Eyeworld

OCT 2020

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

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68 | EYEWORLD | OCTOBER 2020 G UCOMA G laucoma procedures in the form of MIGS are increasingly being per- formed by non-glaucoma specialists. The 2019 ASCRS Clinical Survey found that 45% of respondents were currently performing MIGS. In terms of the overall survey demo- graphics, 44.4% were cataract/anterior segment specialists, 25.3% comprehensive ophthalmolo- gists, 14.4% cornea/external disease specialists, and 5.3% glaucoma specialists. The ASCRS survey also found the majority (48%) of respondents (N=737 for this ques- tion) did not perform any incisional glaucoma procedures, but 36.6% said they performed tra- beculectomy, followed by 21.8% who said they did Schlemm's canal-based surgery, 16% tube shunts, and 6% transscleral gel stents. Options for microinvasive glaucoma proce- dures are expanding, with some being per- formed standalone (instead of combined with cataract surgery as many are labeled) and some, like the PRESERFLO MicroShunt (Santen, not yet FDA approved) and XEN Gel Stent (Allergan, FDA approved in 2016), toeing the line of more traditional glaucoma procedures. The latter procedures, which are subconjuncti- val and bleb-forming, raise the question: Should non-glaucoma specialists be performing them? EyeWorld spoke with a glaucoma special- ist and a cornea specialist to get their take on this question and use of these devices that are often lumped in with MIGS, despite being more invasive and requiring more management than others in the category. Tak Yee Tania Tai, MD Glaucoma specialist Dr. Tai said she does most, if not all, MIGS procedures, including XEN, and performed PRESERFLO when it was in U.S. clinical trials. "I don't think XEN and PRESERFLO should be regularly performed by compre- hensive ophthalmologists, especially if they're not well-versed in bleb management. These surgeries do invade the subconjunctival space, and bleb management takes a lot of experience to do well. Even a lot of beginning glaucoma by Liz Hillman Editorial Co-Director Should non-glaucoma specialists take on subconjunctival MIGS? About the doctors David Goldman, MD Goldman Eye Palm Beach Gardens, Florida Tak Yee Tania Tai, MD New York Eye and Ear Infirmary of Mount Sinai New York, New York Dr. Tai performs a glaucoma procedure at New York Eye and Ear Infirmary of Mount Sinai. Source: New York Eye and Ear Infirmary of Mount Sinai

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