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E W MEETING REPORTER 102 "These are patients who are more likely to have mutations in genes known to cause familial forms o f glaucoma," Dr. Wiggs said. "Ge- netic testing for these patients will impact the treatment outcomes of the clinical course." In her talk "The role of genetics (today) in the glaucoma clinic," Dr. Wiggs said that genetic testing is an "accurate, precise, and specific" way to define disease risk for patients. Testing is simple, done once with blood or saliva samples, she said. The results are well worth it: "Impor- tantly, we can give informed genetic counseling to families with these mutations," she said. Editors' note: Dr. Wiggs has no financial interests related to this p resentation. MIGS offers new opportunities in glaucoma treatment New microinvasive glaucoma sur- gery (MIGS) procedures are adding options to the glaucoma surgical treatment paradigm, especially in less advanced cases. Malik Y. Kahook, MD, Denver, said that while trabeculectomy is still the gold standard in glaucoma surgery, it also has increased compli- cations. "There's been a constant effort to improve upon that surgery and that's where MIGS comes into it," he said. Dr. Kahook showed his "MIGS wish list," a group of factors that the ultimate MIGS procedure would en- capsulate. His list included "as effec- tive as trabeculectomy with better safety," "easy to perform," and "cost effective." He discussed devices including the iStent (Glaukos, Laguna Hills, Calif.), Hydrus (Ivantis, Irvine, Calif.), CyPass (Transcend Medical, Menlo Park, Calif.), and the XEN Gel Stent (AqueSys, Irvine, Calif.). He said many glaucoma patients do not need significant pressure lowering with reduction of multiple medica- tions, so these procedures might prove effective additions to the surgical armamentarium for early mild to moderate glaucoma cases. "There's no cookbook approach at this point," he said. "Each MIGS procedure has a unique personality and we're starting to understand that, but one thing I can say is that f inally, as a glaucoma surgeon, we have options." Editors' note: Dr. Kahook has no financial interests related to this presentation. Thursday, Jan. 23, 2014 Refer to neuro-ophthalmologists in difficult neuro cases If you are going to refer a challeng- ing case to a neuro-ophthalmologist, do so directly—"pass the baton" straight to the specialist who can assist, said Andrew G. Lee, MD, Houston. In the "Mini-symposium on n euro-ophthalmology," Dr. Lee said ophthalmologists need to be aware of and ready for those cases that might need to be referred to a neuro-ophthalmologist. "If you don't want to do special tests, you don't have special tests, that's your indication to refer," he said. "If you write 'impression: atypi- cal,' whatever you write next, it doesn't matter. The next thing that should come out of the pen is 'plan: refer.'" It is the vital role of the ophthalmologist in neuro-ophthal- mology cases to rule out the two ophthalmic conditions that are life threatening—optic neuropathy and hemianopsia—or to refer to a spe- cialist so they can do so, he said. These cases can be serious, and the correct diagnosis can be the differ- ence between life and death, he said. " People die from undiagnosed optic neuropathies, undiagnosed pituitary tumors, undiagnosed brain tumors," Dr. Lee said. "It's your job to make sure it's not that." He showed a case of a 73-year- old female patient that he diagnosed with paraneoplastic optic neuropa- thy secondary to small cell lung can- c er in 1998. Fourteen years later, she returned to his office to tell him that she was still alive and to thank him. She is the longest known survivor of the syndrome. "She is alive today because of something we saw in her eye," Dr. Lee said. E ditors' note: Dr. Lee has no financial interests related to this presentation. How to avoid five easy neuro- ophthalmology exam errors There are five common exam errors in neuro-ophthalmology cases. Dr. Lee advised physicians avoid the first error by checking pupils in light and dark conditions. He cautioned them not to use "PERRLA"—pupils equal, round, reactive to light, and accommodation—without adding dark as well, plus relative afferent pupillary defect (RAPD). "PERRLA only checks one por- tion of the three things you're sup- posed to check. You're supposed to check the pupil in the light, in the dark, and swing the flashlight [for the RAPD]—you know this from res- idency, but then this PERRLA things February 2014 Reporting live from the 2014 Hawaiian Eye, Kauai, Hawaii Sponsored by View it now ... EWrePlay.org Rohit Varma, MD, MPH, discusses the results of the TVT (Tube vs. Trabeculectomy) trial. Wednesday on EWrePlay 98-105 MR Hawaii_EW February 2014-DL2_Layout 1 1/30/14 11:57 AM Page 102