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EW MEETING REPORTER 64 World Glaucoma Congress August 2011 tem, and a cannula that delivers the drug into the eye. The device is im- planted much like a tube shunt. It has the advantages of being reload- able in the office setting when de- pleted of drug, and the pump rate can be tuned non-invasively to in- crease or decrease drug delivery rate based on IOP reduction goals. Editors' note: Dr. Sit has financial interests with Alcon, Allergan, and Glaukos (Laguna Hills, Calif.). He is an unpaid advisor for AcuMEMS (Menlo Park, Calif.). Dr. Varma has financial interests with Replenish Inc. Myths and misconceptions in glaucoma Myths and misconceptions exist in medicine, for patients and physi- cians alike. Several physicians came together to present some of the big- ger myths and misconceptions in glaucoma. Felipe Medeiros, M.D., University of California-San Diego, discussed three myths about IOP. The first is that 21 mm Hg separates normal subjects from glaucoma pa- tients. The number 21 arose from a population study in the 1950s and in no way indicates whether glau- coma is present or absent. The sec- ond is that IOP can be corrected for central corneal thickness. In fact, nomograms for this purpose are in- valid and not useful. The third is that IOP is highest in the morning. This may be true in the sitting posi- tion, but in the habitual position (sitting while awake, supine when asleep), IOP is highest during sleep. Malik Kahook, M.D., Univer- sity of Colorado, reported that the monocular drug trial is inadequate to evaluate the effectiveness of med- ical therapy in individual patients. The monocular trial was designed to distinguish between spontaneous IOP variation and therapeutic IOP change. For it to work, several as- sumptions must hold true, the most important of which is that sponta- neous IOP variations must be sym- metric between fellow eyes. This has been shown not to be true. Several studies have confirmed that the monocular trial poorly predicts long- term IOP reduction. Instead, we should obtain several pre-treatment and several on-treatment IOP read- ings and determine mean IOP reduc- tion to assess medication effectiveness. Saturday was the final day of the 4th biennial World Glaucoma Congress. Here are highlights from the free paper/poster sessions from the past 4 days. Eugenio Maul, M.D., and colleagues from Johns Hopkins University, Bal- timore, evaluated the frequency of travel away from home among glau- coma patients. Using a cellular net- work-based tracking device, they observed that glaucoma patients were substantially less physically ac- tive and made fewer excursions out- side the home than non- glaucomatous control subjects. Glaucoma patients restricted their physical activity to levels well below recommended activity guidelines. This study underscores the impor- tance of therapy to prevent loss of visual function so that glaucoma pa- tients can maintain their independ- ence and appropriate activity levels. Simon Skalicky, M.D., and col- leagues from the University of Syd- ney, administered the Ocular Surface Disease Index (OSDI) and the Glau- coma Quality of Life (GQL) ques- tionnaires to patients covering the Reporting live from the 2011 World Glaucoma Congress, Paris World continued from page 62 Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team and is supported by a grant from Alcon Inc. Discover a fixed PGA combination without BAK P hilippe Denis, M.D., University Hospital of Lyon, France, discussed the ben- efits and advantages of fixed combination formulations. These include fewer drops per day from fewer bottles, which is a simplified regimen that may improve adherence; quicker installation and minimization of the washout ef- fect; and reduced exposure to preservatives that can be potentially harmful to the ocular surface with chronic exposure. Fixed combinations are in widespread use throughout the world, as 30-40% of European glaucoma patients and up to 50% of American glaucoma patients require more than one medication for glaucoma control. Norbert Pfeiffer, M.D., University of Mainz, Germany, introduced the travo- prost/timolol fixed combination (DuoTrav, Alcon) and described two recent Euro- pean studies of this product. In the first, glaucoma patients uncontrolled on a variety of one- and two-drug regimens were transitioned to the travoprost/ timolol fixed combination. IOP dropped an average of 5.6 mm Hg over 12 weeks. In the second study, patients using both bimatoprost (Lumigan, Allergan, Irvine, Calif.) and timolol (Timoptic, Merck, Whitehouse Station, N.J.) in either fixed or unfixed combination were transitioned to travoprost/timolol fixed combination. IOP went down by approximately 1-2 mm Hg, stinging and burning were reported to be less severe, and patients preferred travoprost/timolol over bimatoprost and timolol four to one. Malik Kahook, M.D., University of Colorado, stated that the preservative BAK is associated with significant damage to corneal and conjunctival cells, while al- ternate preservatives such as SofZia and Polyquad (proprietary Alcon preservation systems) are not. Both travoprost (Travatan Z, Alcon) and travoprost/timolol have been formulated as BAK-free products using these alternate preservatives. Both products have com- parable efficacy and safety to their BAK-preserved counterparts. Dr. Kahook re- cently conducted a study in which patients with impaired tear break-up time (TBUT) on latanoprost were transitioned to Travatan Z. Over 8 weeks, mean TBUT improved from 2 sec. to 6 sec., and ocular surface symptoms improved as well. "In patients with ocular surface disease, a non-BAK preserved medication might be the best option," he said. Editors' note: Dr. Pfeiffer has financial interests with MSD and Alcon. Dr. Kahook has financial interests with Alcon. Symposium sponsored by Alcon

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