Eyeworld

60 | EYEWORLD | DECEMBER 2019 G UCOMA YES CONNECT By Liz Hillman EyeWorld Editorial Co-Director and his practice considered the ones they felt would be most efficacious for their patients. "In our playbook, we felt very clear that we were going to offer as many as we could," Dr. Patterson said, noting that he has experience with OMNI (Sight Sciences), XEN Gel Stent (Allergan), iStent, iStent inject, Hydrus (Ivantis), and endocyclophotocoagulation (Beaver-Vis- itec). Dr. Okeke said she started with Trabectome (MST) after fellowship in 2009 and has since added iStent, iStent inject, OMNI, ab inter- no canaloplasty (ABiC, Ellex), Kahook Dual Blade (New World Medical), XEN Gel Stent, and GATT (gonioscopy-assisted transluminal trabeculotomy) to her practice. Making sure you can offer MIGS After learning about what a MIGS option has to offer, based on studies and experience of other surgeons, and deciding that it's some- thing that would benefit your patients, both Dr. Okeke and Dr. Patterson said you have to find out if you can actually perform the procedure where you practice. Dr. Okeke said she finds out if a MIGS procedure is actually viable option at her surgery center, if the codes are something the center can accept, and if it makes sense for the practice to make it financially viable for her to do. Dr. Patterson emphasized the importance of ensuring that you'll get reimbursed for a new MIGS procedure before taking it on. Getting started Dr. Patterson advised that new surgeons pick one or two MIGS procedures to start out with. "Get really good at those—ones that you can hit home runs with—because if you're trying to manage all of them all at once when you come out, it's going to be very difficult," he said. To get familiar with these procedures, Drs. Patterson and Okeke said to start watching surgical videos and attend wet lab training. Dr. Patterson suggested wet labs at ophthalmic meetings. While Dr. Okeke agrees this early It has been almost a decade since MIGS joined our surgical tool box, with several different devices now available. However, as MIGS slowly incorporates into residency surgical training with varying degrees of expo- sure to different devices among programs, there are still many young eye surgeons learning this technique after completing residency. In this month's column, Constance Okeke, MD, and Michael Patterson, DO, discuss how young eye sur- geons can become proficient in implantation of MIGS, having had little exposure and experience during their training. –Claudia Perez-Straziota, MD YES Connect Co-Editor T he extent to which young eye surgeons are receiving training with MIGS in residency varies and, as such, many will need continued training with these devices and techniques as they start incorporating them into their practice. "Every program is a little different, and every program has a different opinion on what should be taught first, second, third, fourth, and fifth," Michael Patterson, DO, said. "Some surgeons are exposed to [MIGS] not at all, and other surgeons are exposed to it aggres- sively." Dr. Patterson said he thinks most oph- thalmologists are, at least in training, getting exposure to "something simple" like iStent (Glaukos) or iStent inject (Glaukos). Constance Okeke, MD, said she thinks a "good portion of residents or fellows will need to have some additional learning that will be done after their training" when it comes to MIGS. And that's what she and Dr. Patterson are discussing in this month's column: How young eye surgeons can get involved with MIGS if they have little exposure and experience. Both Dr. Patterson and Dr. Okeke have had to do most of their MIGS learning while in practice. Dr. Patterson said he had some experience with the first-generation iStent in training, as it was just being approved at that time. Since then, as more MIGS procedures became approved, he The lowdown on MIGS for the young eye surgeon About the doctors Constance Okeke, MD, MSCE Assistant professor of ophthalmology Eastern Virginia Medical School Virginia Eye Consultants Norfolk, Virginia Michael Patterson, DO CPT United States Army Reserves Eye Centers of Tennessee Crossville, Tennessee Claudia Perez-Straziota, MD YES Connect Co-Editor

• Blank Page
• Blank Page (1)