Eyeworld

EW GLAUCOMA 107 cause a problem. Visual fields can change even mildly and go unrecog- nized." In years gone by, surgery has of- fered a "pretty good success rate in controlling pressure," Dr. Mundorf said, and whether or not the newer generic glaucoma medications will be as successful cannot be predicted. Glaucoma, as is the case with any chronic degenerative disease, cannot be cured, Dr. Singh said. As a colleague of his once opined: "With glaucoma, you can't win, and you can't break even. If you're lucky, you'll lose very slowly," he said. As Dr. Singh noted, the goal of any glaucoma specialist is to slow the rate of disease progression to a rate consistent with visual preserva- tion for the remainder of the pa- tient's life. While physicians may tell their patients that their glaucoma is stable, "what they are really saying is that there is no significant measura- ble change in structural or func- tional parameters. The reality is that all of our patients are losing retinal ganglion cells on a daily basis, and it is only the rate of such loss that dis- tinguishes those who are doing well from those who are doing poorly," Dr. Singh said. "While the nature of such care may not be attractive to some practi- tioners who are looking for cures, the chronicity of glaucomatous dis- ease has led to patient-physician bonds that are among the strongest in all of medicine. This, combined with the facts that most patients under care do not go blind from the disease and glaucoma practitioners generally perform cataract surgery providing an opportunity to im- prove vision in such longstanding patients, is why glaucoma care is, without a doubt, the most rewarding in ophthalmology. I wouldn't trade jobs with any other subspecialist," Dr. Singh said. Until there are more advances in genetics, "we'll only be able to 'manage' rather than 'cure' the dis- ease," Dr. Samuelson said. EW Editors' note: Dr. Cantor has financial interests with Abbott Medical Optics (AMO, Santa Ana, Calif.), Alcon (Fort Worth, Texas), Allergan, and Pfizer. Dr. Mundorf has financial interests with Allergan. Dr. Noecker has finan- cial intersts with Alcon, Allergan, and Endo Optiks (Little Silver, N.J.). Dr. Samuelson has financial interests with AMO, AcuMems (Menlo Park, Calif.), Alcon, Allergan, AqueSys (Irvine, Calif.), Endo Optiks, Glaukos (Laguna Hills, Calif.), iScience (Menlo Park, Calif.), Ivantis (Irvine, Calif.), Pfizer, QLT (Menlo Park, Calif.), and Santen (Napa, Calif.). Dr. Singh has financial intersts with Alcon, Allergan, Bausch & Lomb (Rochester, N.Y.), iScience, Ivantis, and Transcend Medical (Menlo Park, Calif.). Contact information Cantor: 317-274-8485, lcantor@iupui.edu Mundorf: 704-334-3222, tommundorf@aol.com Noecker: 412-526-1757, noeckerrj@upmc.edu Samuelson: 612-813-3628, twsamuelson@mneye.com Singh: 650-575-8849, kuldev@yahoo.com February 2011 March 2011 Occu-Flo ™ Punctum Plugs 2500 Sandersville Rd., Lexington, KY 40511 USA Phone: 859-259-4925, 800-354-7848 Fax: 859-259-4926 E-Mail: usiol@aol.com We fit the world INC. Visit our Booth #438 for the Special ASCRS Promotional Offer. www.usiol.com 0.880 1.800 .410 1.150 1.980 .460 1.010 1.930 .460 Occu-Flo™ Plugs Offer: • Easy Insertion • A smooth finish which creates immediate patient comfort • High tolerance by patients • Easy removal if necessary Occu-Flo™ Relieves Dryness and Discomfort Due To: • Post Surgical Complications • Seasonal Allergies • Medication Side Effects • Contact Lens Usage USP-2005 Medium 0.750 1.630 .410 USP-2004 Small USP-2006 Large USP-2007 X-Large Available Preloaded Sterile on Insertion Handle or Nonsterile Bulk Changes continued from page 105 Results good for combined pars plana vitrectomy and glaucoma tube shunt surgery in glaucoma patients C ombined endoscope-assisted pars plana vitrectomy with place- ment of a Baerveldt tube shunt (Abbott Medical Optics, AMO, Santa Ana, Calif.) into the vitreous cavity is a useful interven- tion in patients who have uncontrolled chronic angle-closure glaucoma, media opacities, and patients who have limited surgi- cal options, according to a study published in the February issue of Retina. The purpose of the study, authored by Ryan Tarantola, M.D., was to eval- uate the long-term results of the procedure. Researchers reviewed the records of 18 adult patients who had uncon- trolled chronic angle-closure glaucoma associated with corneal opacifica- tion or fibrosed pupils. Those 19 eyes had undergone endoscope-assisted pars plana vitrectomy with the Baerveldt tube shunt placed into the vitre- ous cavity between 1997 and 2005. Researchers analyzed IOP reduction, glaucoma medication reduction, complications, and visual acuity. The mean follow-up duration was 62 months. During that time, mean pre-op intraocular pressure was 31.3±10.5 mm Hg on 3.4±1.0 glaucoma medications. Researchers found that IOP was significantly reduced at each post-op examination. In 17 eyes without phthisis, IOP was significantly re- duced at the final follow-up examination to a mean of 11.4±2.9 mm Hg (P<0.0001) on 1.3±1.2 medications (P<0.0001). No complications were found in 14 of 19 eyes. Post-op, best attained visual acuity improved in 14 of 19 eyes, remained unchanged in four of 19 eyes, and was reduced in one of 19 eyes, leading researchers to conclude that the procedure is useful in these patients.

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