Eyeworld

NOV 2012

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

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A SCRS World view The glaucoma times they are a-changin' S Reay Brown, M.D., glaucoma editor uddenly nothing is the same in glaucoma treatment. Well, maybe "suddenly" is not the right word— maybe "finally" would be better. But there is no question that momentum from new concepts, procedures, and devices is growing in glaucoma surgery. Nowhere are these changes more evident—or more needed—than in the realm of combined cataract and glaucoma surgery, which is this month's cover focus. A seismic shift in glaucoma surgical therapy may be under way with the recent FDA approval of the iStent (Glaukos Corp., Laguna Hills, Calif.)—the first MIGS (micro- invasive glaucoma surgery) device. For the first time, cataract surgeons have a MIGS device that they can implant at the end of cataract surgery to help lower pressure and reduce the medication burden in glaucoma patients. Fault lines in glaucoma treatment were already started by other minimally invasive procedures like ECP and trabeculotomy with Trabectome (NeoMedix, Tustin, Calif.), but the iStent may trigger the earthquake. Other MIGS technologies—the Hydrus (Ivantis, Irvine, Calif.) and CyPass (Transcend Medical, Menlo Park, Calif.)—are in FDA trials and hopefully will be options in the future. Drs. Lewis, Vold, Craven, and Bacharach discuss the MIGS devices in this issue. But not all cataract patients with glaucoma are candidates for the iStent. Other efficient and safe procedures are available such as ECP and trabeculotomy with the Trabectome. These procedures have greatly expanded the options for successful combined surgery. Drs. Rhee, Berke, and Loewen discuss which patients may benefit from these procedures. However, glaucoma patients with very advanced disease may need more substantial pressure lowering, and for them a combined cataract and tube-shunt may be the best option. Drs. Fechter, Gedde, Rhee, and Reynolds describe patient selection and techniques for using tubes during cataract surgery. Another change in our approach to glaucoma patients stems from the discovery that cataract surgery alone may significantly reduce their pressure. Multiple studies have shown the pressure-lowering impact of cataract surgery and that the improvement in pressure is proportional to the pre-op pressure. So glaucoma patients with higher pressures may achieve the greatest pressure reductions—just what we want. Drs. Mansberger, Brandt, Herndon, Mundorf, and Samuelson discuss the power of cataract surgery to lower pressure in this issue. It has been extremely difficult to change treatment patterns in glaucoma. But the feature articles in this issue demonstrate that change is happening for glaucoma patients with cataract. Instead of being avoided, cataract surgery is being considered earlier for glaucoma patients and with the expectation of a significant pressure reduction. MIGS therapies—the iStent, ECP, and trabeculotomy with Trabectome—have brought glaucoma surgery back into cataract surgery. The growing popularity of combined surgery will not only increase the volume of glaucoma procedures, it will also greatly expand the number of cataract surgeons treating glaucoma. Combined surgery will be a major driver of innovation in glaucoma surgery. With more procedures and more surgeons, greater advances will surely follow. The iStent is the first MIGS device, but it is only the begin- ning. The creative spirit of cataract surgeons will be synergistic with glaucoma surgeons as we address one of the greatest challenges in eye surgery: bringing both good vision and good pressure control to glaucoma patients. Reay Brown, M.D., glaucoma editor The official publication of the American Society of Cataract & Refractive Surgery November 2012 Publisher Donald R. Long dlong@eyeworld.org Editorial Editor Jena Passut jena@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Senior Staff Writer Erin Boyle erin@eyeworld.org Staff Writer Ellen Stodola ellen@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Daniela Galeano daniela@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Florida Michelle Dalton Reading, Pennsylvania Volume 17 • No. 11 PUBLIS HING S TAFF Enette Ngoei Singapore Matt Young Malaysia Rich Daly Arlington, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Advertising Sales Jeff Brownstein jeff@eyeworld.org 703-788-5745 Paul Zelin paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org 703-591-2220 ASCRS Publisher: EYEWORLD (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. 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