Eyeworld

EW MEETING REPORTER 124 October 2015 Reporting from the 2015 Combined Ophthalmic Symposium, August 21–23, Austin, Texas has also been shown to be effective in younger patients—aged 29–59— so feel free to use it in this patient group, he added. It's important to understand that the laser works by denuding cells in the trabecular meshwork, promoting cell proliferation, Dr. Rhee said. This is clinically relevant because you don't want to "paint" the trabecular meshwork when doing SLT—leave some areas of the meshwork untreated so that cells have room to proliferate. Dr. Vold concluded the glauco- ma session by challenging attendees to think differently about the role of electronic medical records (EMRs) in their practice. Rather than seeing EMRs as an expensive and unneces- sary tool that disrupts patient flow— or a tool for the government to tell doctors how to practice medicine— consider EMRs as a tool that can make you a better doctor and raise the standard of care. Dr. Vold outlined several ways that physicians can use EMRs to assess the risk, track the progression, and determine the best treatment for patients with glaucoma. By assessing multiple risk factors at once—such as a patient's age, corneal thickness, IOP, and angle—and incorporat- ing advanced imaging techniques, physicians can determine a patient's relative risk of developing glaucoma and predict how fast the disease will progress. By taking advantage of all the electronic data that is available, glaucoma specialists can compare themselves with their peers and bring glaucoma management to the next level. "This holds us to a higher level of care at the end of the day," he concluded. Editors' note: Drs. Rhee and Vold have no financial interests related to their comments. Phacodynamics Barry Seibel, MD, Los Angeles, highlighted phacodynamics and un- derstanding of machine parameters in his presentation. He referenced the 2015 ASCRS Clinical Survey, which indicated that a quarter of respondents rated themselves as having a moderate to poor under- standing of how to manage phaco machine settings. The problem that surgeons have is how they are taught, he said, which is from books. There are multiple settings, depend- ing on which machine you're using. One way to approach this is to memorize these settings, but Dr. Seibel prefers to try to understand what is going on with the settings. There are 4 things surgeons need to be concerned about with phacody- namics. There are 3 fluidic param- eters, flow, vacuum, and bottle height. There is also ultrasound, which has several clinical roles, including the disruption and desta- bilization of the cataract. Dr. Seibel went over types of pumps, flow pumps and vacuum pumps, and the details of these two basic machines. Editors' note: Dr. Seibel has financial interests with Slack Inc. (Thorofare, N.J.). Tackling glaucoma: What works and what doesn't? Glaucoma specialists have a wealth of options to choose from when treating patients with glaucoma, but determining which treatment is best for each patient can be challenging. Douglas Rhee, MD, Cleveland, and Steve Vold, MD, Fayetteville, Ark., gave tips for navigating the complex landscape of available medications, laser, and surgical glaucoma treat- ments in "Expanding the Glaucoma Toolbox." Medications are often the first line treatment for open angle glaucoma, but we're not getting any better with improving drop compli- ance, Dr. Rhee said, so it's reasonable to offer laser trabeculoplasty as a pri- mary option. Selective laser trabecu- loplasty (SLT) has been shown to be equally effective at lowering IOP as prostaglandin analogs, Dr. Rhee said, and is slightly more cost effective over the long term than drops. SLT Reporting from the 2015 Combined

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