that situation. "Absolutely we've incorporated iStent into early and moderate glau- coma, but as we go forward, I don't know that it needs to end there," he said. Individualizing care Incorporating the iStent into surgi- cal management of glaucoma gives surgeons even more of an ability to individualize patient care. Dr. Samuelson said he will often choose different options for different pa- tients or even use different treat- ments for the right and left eyes of a patient with asymmetrical disease. "For too long we have been applying the same procedures, tra- beculectomy and tube shunts, in a one-size-fits-all fashion across the entire spectrum of glaucoma sever- ity," he said. Patients vary in their risk from person to person. "It makes sense that we tailor the surgi- cal management, and now we have more options to do that," Dr. Samuelson said. Changing the definition of success When determining the "success" of a surgery, Dr. Samuelson said he sees the necessity of changing the con- cept of what is deemed a successful surgery. Previously there would be an absolute success or a qualified success, with an absolute success meaning the patient had controlled pressure and was off medications and a qualified success meaning the patient had controlled pressure and was still on some medications. Now it's possible that a surgery could be a success simply if there is little or no risk to vision loss or if the procedure is impeccably safe. "I think the adoption of iStent and the other MIGS procedures in the glaucoma portfolio has changed the way we think about the surgical management of glaucoma in a favor- able way," Dr. Samuelson said. "Now we've got something to offer, espe- cially in conjunction with cataract surgery, that can have a favorable effect on glaucoma, maybe not elim- inate all the medications, but be performed in a safe way that retains the terrific vision-enhancing aspects of cataract surgery." EW Editors' note: Dr. Samuelson has financial interests with Glaukos, AqueSys (Aliso Viejo, Calif.), Alcon (Fort Worth, Texas), Endo Optiks (Little Silver, N.J.), and Ivantis (Irvine, Calif.). Contact information Samuelson: twsamuelson@mneye.com February 2011 March 2014 At LENSAR ™ , we're always thinking ahead. That's why the LENSAR Laser System was specifcally designed with the needs of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR's ability to place laser pulses within 500 µm 1 of the posterior capsule results in a reduction in phaco energy up to 100%. 1 Visit LENSAR Booth #1321 at ASCRS 2014 to learn more. Come see what else we've thought of that makes LENSAR the intelligent choice for cataract surgery. ALWAYS THINKING AHEAD The LENSAR Laser System – fs 3D (LLS-fs 3D) is intended for use in patients undergoing cataract surgery for removal of the crystalline lens. Intended uses in cataract surgery include anterior capsulotomy, laser phacofragmentation, and the creation of full and partial thickness single-plane and multi-plane arc cuts/incisions in the cornea, each of which may be performed either individually or consecutively during the same procedure. Laser Capsulotomy, laser phacofragmentation and/or corneal incisions surgery is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greater than that of the intended treatment and for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have existing corneal implants, who have previous corneal incisions that might provide a potential space into which the gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsulotomy cut and the corneal endothelium, such as: hypotony, uncontrolled glaucoma, who have corneal disease or pathology that precludes transmission of light at the laser wavelength or causes distortion of laser light, such as: corneal opacities, residual, recurrent, active ocular or uncontrolled eyelid disease or any corneal abnormalities (including endothelial dystrophy, guttata, recurrent corneal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be treated, a history of severe dry eye that has not responded to therapy, a history of herpes zoster or herpes simplex keratitis. Potential contraindications are not limited to those included in the list. WARNING: The safety and effectiveness of this laser have NOT been established in patients with diabetic retinopathy, a history of treated glaucoma, or prior intraocular surgery. 1. Data on fle. LENSAR, Inc. © 2014 LENSAR, Inc. All rights reserved. LENSAR, the LENSAR logo and Augmented Reality are trademarks of LENSAR, Inc. 50-00060-000 01/14 At LENSAR ™ , we're always thinking ahead. That' of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR' to place laser pulses within 500 µm Visit LENSAR Booth #1321 Come see what else we've thought of that makes the intelligent choice for cataract surgery The LENSAR Laser System – fs 3D (LLS-fs 3D) is intended for use in patients undergoing cataract surger tial thickness single-plane and multi-plane arc cuts/incisions in the cor of full and par s why the LENSAR Laser System was specifcally designed with the needs , we're always thinking ahead. That' of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR' to place laser pulses within 500 µm 1 of the posterior capsule results in a reduction in phaco energy up to 100%. LENSAR Booth #1321 at ASCRS 2014 to learn more. Come see what else we've thought of that makes . choice for cataract surgery y. y for removal of the cr The LENSAR Laser System – fs 3D (LLS-fs 3D) is intended for use in patients undergoing cataract surger nea, each of which may be per tial thickness single-plane and multi-plane arc cuts/incisions in the cor s why the LENSAR Laser System was specifcally designed with the needs of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR' of the posterior capsule results in a reduction in phaco energy up to 100%. at ASCRS 2014 to learn more. Come see what else we've thought of that makes LENSAR y include anterior capsulotomy ystalline lens. Intended uses in cataract surger y for removal of the cr med either individually or consecutively during the same procedure. for nea, each of which may be per s why the LENSAR Laser System was specifcally designed with the needs of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added s ability time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR' of the posterior capsule results in a reduction in phaco energy up to 100%. 1 , laser phacofragmentation, and the creation ude anterior capsulotomy y, laser phacofragmentation, and the creation med either individually or consecutively during the same procedure. tial thickness single-plane and multi-plane arc cuts/incisions in the cor of full and par , laser phacofragmentation and/or cor Laser Capsulotomy y, laser phacofragmentation and/or cor for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have exis gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsul pathology that precludes transmission of light at the laser wavelength or causes distor neal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be tr rent cor , guttata, recur dystrophy y, guttata, recur zoster or herpes simplex keratitis. Potential contraindications are not limited to those included in the list. ARNING: The safety and effectiveness of this laser have NOT been established in patients with diabetic retinopathy W 1. Data on fle. LENSAR, Inc. © 2014 LENSAR, Inc. All rights reser nea, each of which may be per tial thickness single-plane and multi-plane arc cuts/incisions in the cor y is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greate neal incisions surger , laser phacofragmentation and/or cor for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have exis gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsul tion of laser light, such as: cor pathology that precludes transmission of light at the laser wavelength or causes distor neal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be tr zoster or herpes simplex keratitis. Potential contraindications are not limited to those included in the list. ARNING: The safety and effectiveness of this laser have NOT been established in patients with diabetic retinopathy ved. LENSAR, the LENSAR logo and Augmented Reality are trademarks of LENSAR, Inc. 50-00060-000 01/14 © 2014 LENSAR, Inc. All rights reser med either individually or consecutively during the same procedure. for nea, each of which may be per y is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greate neal incisions that might provide a potential space into which the neal implants, who have previous cor ting cor for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have exis neal endothelium, such as: hypotony otomy cut and the cor gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsul rent, active ocular or uncontrolled eyelid disease or any cor neal opacities, residual, recur tion of laser light, such as: cor y of severe dr eated, a histor neal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be tr . y y of treated glaucoma, or prior intraocular surger , a histor etinopathy y, a histor ved. LENSAR, the LENSAR logo and Augmented Reality are trademarks of LENSAR, Inc. 50-00060-000 01/14 med either individually or consecutively during the same procedure. r than that of the intended treatment and y is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greate neal incisions that might provide a potential space into which the neal disease or , uncontrolled glaucoma, who have cor as: hypotony y, uncontrolled glaucoma, who have cor malities (including endothelial neal abnor rent, active ocular or uncontrolled eyelid disease or any cor y of herpes , a histor y eye that has not responded to therapy y, a histor y of severe dr 130-135 Glaucoma_EW March 2014-DL2_Layout 1 3/6/14 4:12 PM Page 135