MAY 2013

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

Issue link: https://digital.eyeworld.org/i/129516

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A S C R S World view Is glaucoma becoming a surgical disease? A t the ASCRS•ASOA Symposium & Congress this year Eric Donnenfeld, MD, the new ASCRS president, said that the most exciting area in ophthalmology is glaucoma. But lest glaucoma specialists be overcome with unexpected love, he added that it was something he never expected to say. Dr. Donnenfeld's comments highlight both the optimism surrounding new developments in glaucoma as well as the surprise at the level of enReay Brown, MD, thusiasm. Signs of the rise of glaucoma were all glaucoma editor around the recent ASCRS meeting. Glaucoma Day had a banner year with a new record for attendance. There were more glaucoma papers presented than ever before. An EyeWorld symposium on the iStent (Glaukos, Laguna Hills, Calif.) had 600 attendees. All the ASCRS symposia dealing with glaucoma had full audiences. The main reasons for the surge of interest in glaucoma are microinvasive glaucoma surgery (MIGS) and the use of cataract surgery to lower eye pressure. Both of these have brought comprehensive ophthalmologists back into the surgical treatment of glaucoma. This has dramatically increased the number of eye surgeons wanting to learn about glaucoma issues and has ratcheted up the need for glaucoma courses. This month's cover focus on "Glaucoma challenges/MIGS" taps into this rising excitement. Ike Ahmed, MD, Steve Vold, MD, Kuldev Singh, MD, and Tom Samuelson, MD, discuss the current state of MIGS and cataract surgery for glaucoma. The iStent is the only MIGS device currently FDA approved, and the other devices are probably three or more years away, so the first need is to determine how best to use the iStent. One critical issue that has already been raised is whether implanting multiple iStents will lower pressure more than a single device. Another key to success with the iStent is locating it near collector channels. Dr. Singh emphasizes that it will be important to tease out the component of pressure lowering that we get with the iStent and how much is due to cataract surgery alone. The article on beginning with the iStent focuses on tips for new users. Stuart Ball, MD, Leon Herndon, MD, and Joseph Gira, MD, share their insights on how best to adopt the iStent. Advice on how to prevent and overcome early problems will be critical in guiding the large number of comprehensive ophthalmologists who will be using the iStent for the first time. Most general ophthalmologists do not have much experience with gonioscopy. But all users agree that gonioscopy is a key component of successful iStent placement. As the iStent is rolled out to a wider audience, there undoubtedly will be innovations in technique and placement. But getting off to a good start is very important, and new users will do well to read this article carefully. AqueSys (Aliso Viejo, Calif.) is developing a device and surgical procedure designed to bring a MIGS approach to glaucoma filtering surgery. Rick Lewis, MD, Rohit Varma, MD, and Dr. Samuelson are working to develop this concept. The device is designed to do a safer filtering surgery from inside the eye without a conjunctival incision. An improved filtering surgery would be helpful since not all patients with serious glaucoma will be adequately treated with MIGS devices. The device is approved in many parts of the world but is currently in FDA trials in the U.S. Recently, glaucoma surgery has seen shifts in the relative roles of trabeculectomy and tube shunts. This process is discussed by Garry Condon, MD, Steve Gedde, MD, Pradeep Ramulu, MD, and Manishi Desai, MD. Data from multiple sources has shown tubes increasing in popularity and trabeculectomy decreasing. Increasing evidence has shown that tubes are safer and more successful and require less follow up. Interest in glaucoma surgery is at an all-time high due to MIGS. The iStent is the first available device from a group of MIGS devices that may eventually compete with medical treatment as first-line glaucoma therapy. MIGS could make glaucoma a surgical disease—something that even I never expected to say. Reay H. Brown, MD, glaucoma editor The official publication of the American Society of Cataract & Refractive Surgery May 2013 Volume 18 • No. 5 P U B L I S H I N G   S TA F F Publisher Matt Young don@eyeworld.org Enette Ngoei Donald R. Long Editorial Editor Jena Passut jena@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Senior Staff Writer Erin Boyle erin@eyeworld.org Malaysia Dublin, Ireland Rich Daly Arlington, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 ellen@eyeworld.org 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Production Advertising Sales Graphic Designer Jeff Brownstein Julio Guerrero jeff@eyeworld.org julio@eyeworld.org 703-788-5745 Production Manager Paul Zelin Staff Writer Ellen Stodola Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Daniela Galeano daniela@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Florida Michelle Dalton Reading, Pennsylvania paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org 703-591-2220 ASCRS Publisher: EYEWORLD (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. 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