EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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May 2013 Glaucoma February 2011 challenges/MIGS "I'm seeing patients who have to drive three hours to see me at $4 a gallon and their daughter has to take half a day off work to do that; if I can reduce the number of visits for that family, and I can have them back to work sooner, and I get the same outcomes … in the long run, that's a better operation," he said. Dr. Desai said the postoperative period for trabeculectomy cases can be either a "bonding or nonbonding experience" for physicians and patients from the labor-intensive aspect of the procedure. "With [all of these factors] in mind, I don't feel that tubes are necessarily replacing trabeculectomy, but that tubes are being utilized more optimally, so to speak, i.e., utilized more often when a patient may be better served by a tube versus a trabeculectomy," Dr. Desai said. "Overall, most physicians are still tailoring treatment specific to the patient so as to choose what is best for the individual. The reason being that there are so many factors that guide physicians to their choice of glaucoma surgery—stage of glaucoma, prior eye surgery, history of inflammation, age, comorbidities/ physical limitations, patient tolerance to drops, social support systems, presence or absence of cataract, ability to follow-up, etc.— that it is hard to assign a particular surgical option for all patients." Dr. Condon said improvements in the current design of tube devices are needed. "There haven't been any real improvements in the general design of the various devices in this category. Placing these devices as far behind the limbus as required means we have to make very large incisions ... and I believe there's real EW FEATURE 37 room for bringing the design forward—perhaps a much smaller diameter tube and the possibility of a foldable 'plate' portion akin to continued on page 38 Future Dr. Ramulu said he is not sure if trabeculectomy will remain the gold standard in glaucoma surgery. In the past, he would have said yes, but now he thinks that glaucoma surgical treatment overall will become more customized. "We're going to be thinking of several different options, which compete with each other, and I think we're going to find people who may, as part of what they offer surgically to patients, offer three or four choices and do all of them at roughly equal frequencies," he said. "Before, I think most doctors just did trabeculectomy and would rarely do any other kind of IOP-lowering procedure besides that. I think now we are increasingly seeing people who do a variety of procedures, some MIGS, some trabeculectomy, some tube shunts." Only One System Delivers the Shield of PROTECTION. DuoVisc® Viscoelastic System offers both the endothelial protection of chondroitin sulfate in VISCOAT® OVD with the proven mechanical protection and space maintenance found in PROVISC® OVD.1 1. DuoVisc® OVD Product Insert. © 2013 Novartis 1/13 VIS13003JAD One System. No Compromises.