MAR 2014

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

Issue link: https://digital.eyeworld.org/i/276058

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Reporting live from the 2014 ASCRS•ASOA Winter Update Fajardo, Puerto Rico Sponsored by E W MEETING REPORTER 152 donor tissue waste," he said, as well as a lower rebubbling rate. Dr. Samuelson discussed the n ext generation of microinvasive glaucoma surgery, or MIGS. One of the new and upcoming innovations, he said, is the AqueSys XEN (AqueSys, Aliso Viejo, Calif.). Although it is not yet approved for use in the United States, he said that it has the potential for extremely good efficacy. No one would argue t hat trabeculectomy and tubes are efficacious, but the question is how safe they are. The XEN is a portfolio that features three different sizes of gelatinous stents, and these provide communication between the ante- rior chamber and the subconjuncti- val space. Other features of the AqueSys product are that the stents a re soft, compressible and tissue conforming, and come pre-loaded with a disposable injector. It largely spares the conjunctiva and is an ex- cellent option for a variety of patient types, including those with moder- ate to advanced glaucoma, who have failed MIGS and those who are pseudophakic, Dr. Samuelson said. If safety is proved, perhaps it can com- pete with canal-based procedures. Dr. Samuelson said he has done a lot of cases with the XEN in the Dominican Republic and some in the United States as part of a trial. He said there is significant efficacy with the product. "You can get pres- sures that are significantly lower than canal-based procedures. It's minimally invasive in terms of its technique." He added that it still needs to be proven whether or not the XEN is minimally invasive in terms of mechanism. Editors' note: Dr. Rubenstein has no financial interests related to his presentation. Dr. Samuelson has financial interests with AqueSys. Management of complex cataracts An afternoon session led by Dr. Condon focused on managing complex cataracts. "The most challenging cataract scenarios that we typically see are the patients with very dense lenses and the patients with very loose lenses, and the p seudoexfoliation cases," he said. He discussed several particularly dense and challenging cataracts and showed videos, offering tips for how to handle these cases. Dr. Condon has several ways to deal with com- plex cataracts. "My approach to dealing with these lenses over the years is two-fold," he said. The first p oint is to protect the corneal endothelium as much as possible. The second point is to address the cataract in the capsular bag. "I try to remove as much of these lenses as possible while they're in the capsu- lar bag," he said. "I don't try and get to the chop point." If you do this, the lens is in a well-controlled posi- t ion, and phaco is used behind the plane of the anterior capsular lens, Dr. Condon said. Editors' note: Dr. Condon has no finan- cial interests related to his presentation. Rapid F-Eye-R A panel of physicians shared quick pearls on topics ranging from fem- tosecond technology to microinva- sive glaucoma surgery (MIGS) in short presentations during the popu- lar "Rapid F-Eye-R" session. In the first discussion, Dr. Solomon touted the benefits of toric IOLs for astig- matism correction, but said the technology isn't reaching enough patients. "We've just barely scratched the surface," he said. "Fifty percent of patients in your practice are eligible for a toric lens, so we have a long way to go." Next, t he panelists debated the use of the femtosecond laser. "The price tag is so much that a lot of practices are going to wait to see what happens," said Brock K. Bakewell, MD, Tucson, Ariz. "I think it makes me a better surgeon," Dr. Solomon said. "I think it's improving my outcomes, and it's the next step of the future." E ric D. Donnenfeld, MD, Rockville Centre, N.Y., agreed. "There's not a single doubt in my mind that it will not only be around but will be the dominant form of cataract surgery," Dr. Donnenfeld said. "There have been 80 peer-reviewed papers on femtosecond laser-assisted cataract surgery, and almost all of them are s howing positive signs." In a session called "What am I doing new this year?" Dr. Bakewell gave pearls about transitioning to an electronic health record (EHR) system: In a multi-doctor practice, switch only one doctor at a time; start with younger doctors who are more tech savvy; decrease the daily patient schedule by 20 to 25% for the first month, then ramp back up; phase in each doctor every one to two months; and have the doctors give feedback to the EHR committee to help them improve templates. "Also, definitely have a scribe to put information into the computer," Dr. Bakewell. "I have two scribes who allow me to see 50 patients a day." March 2014 View it now ... EWrePlay.org Kerry D. Solomon, MD, discusses an integrated system for operative planning and intraoperative assistance for toric IOL implantation. 149-159 MR WU2014_EW March 2014-DL2_Layout 1 3/6/14 4:21 PM Page 152

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