EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW FEATURE 54 Secondary glaucoma challenges May 2015 by EyeWorld Staff MIGS adoption in cataract patients: ASCRS members weigh in According to Richard Lewis, MD, in private practice in Sacramen- to, Calif., this number varies with the specialty of the practice. "I have a predominantly glau- coma practice, so the percentage of cataract patients in my practice who are candidates for a safe, effective MIGS procedure is significantly higher. It all depends on the type of practice that you have," he said. When asked about their use of or interest in MIGS, almost 20% of U.S. respondents said that they currently implant MIGS devices in some portion of their glaucoma patients, nearly twice the percentage of non-U.S. respondents (19.6% and 10.9%, respectively). This difference was statistically significant. Add - tionally, 28.9% of all respondents said that they are undecided about using MIGS devices and are waiting for more information (Figure 2). Dr. Lewis noted that more American surgeons are interested in I n the past, surgical glaucoma treatments were reserved for patients with advanced disease because they might be more in- vasive or riskier than the tradi- tional treatments with medications and lasers. However, new microin- vasive glaucoma surgeries (MIGS) are gaining popularity because they involve less risk than other surgical treatments. In the 2014 ASCRS Clinical Survey, members were asked about their adoption of MIGS in cataract patients. When asked about the percent- age of their cataract patients who are candidates for a MIGS device, respondents estimated that 8.6% of their cataract patients are can- didates. Interestingly, the estimate for U.S. respondents was nearly 2% higher, on average, than non- U.S. respondents (9.5% and 7.7%, respectively), and this difference was statistically significant (Figure 1) Global Trends in Ophthalmology ™ Copyright © 2015 Global Trends in Ophthalmology and the American Society of Cataract & Refractive Surgery. All rights reserved. Figure 1 Figure 2 Source: ASCRS 2014 ASCRS Clinical Survey using MIGS because the marketing of the iStent (Glaukos, Laguna Hills, Calif.) and training of the surgeons facilitated an easier transition. "Also, when the initial MIGS devices were launched in Europe, they were not as well understood as they are now in regard to the avail- able data and training to overcome the learning curve, so there may have been some more resistance," he said. "When it first came out, it was introduced as a simple technique, and the fact is that it takes a lot of skill. Some people who tried it in the beginning may have quit using it." Surgeons who are interested in incorporating MIGS into their practice should note that there is a significant learning cu ve with this procedure. Dr. Lewis explained that one of the most important parts of the procedure is the positioning of the patient. "You have to be very comfort- able positioning the patient. One of the most important things you can teach someone who is new to MIGS is that you want to go as high on the magnification as possible with the right positioning of the patient's head in the microscope," he said. "You must optimize your view. If you don't optimize the view to the maximum, you are not going to see your target, and you are not going to succeed in placing the device." In addition, "it is important to look at the patient with a gonio- prism. When performing high-mag- nification surge y, the surgeon's hands must be really stable. A little bit of movement creates a lot of problems," he said. EW Editors' note: Dr. Lewis has no fina - cial interests related to this article. Contact information Lewis: rlewiseyemd@yahoo.com