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EW GLAUCOMA 47 lower pressure or get off more med- ications, he might use multiple stents. "We also know that cataract surgery alone lowers pressure," he said, so the big question to look at is how much pressure is being lowered by cataract surgery alone vs. the implant itself. For that reason, Dr. Ahmed said studies are looking at one stent plus phaco vs. phaco alone, as well as multiple stents plus phaco vs. phaco alone. Early results for one stent were modest, he said, but there seems to be a greater efficacy with multiple stents and over a longer time. "I think we're seeing a real difference in the function of the device," he said. Dr. Ahmed noted that these expanded indications include the use of the iStent on its own without cataract surgery. Dr. Ahmed has reported the use of multiple iStents in patients without cataract surgery, which shows that the device lowers pressure on its own, he said. Best cases Dr. Ahmed has been using the device in mild to moderate cases, as well as advanced patients who can tolerate medications as a safer alter- native to trabeculectomy. Targeted iStents and multiple stents have begun to take up more procedure volume compared to trabeculec- tomies. The ideal patient in the U.S. is someone who has mild to moderate glaucoma and is controlled on med- ications, Dr. Ahmed said. As indica- tions expand to multiple stents, he believes surgeons may expand the use of this device. The safety of the procedure is the major point to emphasize. Historically, physicians have talked about glaucoma surgery and empha- sized the risk, Dr. Ahmed said. They have delayed surgery as a result, often waiting until the patient has progressed and there is a high complication rate. Putting the iStent in with the proper technique and experience is safe, with a risk no greater than cataract surgery alone, and can help prevent that visual loss and high complication rate of the past. "We're in a new era of these MIGS procedures," Dr. Ahmed said. "There's a lot we still have to understand and learn from an anatomy perspective about how the device can be optimized." EW Editors' note: Dr. Ahmed has financial interests with Glaukos, Ivantis (Irvine, Calif.), Transcend Medical (Menlo Park, Calif.), and AqueSys (Aliso Viejo, Calif.). Contact information Ahmed: ike.ahmed@utoronto.ca February 2011 June 2014 `iÊ { *ÀÕÃÊ*>Ìi Ü Ü Ü ° > i ` Û > Û i ° V nää°nÎÓ°xÎÓÇ 3PRL5V6[OLY Expanded continued from page 45 "We're in a new era of these MIGS procedures. There's a lot we still have to understand and learn from an anatomy perspective about how the device can be optimized." 45-47 Glaucoma_EW June 2014-DL_Layout 1 6/3/14 12:35 PM Page 47

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