FEB 2014

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

Issue link: https://digital.eyeworld.org/i/274531

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Page 75 of 114

E W GLAUCOMA 7 3 glaucoma drainage devices inserted with the combined surgery. Patients in the combined group e nded up about 0.5 D more myopic than those who underwent cataract surgery alone. Dr. Wellik speculates that it could be that practitioners targeted more myopia in these pa- tients to compensate for any change that the glaucoma might cause. Clinical options To attain best results with the com- bined surgery, Dr. Wellik advises practitioners begin with a discussion with patients. "We need to have ade- quate discussions with our patients about what to expect and do ade- quate preop planning so that we know what the patients' refractive goals are," she said. She added that it's important to let patients know that with combined surgery they can expect a good outcome but may have a different result than someone who is having cataract surgery alone. In terms of potentially compen- sating for astigmatism, Dr. Wellik ac- knowledged that the use of a toric IOL might be an option for some. "I am a little hesitant to do toric IOLs in combined surgery because I think the astigmatism issue is harder to predict, but I know that some of my colleagues are very comfortable doing toric IOLs in these patients," she said. "I think that has to do both with the surgeon's comfort level and making sure that the patient under- stands that there may be more vari- ability with the combined surgery." As for minimally invasive glau- coma procedures such as use of the iStent (Glaukos, Laguna Hills, Calif.) or Trabectome (NeoMedix, Tustin, Calif.), these should have very little effect on refractive outcomes, Dr. Wellik believes. "I think that's one of the advantages of those devices," she said. "I would welcome any study to show that." Overall, Dr. Wellik hopes that practitioners come away more confi- dent that performing trabeculec- tomy or tube surgery combined with cataract removal on patients can have very good refractive outcomes. "I think the take-home message is if someone needs both procedures, we shouldn't hesitate to do them in a combined fashion," she said. With use of glaucoma drainage devices be- coming more common, she stressed the need for further investigations looking into things such as use of multifocal or toric IOLs here. EW Editors' note: Drs. Tzu and Wellik have no financial interests related to this article. C ontact information Tzu: jtzu2@med.miami.edu Wellik: SWellik@med.miami.edu February 2011 February 2014 72-77 Glaucoma_EW February 2014-DL2_Layout 1 1/30/14 10:55 AM Page 73

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