Eyeworld

99 EW GLAUCOMA October 2015 Finally, Dr. Ramulu said, "more work is needed" to evaluate the vari- ous techniques'/devices' efficacy in a cost/benefit scenario. EW Canaloplasty was introduced in 2007, and has steadily increased from 161 procedures in 2007 to 2,426 in 2012. "We expected that the intro- duction of surgical therapy into the realm of early to moderate disease would result in more overall surgery being done, especially with these newer procedures, particularly Trabectome [NeoMedix, Tustin, Calif.], ECP, and maybe canaloplas- ty," he said. In contrast, however, the overall number of surgeries de- clined, and there's no explanation. Dr. Ramulu said it's possible that patients are reticent to undergo surgery, or that there are fewer glau- coma surgeons, or even that cataract surgery is being used as a means to control IOP. "People are being diagnosed earlier, and they're being medically managed earlier, so there may be other confounding factors to explain the decline in surgery," Dr. Ramulu said. "It seems somewhat of a para- dox. There is this growth in options for early surgery, but that almost makes the finding of an overall decrease in surgical numbers even more dramatic." Still needed The researchers suggested a need for more well-designed clinical trials, which Dr. Ramulu said means "more head-to-head comparisons of dif- ferent surgical options in the same population." The confusion arises because there are "a lot of stand- alone studies" that show a procedure lowers IOP by a certain amount in a certain population; sometimes the studies evaluate the procedure in conjunction with cataract surgery, other times not. "But since they're often not compared to trabeculectomy, it's unclear how these procedures are on a comparative basis. You just know how they performed in that popu- lation," he said, adding that at least one company (InnFocus, Miami) is comparing its MicroShunt to trabe- culectomy outcomes. The group plans to evaluate "how many people are doing each of the procedures," he said. "It's quite possible that the large number of ECPs are being performed by only a handful of people, or there may be cataract surgeons who are doing 4 or 5 a week." Reference 1. Arora KS, Robin AL, Corcoran KJ, Corcoran SL, Ramulu PY. Use of various glaucoma surgeries and procedures in Medicare beneficiaries from 1994 to 2012. Ophthalmology. 2015;122(8):1615–24. Editors' note: Dr. Ramulu has no finan- cial interests related to this article. Contact information Ramulu: pramulu@jhmi.edu M&S holds US Patents 7,354,155; 7,926,948; 8,425,040; 8,167,429; 8,419,184 & 8,550,631. Other Patents Pending. ©2015 M&S Technologies, Inc. Smart System and M&S are registered trademarks of M&S Technologies, Inc. All Rights Reserved. www.mstech-eyes.com 1-877-225-6101 YEARS See us at the Academy Meeting in Las Vegas! Booth 2440 Clinical Trial Suite ( CTS TM ) FULLY-AUTOMATED RESULTS-DRIVEN PROTOCOLS BASED ON ANSI/ISO SPECIFICATIONS When conducting a clinical trial or a comprehensive research study, there is no room for error. Each test in the M&S Smart System® Clinical Trial Suite automatically steps through the eye charts presented, and directly responds to user input regarding correct/incorrect results. The CTS controlled approach to testing stands out in these critical areas: 1) Protocol-led testing ensures consistent operator use across test sites and eliminates bias and erroneous data 2) Quality hardware built-to-last and patented software developed to ANSI/ISO standards 3) Peer-reviewed tests certified to existing standards 4) Superior, responsive USA-based technical and engineering team for support and training 5) Exportable real-time data significantly reduces data collection expense M & S T E C H N O L O G I E S , I N C . S M A R T S Y S T E M® Customize Your Suite Based on Your Trial Needs! Pick and Choose from These Tests: AUTOMATED ETDRS at DISTANCE, INTERMEDIATE * & NEAR * eETDRS (electronic ETDRS) DEFOCUS CURVE (configurable from +2 to –5 Diopters) AUTOMATED CONTRAST SENSITIVITY FUNCTION SYSTEM (ACSFS) LETTER CONTRAST TESTING at 1.2%, 2.5%, 5% and 25% ETDRS TESTING WITH LOW CONTRAST LETTERS LINEAR SINE GRATING CONTRAST TESTING WITH MULTIPLE ORIENTATIONS *High-Resolution Laptop required Test Results Letter Score: 81 Equivalent Acuity: 20/25 Log: 0.12

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