Eyeworld

SUMMER 2024 | EYEWORLD | 63 G by Ellen Stodola Editorial Co-Director About the physicians Lorraine Provencher, MD Vance Thompson Vision Omaha, Nebraska Douglas Rhee, MD Professor and Chair University Hospitals Case Western Reserve University School of Medicine Cleveland, Ohio Kuldev Singh, MD, MPH Professor of Ophthalmology Chief of the Glaucoma Division Stanford University School of Medicine Stanford, California Christopher Teng, MD, MBA Associate Professor of Ophthalmology and Visual Science Yale University School of Medicine New Haven, Connecticut Sarah Van Tassel, MD Associate Professor of Ophthalmology Weill Cornell Medicine New York, New York moves and shifts down, even if it's still in the green zone, this can be progression. Dr. Provencher encouraged everyone to get in the VR visual field groove. It can improve your workflow, it's portable, and it's loved by technicians and patients, she said. Oftentimes, you'll get a more reliable visual field result due to improved patient comfort. There are several products available so when choosing a product, do your research. The product should have a strong correlation with HVF, proper background luminance, and validation for all ranges of severity. Dr. Teng's diagnostic pearl was that OCT macula is key. You can't diagnose what you can't see, he said. Laser tips Dr. Van Tassel encouraged everyone to con- firm (and reconfirm) laser settings. With the dual mode capsulotomy/SLT laser systems, it's possible to inadvertently use SLT laser beam to perform capsulotomy. The literature tells us that it happens, she said, and it's associated with vision loss. Dr. Singh's laser pearl was to do less more often rather than doing more less often. The future of laser is doing regular treatments, D uring the 2024 ASCRS Annual Meeting, a symposium moderated by Manjool Shah, MD, and Nathan Radcliffe, MD, featured quick-hit tips from glaucoma specialists. Panelists were asked to share a 1-minute pearl in a vari- ety of categories and included Sarah Van Tassel, MD, Kuldev Singh, MD, MPH, Douglas Rhee, MD, Lorraine Provencher, MD, and Christopher Teng, MD, MBA. Maximizing your diagnostics Dr. Van Tassel's diagnostic pearl was to think of the ganglion cell layer as the "how worried should I be" index. She said to get ganglion cell layer for every patient. Dr. Singh's pearl was to only perform tests that will likely impact therapeutic decisions. For example, he said that he generally does not perform OCT testing in patients with advanced visual field loss. OCT is helpful in early dis- ease but not so much in severe disease. Let the course of the disease or where the patient is on the disease spectrum guide what they need in terms of diagnostics, he said. Dr. Rhee said RNFL measurements are great when they're normal, but don't just quickly glance at them without looking at the year-to- year transition. Don't forget green disease, he said, where you can have progression. If the line 'Glaucoma Pearls—High Speed, High Impact' continued on page 64 As his laser tip in the session, Dr. Teng suggested placing the third finger below the Abraham lens to facilitate stabilization and rotation. Source: Christopher Teng, MD

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