Eyeworld

69 EW GLAUCOMA November 2015 Contact information Francis: bfrancis@doheny.org Rhee: dougrhee@aol.com Samuelson: twsamuelson@mneye.com will be "uniquely applicable in situ- ations such as angle-closure glauco- ma where we can't use canal-based surgery," he said. "I don't think it will be that much longer before we're discussing MIGS as an option before, during, or after cataract surgery. That's not to say that trabeculectomy and tubes won't be utilized. They certainly will, but we'll have options at earlier stages in the disease to intervene surgically," Dr. Samuelson said. Cataract procedures alone For patients with advanced open- angle glaucoma, cataract surgery by itself probably should not be a standalone procedure to control IOP, Dr. Rhee said. "Not even the most avant-garde glaucoma special- ists would look at a patient and tell them they need a lower pressure so we're going to only remove their lens because of the risk of an IOP spike." Plus, he said, 20/20 with a crys- talline lens is not the same visual quality as 20/20 with an IOL. When he's removed a lens primarily as a pressure-lowering move in cases of phacomorphic glaucoma and the patient had good vision, anecdotally patients note the loss of accommo- dation or the ability to see near. "This is just my sample of a handful of people," he said. "But should standalone cataract surgery be considered? Yes." Deciding on a procedure depends on how difficult it is to manage IOP and where the baseline levels were, Dr. Francis said. One medication and well controlled? Cataract surgery alone may be ade- quate. "But if they're on two meds and pressure is not well controlled, then I'd definitely do cataract plus MIGS. Cataract surgery by itself does have a place, but it can also be dangerous to assume that just doing cataract surgery is going to control their glaucoma." Plus, surgeons may "lose an op- portunity" to further reduce the IOP by only performing cataract surgery, he said. EW Editors' note: This article was written before Allergan's purchase of AqueSys was completed. Dr. Francis has fi- nancial interests with Beaver-Visitec International (Waltham, Mass.) and NeoMedix. Dr. Rhee has financial interests with Glaukos and Ivantis. Dr. Samuelson has financial interests with AqueSys, Glaukos, and Ivantis. Be Part of WOC2016! /attendwoc /attendwoc • Choose from over 200 scientific sessions, 1,446 free papers and posters, and 26 subspecialty day sessions with 70 contributing societies • Learn about the latest products and services from over 100 exhibitors • Network with 900+ invited speakers and 7,000+ participants from 100+ countries World Ophthalmology Congress ® of the International Council of Ophthalmology Host: Mexican Society of Ophthalmology Co-host: Pan-American Association of Ophthalmology Register to Attend this Global Event February 5-9 in Guadalajara, Mexico: woc2016.org Mark Your Calendar: WOC2018 June 16-19 Barcelona, Spain

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