Eyeworld

EW MEETING REPORTER 74 November 2018 EyeWorld/ASCRS reports from the 2018 ESCRS Congress, September 21–26, Vienna, Austria High myopes need to be carefully considered for glaucoma, according to a talk by Christoph Faschinger, MD, PhD, Graz, Austria, who thinks that "highly myopic eyes have glaucoma as long as the opposite has not been proven." Current diagnostic tools cannot ac- curately differentiate changes shared by both high myopia and glaucoma. He recommends drops in highly my- opic patients as the side effects are negligible compared to the benefits of the pressure-leveling effects. Augusto Azuara-Blanco, PhD, Belfast, U.K., discussed the use of peripheral iridotomy as more of a comfortable habit. He said that implementation failures persist in clinical medicine due to our diffi- culty in letting go of what we've learned will work. According to An- ton Hommer, MD, Vienna, Austria, even trabeculoplasty has come under scrutiny in the face of newer, more effective glaucoma medi- cations. Laser treatment remains a reliable option for clinicians, however, as drops lose efficacy over time. First and second SLT and ALT applications are predictable, with third and fourth applications largely ineffective. Arguments in favor of initial laser include IOP-lowering effects like monotherapy, higher safety than medication and surgery, cost effectiveness, and better efficacy than secondary laser. Andrey Brezhnev, MD, Kursk, Russia, maintained that traditional glaucoma surgeries achieve good Glaucoma Day at ESCRS Kicking off a morning of thought-provoking presentations was Fotis Topouzis, MD, Thessa- loniki, Greece, who discussed the current glaucoma burden, remarking that 50% of OAG is undiagnosed in developed countries. In 2013, POAG was diagnosed in 5.36 million indi- viduals in Europe and is estimated to rise to 6.39 million by 2040. Despite the rising numbers of glaucoma patients in our aging population, treating people who actually need help was the theme of a talk given by Anja Tuulonen, MD, PhD, Tampere, Finland. Aging alone increases yearly health costs by 1%, making it impossible to do everything for everybody with the resources at hand. It is crucial to stratify patients by risk and stop treating those who are largely glau- coma-free. Identifying risk factors for dis- ease progression was a topic of dis- cussion with IOP at its core, howev- er, IOP does not explain everything, said Gordana Sunaric-Megevand, MD, Geneva, Switzerland. Neverthe- less, lowering IOP reduces the risk of glaucoma progression and remains pivotal in any discussion about the disease. IOP shows dynamic pat- terns, with diurnal and body/head position-related fluctuations that are unrelated to patient age or glaucoma stage. Clinicians should use office hour supine IOP to predict night IOP and prescribe prostaglandins to reduce postural IOP changes. Update on fungal keratitis A session on the EuCornea program focused on the topic of fungal kera- titis. Irina Barequet, MD, Tel-Aviv, Israel, discussed the clinical picture and diagnostics. Fungal keratitis, she said, is a continuously challenging condition and is an important cause of visual loss and even blindness. It requires a high level of suspicion, prompt diagnosis, and aggressive treatment, Dr. Barequet said, adding that the most common causative pathogens are filamentous fungi and yeasts. Dr. Barequet said the etiolo- gy varies geographically. It's most common in tropical and subtropical areas. In the U.S., it makes up 5–10% of corneal infections, while in South India, fungi cause up to 47% of keratitis, and in Malaysia, it's about 12–25%. The intrinsic virulence of fungi depends on the substances produced by the organism and the generated host response, Dr. Barequet said. The organisms that infect preexisting ep- ithelial defects belong to the normal microflora of the conjunctiva and adnexa. Symptoms may include a slow initial course, manifesting 24–48 hours following the initial incidence of contact. Other symptoms include foreign body sensation, increasing eye pain, and photophobia. There are fewer inflammatory signs and symptoms during the initial period than with bacterial keratitis, Dr. Barequet said. EyeWorld/ASCRS reports from the 2018 ESCRS Congress Sponsored by

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