Eyeworld

JUN 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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June 2012 EW MEETING REPORTER 61 field loss," he said. "Elevated pres- sure is a major risk factor, thought to be due to an increased resistance in the trabecular meshwork, Schlemm's canal apparatus, leading to elevated pressure. The only proven treatment for prevention of visual loss is IOP lowering. The more advanced the disease, the lower the pressure needs to be." The treatment for glaucoma has not changed in the last 40 years, said Dr. Ahmed. Early interventions include pressure-lowering prescrip- tion drops followed by surgery such as trabeculectomy, but all of these treatments have significant prob- lems. "Glaucoma drops are our main- stay of treatment," he said. "We know that over a couple of years of treatment most patients require more than one drop. Most patients are not compliant. Drops are suc- cessful—they can work—but we have issues with compliance, side effects, and costs." Although trabeculectomy is considered the "gold standard" of glaucoma treatment, it can lead to the dreaded intraoperative choroidal hemorrhage and other complica- tions. "Trabeculectomy has significant baggage," Dr. Ahmed said. "There are a variety of complications that can occur making it less desirable for us as clinicians and our patients to embark on this road at any stage of the disease." It's the middle-ground glaucoma patients who are lacking treatment options, he said. These are the pa- tients who have mild to moderate glaucoma and are on multiple med- ications. This is where the need is, Dr. Ahmed said, and this is where MIGS comes in. MIGS "is an ab-interno ap- proach," Dr. Ahmed said. "It's typi- cally clear corneal, sub-2 mm. There are no typical conjunctival incisions that are made, which is traditional in glaucoma surgery. It's minimally traumatic. It must have at least mod- est efficacy. I emphasize modest. We're not talking about a dramatic procedure; we have those already. A rapid recovery and ease of use are all important with this procedure." MIGS is not a procedure that will get IOP down to 12. It's typi- cally an earlier intervention and can be combined with phaco. The key to MIGS is to get to patients before their glaucoma becomes advanced. MIGS devices include the iStent (Glaukos, Laguna Beach, Calif.), the CyPass Micro-stent (Transcend Medical, Menlo Park, Calif.), and the AqueSys (Irvine, Calif.). Although continued on page 62

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