EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
48 EW ASCRS PREVIEW March 2013 April 19-23, 2013 Glaucoma symposia offer expert advice A s treatment options abound when a patient has multiple ophthalmic problems, how does a surgeon know what's best for the patient? There's help available if the patient has cataracts and glaucoma. A symposium at this year's ASCRS•ASOA Symposium & Congress in San Francisco will provide insight into the best approaches for a glaucoma patient requiring cataract surgery. The session, "Cataract Surgery in the Glaucoma Patient: How to Select the Best Option for My Patient?" will take place on Sunday, April 21, from 3 to 4:30 p.m., at the Moscone Center. The symposium is jointly sponsored by the ASCRS Cataract Clinical Committee and the Glaucoma Clinical Committee, enabling both sides of the surgical coin to share their insights. "The symposium will involve didactic presentations and dynamic panel discussion with some of the leading experts but is directed at the comprehensive ophthalmologist," said co-moderator Rosa Braga-Mele, M.D., associate professor, University of Toronto, and director of professionalism and biomedical ethics, Department of Ophthalmology, University of Toronto. Dr. BragaMele is chair of the ASCRS Cataract Clinical Committee. "We'll talk about the entire disease spectrum of cataract in mild, moderate, and severe glaucoma patients," said co-moderator Thomas W. Samuelson, M.D., Minnesota Eye Consultants, Minneapolis. Dr. Samuelson chairs the ASCRS Glaucoma Clinical Committee. "We'll discuss different surgical procedures to be combined with cataract surgery in these patients." The session features a host of well-known speakers who will address traditional as well as newer approaches to this unique type of patient. "The symposium will feature controversial and timely presentations that deal with how ophthalmologists should treat early glaucoma versus advanced glaucoma surgically, from phacoemulsification alone—is it enough?—to newer MIGS [microinvasive glaucoma surgery] technology," Dr. Braga-Mele said. The introduction of MIGS technology to the U.S. market last year with the FDA approval of devices to by Vanessa Caceres EyeWorld Contributing Writer Co-moderator Marlene R. Moster, M.D., promises practical points from the "Angle Closure from A to Z" symposium. Source: EyeWorld be place in Schlemm's canal will no doubt influence future surgical approaches, Dr. Samuelson said. "The beauty of our expanding menu of glaucoma operations is that we can better individualize for a given patient," he said. "We used to have just trabeculectomy and tube shunts to offer as our outflow procedures for use in all surgical glaucoma patients regardless of severity. Now we have procedures that can be tailor-made for a given level of glaucoma severity." The schedule Short talks by panelists and a panel discussion will tackle relevant topics, such as "What is the effect of phacoemulsification on IOP?" from Gary Foster, M.D., and "Does glaucoma change the indication for cataract surgery?" from Kuldev Singh, M.D. Other panelists will hone in on the combination of phaco with specific glaucoma treatment approaches. Panelists will take part in two point/counterpoint discussions: "Combined procedures for early to moderate glaucoma: Which one? Why?" and "Combined procedures for advanced glaucoma: Which one? Why?" The symposium will end with a panel discussion as well as an audience response/vote section. Getting a better view of angle closure glaucoma Angle closure glaucoma brings its own challenges to the exam room. Another symposium aims to answer some common concerns associ- ated with angle closure glaucoma. "Angle closure from A to Z" will take place on Monday, April 22, from 3 to 4:30 p.m. The session will be held in the Moscone Center. The symposium is sponsored by the ASCRS Glaucoma Clinical Committee. Expect the symposium to offer a soup-to-nuts perspective on treatments for angle closure. "The symposium will be a rapidfire video event where the leaders in the fields of cataract and glaucoma provide pearls on how to handle complicated clinical situations," said co-moderator Marlene R. Moster, M.D., professor of ophthalmology, Jefferson Medical College, and Wills Eye Institute, Philadelphia. "The participants will be able to take home practical points that can be used immediately after attending this program." "The angle closure symposium is aimed at comprehensive practitioners to bring them up-to-date with angle closure epidemiology and diagnostic evaluation using some of the newer instrumentation and techniques for looking at angles," said co-moderator Garry P. Condon, M.D., associate professor, College of Medicine, Drexel University, Pittsburgh. The session will begin with a talk on "Angle closure: Epidemiology, genetics, gonioscopy and future novel treatments," led by Douglas J. Rhee, M.D. Indications to perform a laser iridotomy will be covered by Leslie S. Jones, M.D. in her talk "When to do a PI." "She'll talk about timing and location," Dr. Condon said. "From there, we'll talk about treatment options for patients with angle closure, and if they have a cataract, whether phaco alone would do the trick or combined cataract and some form of glaucoma surgery might be considered," Dr. Condon said. Talks on the cataract/glaucoma patient will be kicked off by Reay H. Brown, M.D., with "Choices with angle closure: Cataract alone or combined surgery?" Then, Alan S. Crandall, M.D., will discuss "Increased risks for performing cataract surgery in angle closure patients." Rengaraj Venkatesh, M.D.,will address "Techniques for removing dense lenses in angle closure patients." Both Paul Harasymowycz, M.D., and Ike K. Ahmed, M.D., will talk about direct angle surgery and challenges associated with approaches to open the angle, Dr. Condon said. Dr. Harasymowycz's talk will be "What is the role of goniosynechialysis?" and Dr. Ahmed will focus on "Surgery in narrow angles with large lenses after the peripheral iridotomy." Ronald L. Fellman, M.D., will present an alternative approach with "When removing the cataract is not enough: Techniques for combined surgery and the role of endoscopic cyclophotocoagulation." "This involves approaching the angle from behind the iris instead of the front. If we can't push it open, we can help it open by reducing what's behind the iris," Dr. Condon said. Finally, Dr. Condon will address "Aqueous misdirection or malignant glaucoma and other challenges." This will emphasize signs and symptoms for recognizing early aqueous misdirection in the narrow angle patient who's just undergone surgery. Medical and surgical approaches to manage these extremely concerning scenarios will be outlined and demonstrated, Dr. Condon said. EW Editors' note: The physicians interviewed have no financial interests related to their comments. Contact information Condon: 412-359-6300, garrycondon@gmail.com Braga-Mele: 416-462-0393, rbragamele@rogers.com Moster: 484-434-2717, marlenemoster@aol.com Samuelson: 612-813-3628, twsamuelson@mneye.com