Eyeworld

by Title Heading Name title Contact Name: email G UCOMA On average, Dr. Ristvedt said that 1 in 5 patients who come in for cataract surgery also have glaucoma. "This has become the perfect opportunity to address both," she said. "We now have years of data to show that intervening at this stage reduces drop dependence, improves the ocular surface, and provides for stability in IOP, leading to less need for more incision-based surgery over time." She add- ed that this combination therapy is becoming more widely accepted over time due to these key factors. "With this mindset shift, it is vital that anterior segment surgeons see the value add in committing to learning angle based-sur- gery or to give their patients the option of combination surgery with their colleague," she said. Dr. Yadgarov said that the "hang up" for many sur- geons to enter the interventional MIGS space is how to bring it up to the patient. "It may seem difficult to convince a patient to go to the operating room to do a surgery when there are so many medication options available that they can try," he said. After informing them of the safety and speedy recovery that is associated with MIGS and bene- fits of avoiding daily medication, most patients will not hesitate to heed the surgeon's recommendations to under- go a MIGS procedure. The patient scenario of suboptimal compliance is where surgeons new to MIGS should initially focus on, he said. Dr. Singh emphasized how important the patient dis- cussion is and understanding patient expectations. "I think it's important to tell patients, 'Glaucoma is a long-term condition, but I'm with you for that journey, and I'm going to use multiple treatments to help keep that pressure down to a safe range and maintain the highest quality of life.'" He said this could require one or several interventions, and it also depends on the type of glaucoma the patient has. But emphasizing to the patient that you'll try one thing at a time and that you have multiple options in the future is key. "I set the stage and say, 'There's not one procedure that's going to cure you; there's a lot of different options because there's no perfect surgery or perfect procedure for every patient.'" Dr. Ristvedt added that education and passion around interventional glaucoma has started to change the mindset. "This is not possible without other doctors coming together to lead this movement in their community," she said. "We have held many educational seminars to keep eyecare pro- viders and patients updated on how glaucoma is evolving and changing. This team effort, in my opinion, leads to better communication and patient care when we are all on the same page and operating at the highest level of our skillset. Nothing makes me happier than when a patient comes in for an SLT and explains that their doctor gave them options and they would love to start here." continued from page 12 Mitosol® (mitomycin for solution) 0.2 mg/vial Kit for Ophthalmic Use\ Rx only BRIEF SUMMARY: Please consult package insert for full prescribing information INDICATIONS AND USAGE: Mitosol® is an antimetabolite indicated for use as an adjunct to ab externo glaucoma surgery. CONTRAINDICATIONS: Hypersensitivity: Mitosol® is contraindicated in patients that have demonstrated a hypersensitivity to mitomycin in the past. WARNINGS AND PRECAUTIONS: Cell Death: Mitomycin is cytotoxic. Use of mitomycin in concentrations higher than 0.2 mg/mL or use for longer than 2 minutes may lead to unintended corneal and/or scleral damage including thinning or perforation. Direct contact with the corneal endothelium will result in cell death. Hypotony: The use of mitomycin has been associated with an increased incidence of post-operative hypotony. Cataract Formation: Use in phakic patients has been correlated to a higher incidence of lenticular change and cataract formation. EMBRYO FETAL TOXICITY: Can cause fetal harm. Advise of potential risk to a fetus. Verify pregnancy status in females of reproductive potential prior to use. ADVERSE REACTIONS: Ophthalmic Adverse Reactions: Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reect the rates observed in practice. The most frequent adverse reactions to Mitosol® occur locally, as an extension of the pharmacological activity of the drug. These reactions include: Blebitis: bleb ulceration, chronic bleb leak, encapsulated/cystic bleb, bleb-related infection, wound dehiscence, conjunctival necrosis, thin-walled bleb; Cornea: corneal endothelial damage, epithelial defect, anterior synechiae, supercial punctuate keratitis, Descemet's detachment, induced astigmatism; Endophthalmitis; Hypotony: choroidal reactions (choroidal detachment, choroidal eusion, serous choroidal detachment, suprachoroidal hemorrhage, hypotony maculopathy, presence of supraciliochoroidal uid, hypoechogenic suprachoroidal eusion); Inammation: iritis, brin reaction; Lens: cataract development, cataract progression, capsule opacication, capsular constriction and/or capsulotomy rupture, posterior synechiae; Retina: retinal pigment epithelial tear, retinal detachment (serous and rhegatogenous); Scleritis: wound dehiscence; Vascular: hyphema, central retinal vein occlusion, hemiretinal vein occlusion, retinal hemorrhage, vitreal hemorrhage and blood clot, subconjunctival hemorrhage, disk hemorrhage; Additional Reactions: macular edema, sclera thinning or ulceration, intraocular lens capture, disk swelling, malignant glaucoma, lacrimal drainage system obstruction, ciliary block, corneal vascularization, visual acuity decrease, cystic conjunctival degeneration, upper eyelid retraction, dislocated implants, severe loss of vision. USE IN SPECIFIC POPULATIONS: Pregnancy: Risk Summary: Based on ndings in animals and mechanism of action, Mitosol® can cause fetal harm when administered to a pregnant woman. There are no available data on Mitosol® use in pregnant women to inform the drug-associated risk. In animal reproduction studies, parenteral administration of mitomycin resulted in teratogenicity. Advise pregnant women of the potential risk to a fetus. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% - 4% and 15% - 20%, respectively. Data: Animal Data-Parenteral administration of mitomycin in animal reproduction studies produced fetal malformations and embryofetal lethality. Lactation: Risk Summary: There are no data on the presence of mitomycin in human milk, the eects on the breastfed child, or the, eects on milk production. Because of the potential for serious adverse reactions in a breastfed child, advise women not to breastfeed during and for 1 week following administration of Mitosol®. FEMALES AND MALES OF REPRODUCTIVE POTENTIAL: Mitosol® can cause fetal harm when administered to pregnant women. Pregnancy Testing: Verify pregnancy status in females of reproductive potential prior to using Mitosol®. Pediatric Use: Safety and eectiveness in pediatric patients have not been established. Geriatric Use: No overall dierences in safety and eectiveness have been observed between elderly and younger patients. More detailed information is available upon request. For information about Mitosol®- contact: 1-877-EYE-MITO (1-877-393-6486) Please also see full Prescribing Information at Mitosol.com MANUFACTURED FOR: Mobius Therapeutics, LLC 1000 Executive Parkway Suite 224, St. Louis, MO 63141 USA (314) 615-6930 Mitosol® is a registered trademark of Mobius Therapeutics, LLC

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