EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/407647
47 EW FEATURE NIDEK Inc. 47651 Westinghouse Drive Fremont, California 94539-7474 USA Telephone: 1-800-223-9044 usa.nidek.com NAVEX Quest with Final Fit ™ , topography-assisted excimer laser system featuring CATz software. #14-0023 CATz, our latest innovation in Laser Vision Correction, enables surgeons to treat myopic astigmatism with corneal irregularities. According to George O. Waring III, MD, principle investigator of the US FDA Study, "the outcomes of the CATz study are astoundingly good. 51% of patients see 20/16 or better without correction*." Dr. CATz CoNTACT NIDEK To ElImINATE yoUr USEr FEES ToDAy! P r o d u c t s • s e r v i c e s • t e c h n o l o g i e s • 200Hz Active Eye Tracker. • TED: Torsion Error Detection, captured by the OPD. • Proprietary Final Fit TM software for accurate outcome simulation and customized corneal treatment. • Full Nidek support including customer tailored service options. • No User or Click Fees associated with Nidek Laser use or service. * Pg 29, 7.4.2 FDA Professional Use of Nidek Topography assisted Lasik. continued on page 48 November 2014 Combined procedures for glaucoma With ECP, the treated ciliary processes on the left are shrunken and whitened compared with the untreated processes on the right. Source: Brian A. Francis, MD For example, you need a functional outflow system and an open angle to consider a trabecular treatment, so someone with neovascular glaucoma would not be a good match, he said. Also, the extent of the glauco- ma and the target pressure are an important consideration here, Dr. Francis said. "It you have someone who you do not want to do a traditional filter on but who needs a pressure that's lower than 16, which is what you can get with traditional MIGS, you can combine any of the first 3 categories," he said, adding that as long as the pathways are different, the effect should be additive. Dr. Radcliffe agreed that mixing and matching procedures could play an important role in future glauco- ma management. "You might combine an inflow and outflow procedure like ECP and Trabectome or a suprachoroidal shunt," he said. Practitioners may also consider the procedure for those who have already experienced complications with trabeculectomy. "You might have a patient who had a trabe- culectomy in the first eye and had a serious complication and can't bear to go ahead with another one," Dr. Radcliffe said. "That patient is a good near-MIGS candidate." Dr. Noecker views these near- MIGS procedures as a good possibil- ity for those who have a contraindi- cation to a trabeculectomy or a tube, or who do not have the need for very low eye pressure. "Not every- one needs an eye pressure of 10," he said. In fact, sometimes getting the pressure too low can be a problem, he said. "With some people we just want to minimize our chance of overshooting because the only thing worse than high pressure is very low pressure," Dr. Noecker said, adding that in such cases, patients get swell- ing and bleeding, which can cause further issues. However, with these intermediate procedures, it is diffi- cult to get the eye pressure too low. Arguably the best setting is to do these procedures in conjunction with cataract surgery, according to Dr. Noecker. "Some cases may have angle compromise, so getting the cataract out of the way helps at that level and may be beneficial in itself," he said. "There are certainly studies in the literature that support that cataract surgery alone in some glaucoma patients, especially milder ones, can be a very beneficial thing to do." In addition, getting the lens out of the way may give practitioners more space to work in the eye and also offer visual access to areas being treated such as the angle or ciliary processes, Dr. Noecker said. Pressure reduction score Practitioners may see a surprising amount of pressure reduction with