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EW MEETING REPORTER 60 June 2014 ASCRS presidents have come from the Glaucoma Committee, he added. This year's ASCRS Binkhorst lecturer, Ike Ahmed, MD, Toronto, spoke at Glaucoma Day about the future of glaucoma surgery. In 5 years, he believes there will be five approved devices for microinvasive glaucoma surgery (MIGS). These de- vices will have synergies with drug delivery systems, all with the goal of achieving an even lower IOP than currently targeted on average. Some patients may have two MIGS procedures when medically neces- sary, and the MIGS devices that will be available will have three possible outflow targets. In 5 years, tra- beculectomy will almost be retired, but tube shunts will continue to be used. Surgeons will continue to try to reduce medication use and per- form phacoemulsification when it can help lower IOP, Dr. Ahmed said. Glaucoma Day also featured ses- sions on imaging, including optical coherence tomography (OCT) pearls from Vikas Chopra, MD, Los Ange- les. Surgeons should consider signal strength (aiming for at least a 7 out of 10), proper centration, and align- ment when interpreting images, he said. "Inserting artificial tears pretesting can help improve OCT image quality," Dr. Chopra said. OCT should not be used to make a diagnosis, Dr. Chopra said. "Any abnormality on OCT always requires a clinical correlation," he said. However, even with the growth of sophisticated imaging within glaucoma, surgeons will continue to need gonioscopy training and skills, said Brian Francis, MD, Los Angeles. Addressing the ever-growing interest in MIGS procedures, John Berdahl, MD, Sioux Falls, S.D., described his technique to insert the iStent trabecular micro-bypass (Glaukos). Some of his pearls prior to insertion include tilting the scope 30 degrees away from the surgeon, tilting the patient's head 30 degrees away, adjusting the oculars, asking patients to look at their contralateral ear, applying the gonio lens and viscoelastic material, and obtaining an accurate focus. Thomas W. Samuelson, MD, Minneapolis, delivered the 2014 Stephen A. Obstbaum, MD, Honored Lecture on glaucoma management in what he called the "post-renais- sance" era. Editors' note: Dr. Ahmed has financial interests with Abbott Medical Optics, Alcon, Glaukos, and other ophthalmic companies. Dr. Berdahl has financial interests with Alcon, Bausch + Lomb, Glaukos, and other ophthalmic compa- nies. Dr. Brown has financial interests with Glaukos, Ivantis, Transcend Medical, and other ophthalmic companies. Dr. Chopra has financial interests with Allergan. Dr. Francis has financial interests with Allergan, Endo Optiks, Merck, and other ophthalmic companies. Sen. Paul calls for repeal of ICD-10, urges physicians to get involved in the political process Sen. Rand Paul, MD (R-KY), was the featured guest speaker at the joint ASCRS•ASOA Government Relations Session. Sen. Paul spoke to a jam- packed session room about his ob- jections to the Affordable Care Act (ACA), SGR, and ICD-10. Sen. Paul is an ophthalmologist who also serves on the Senate Health, Education, Labor and Pensions Committee. He spoke about healthcare policy from his point of view as a physician serving in Congress. He has co-spon- sored legislation to provide a viable Medicare private contracting option and to delay the implementation of ICD-10, as well as legislation to repeal the Independent Payment Advisory Board. It's a backward way of looking at healthcare, he said about the ACA. "The thing is that we've entrusted government," Sen. Paul said. "We think somehow it's going to be bet- ter if government is in charge of things." The bottom line is the question of whether physicians want to help people. The answer is yes and most of us do it, he said. To increase the number of people that physicians treat, give a tax credit or tax deduction for seeing the poor, Sen. Paul said. The reason that government is not good at solving problems, he said, is because the government is not worried about spending money because it is not their personal money. "We should try to minimize what government does, and we should try to keep things as much as we can in the private sector," he said. The government thinks that you'll provide better healthcare for Sen. Paul speaks to attendees at the ASCRS•ASOA Government Relations Session. Reporting from the 2014 ASCRS•ASOA Symposium & Congress in Boston a Novartis company Sponsored by 58-65 MR-ASCRS_EW June 2014-Dl2_Layout 1 6/3/14 12:43 PM Page 60

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