Eyeworld

G DECEMBER 2019 | EYEWORLD | 61 Contact information Okeke: iglaucoma@gmail.com Patterson: michaelp@ecotn.com this class of patient who might have some ocular surface disease due to the change in anatomy after traditional glaucoma surgeries, as well as the additional drops," she said, adding that she's used canaloplas- ty, goniotomy, and stents, as well as a combination of these, for such patients. Ideal candidates, Dr. Okeke said, are those who have an open angle with normal anatomy, great structures, and mild to moderate disease. "You want them to have enough disease to warrant the procedure," she said. Final thoughts Dr. Okeke shared three, final take-home points for the young eye surgeon taking on a new MIGS procedure. 1) Make a decision that you are ready to embark on adding a new proce- dure to your armamentarium. 2) Find a mentor who has done the procedure, someone you can follow or discuss their experiences. Surgical reps also have helpful resources and can act as a liai- son to find mentors. 3) Consult other resources. Dr. Okeke referenced her iGlaucoma YouTube channel's MIGS University Video series, which she launched specifically to help those new to MIGS. Dr. Patterson advised against trying to do everything at once—master one or two MIGS procedures at a time—and prepare for compli- cations in advance. "I would say most important is take a deep breath and know that sometimes things can go wrong in these surgeries. … Your mental preparation is key to make sure you are ready to go and you understand what are your risks, understand what can happen during surgery," he said. exposure is essential, there will ultimately be a need to sched- ule a wet lab for the weekend or morning before her first cases. This wet lab, she said, includes herself, being instructed, and the surgical rep talking to her surgical staff so they can be oriented on what they'll need to do to assist the surgeon. Dr. Okeke said she'll schedule 3–5 cases in a row with a new MIGS procedure to help get a good handle on the nuances of the technique, while Dr. Patterson advised "slowly [getting] your feet wet." "I think that these devices are easy enough for the average, competent cataract surgeon to take them slowly, one at a time, and then figure out what works," he said. Dr. Patterson and Dr. Okeke both recom- mended starting to practice with intraoperative gonioscopy, learning the correct positioning, ahead of your first MIGS cases. Patient selection To Dr. Patterson, patient selection for MIGS comes down to "really what do your patients want." He said he tries to select patients who are highly motivated to get off drops and, at least to start, who aren't needing a premium IOL, because the vision can be blurry for a few days longer with MIGS-phaco cases. "I think the people who are on two drops or even three seem to have the highest satisfac- tion, because we know from one drop to two or three your compliance is horrible. So if you can get them down to one drop from three, that's a big change in their life," he said. Dr. Patterson also said patients who have severe dry eye love MIGS, if it allows them to come off glaucoma drops that are toxic to the eye. Similarly, Dr. Okeke said she finds patients with a tube or trab with viable angles can benefit from cataract-MIGS procedures for this reason. MIGS can be "quite beneficial to Relevant financial interests Okeke: MST, Glaukos, Ellex, Sight Sciences, Allergan, Santen, Bausch + Lomb, Aerie, Alcon, Novartis, Reichert Patterson: New World Medical, Ivantis, Glaukos, Sight Sciences, Beaver-Visitec, Bausch + Lomb, Johnson & Johnson Vision, Carl Zeiss Meditec "For us, the most important thing is to not try to do everything at once." —Michael Patterson, DO

• Blank Page
• Blank Page (1)