Eyeworld

EW MEETING REPORTER 62 June 2014 focused on cataract and refractive topics. He began by highlighting the contributions of Cornelius Binkhorst, MD, who he said perse- vered by educating colleagues and publishing high quality research. Dr. Ahmed's lecture focused on glaucoma surgery, why it needs to change and how to accomplish that change. There is a big gap between medications and lasers and tra- beculectomy and tubes in terms of safety, he said. This is where MIGS has promise for filling this major gap, he said. Traditional glaucoma surgery tends to be thought of as a "last re- sort" for refractory cases, and there are a number of serious and long- term risks with these surgeries, Dr. Ahmed said. Additionally, there is intense postop recovery and vari- ability in healing and predictability. However, MIGS offers a number of advantages. It is an ab interno ap- proach that is minimally traumatic, offers at least modest efficacy, and has an extremely high safety profile and rapid recovery. "This is predi- cated by extreme safety," he said. Dr. Ahmed also went into detail on current patient profiles for MIGS and trabeculectomy. MIGS patients typically include those with mild to moderate disease, with a modest IOP target and who are able to tolerate some meds if needed. Trabeculec- tomy patients are usually those with advanced disease, with a low IOP target and who are intolerant of meds. The outcome measures physicians look at are reducing medication burden in addition to lowering pressure, Dr. Ahmed said. "We see the merger of cataract and glaucoma surgery," he said, describing a glaucoma patient undergoing phaco combined with a MIGS device as a "zero loss game." A synergy with MIGS makes a lot of sense, he said. There is estab- lished benefit for additional IOP- lowering and medication reduction, as well as improved adoption and surgical techniques, Dr. Ahmed said. Additionally, Schlemm's canal or suprachoroidal space devices could be used for mild to moderate disease, while subconjunctival space devices could be used for full-spec- trum disease. Dr. Ahmed also discussed three main MIGS outflow targets: conventional outflow system, supra- choroidal outflow mechanisms, and the scleral subconjunctival mechanisms. The iStent (Glaukos) is the first approved MIGS device in the U.S. Dr. Ahmed talked about a number of other strategies he's using in his work, like specifically targeted iStent placement and using multiple iStents. He discussed how there is movement on looking into solo procedures, meaning using the iStent on its own in phakic or pseudophakic patients. "I think the promise of MIGS is that we can intervene earlier in the disease, reducing the morbidity of progression." He thinks MIGS will become an option for solo proce- dures and that trabeculectomy will be retired soon. Dr. Ahmed expressed his opti- mism about the future of MIGS and said that it's an idea that is so strong and makes so much sense that he believes nothing will stop the momentum of this process. Editors' note: Dr. Ahmed has financial interests with multiple ophthalmic companies. '60 Minutes' session looks to the future of anterior segment surgery Following the Science and Medicine Lecture, the second part of the Sunday Summit was "60 Minutes: Future Directions in Anterior Segment Surgery." Judges and winners of the 2014 ASCRS Film Festival 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 12:44 PM Page 62

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