EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/194331
October 2013 Combined glaucoma and February 2011 cataract surgery disruptive or induce inflammation, so he prefers the iStent because it is functionally less invasive. Popularity of the procedure The Trulign IOL in combination with istent, after aligning the axis of the IOL. Source (all): John Berdahl, MD less likely to come in for follow-up," Dr. Berdahl said. It is important to stress the need for follow-up care, even if a patient is rid of cataracts and less dependent on glasses and medication. Dr. Berdahl also mentioned a concern many people have. "One likely unfounded concern that people have had with laser cataract surgery and glaucoma is that when you dock the laser to the eye, you raise the pressure inside the eye," he said. However, he said that the pressure using laser platforms is only around 15 to 20 mm of mercury, which is a fraction of the pressure used from a phaco probe during cataract surgery. He estimated that the 100 cm of water used in this procedure translates to about 75 mm of mercury. "So all the laser platforms out there [create] much less pressure on the eye than when you're doing the cataract surgery," he said. Dr. Radcliffe said that there may be some hesitation of refractive cataract surgeons to treat glaucoma conditions. "The main obstacle I see is that some refractive cataract surgeons will not want to enter the glaucoma space, as these patients are a little more complicated and this may slow things down a bit," he said. Additionally, for those patients with a more moderate or advanced stage of glaucoma, surgeons need to be especially cautious when choosing a refractive surgery. He also mentioned that femto surgeons are not using intraoperative gonioscopy regularly. In this case, they will have to pick up this new skill, which he said is easily done. Dr. Berdahl indicated that he believes there are a limited number of surgeons using this combination currently, but he thinks it will catch on. "There's no doubt in my mind that people will do it because there's no real reason not to," Dr. Berdahl said. "If you can get people out of their glasses and off their drops in one surgery, why not?" Dr. Radcliffe said that this combination could help treat patients comprehensively in the future by addressing both refractive and glaucoma related issues. "Since many patients have glaucoma, it is more than likely that busy cataract surgeons will recognize that a reasonable proportion of their cataract patients are using intraocular pressure-lowering medications and will want to offer this benefit," he said. "I think we need to stop thinking of glaucoma management and optimizing refractive outcomes as two separate issues," Dr. Radcliffe said. The patients with these concerns are the same and want to be as free as possible from the burdens of their eye related conditions, he said. EW FEATURE 73 "For patients with mild glaucoma who are undergoing refractive cataract surgery, the use of the iStent could enhance outcomes." Dr. Wiley has been using the femtosecond laser for about a year and a half and the iStent for about six months. Although the iStent is still relatively new, Dr. Wiley said he thinks doctors who have femtosecond laser technology will start to look to provide more premium services for patients. "I think the iStent is a great technology that marries well into the philosophy of providing a premium service to your patients," he said. EW Editors' note: Dr. Radcliffe has financial interests with Alcon (Fort Worth, Texas) and Glaukos. Dr. Berdahl has financial interests with Alcon and Glaukos. Dr. Wiley has financial interests with Abbott Medical Optics (Santa Ana, Calif.). Contact information Berdahl: john.berdahl@vancethompsonvision.com Radcliffe: drradcliffe@gmail.com Wiley: drwiley@clevelandeyeclinic.com The procedure Dr. Wiley said he does not see any major technical differences in the procedures with the combination. He said the use of the femtosecond laser makes a clean and safe procedure, and this makes it easier to implant the iStent at the end of the case. "I've started to do iStents more at the beginning of the case for traditional cataract surgery," he said. However, Dr. Wiley said he will implant the iStent at the end of the procedure when he is doing femtosecond laser-assisted cataract surgery. "The femtosecond cases are clean and easy, and there's very little phaco energy, so the corneas in those cases end up being relatively clear," he said. Dr. Wiley said that there are also alternative procedures for treating glaucoma in cataract surgery, like endophotocoagulation. But some of the other options might be more PLAN AHEAD FOR NEXT YEAR YEAR HOUSI NG NOW OPE N HOUSING IS NOW OPEN www.WinterUpdate.org www.WinterUpdate.org 2014 2014 APRIL 25–29 APRIL 25–29 BOSTON www.AS C R S.org www.ASCRS.org