Eyeworld

Reporting from the 2015 AAO annual meeting, November 14–17, Las Vegas EW MEETING REPORTER 74 Editors' note: Dr. Novack has financial interests with Aerie Pharmaceuticals (Bedminster, N.J.) and Peregrine (Tustin, Calif.). Early cataract surgery in children increases glaucoma risk Cataract surgery at age 6 weeks or younger puts patients at a 3-fold risk for glaucoma later in life, said Scott Lambert, MD, Atlanta. "Unfortu- nately, these patients need earlier surgery for better results," he said. Dr. Lambert reported data from the 114 infants in the Infant Aphakia Treatment Study that found 4.8 years after cataract surgery, 17% of study patients, all of whom had unilateral cataract surgery with or without IOL implantation in infancy, had glaucoma. Thirty-one percent were glaucoma suspect. Other risk factors for glaucoma development include microphthal- mos, reoperations, retained lens material, and chronic inflammation. Researchers concluded that cataract surgery should be deferred to at least 4 weeks of age. Study investigators recently received funding from the National Institutes of Health to conduct another follow-up with patients, who are now about 10 years old. a methodical fashion to provide full data integration, Dr. Friedman said. Editors' note: Dr. Friedman has finan- cial interests with Alcon, Allergan, and Carl Zeiss Meditec. Searching for new strategies for controlled glaucoma drug delivery Although glaucoma eye drops are the tried and true method for drug delivery, they are relatively inefficient and require patients to use them correctly, which can be challenging, said Gary D. Novack, PhD, Davis, Calif. Still, there are no alternate drug delivery systems right now within glaucoma, he said. There are some systems under development, including rings, plugs, and intracameral injections, but the safety and efficacy related to these is not yet clear. The need for better drug delivery systems is especially important in earlier stage patients, who stand to benefit the most from treatment. Until better drug delivery systems are available, Dr. Novack encourages glaucoma specialists to educate patients on how to use their drops, speak with healthcare payers about the importance of patient compliance, and to participate in relevant clinical trials. the level of postop follow-up, said Kathryn Colby, MD, PhD, Chicago. "Don't embark on KPro surgeries un- less you want to get to know these patients well and not be terribly sur- prised if they show up in your office unannounced," Dr. Colby said. It is critical to educate patients to quickly call in if they have problems and regarding the importance of taking their antibiotics. Additionally, diag- nosis and management of complica- tions, including persistent epithelial defect and conjunctival erosion, will help reduce the incidence of infec- tious keratitis and endophthalmitis. "Early diagnosis of infiltrates and aggressive management of keratitis will ensure that these entities do not progress to infectious endophthal- mitis," Dr. Colby said. Editors' note: Dr. Colby has no related financial interests. A new healthcare delivery model will affect glaucoma Changes are needed in the current healthcare delivery model within glaucoma, said David S. Friedman, MD, MPH, PhD, Baltimore. That's because the number of ophthalmol- ogists both in the U.S. and Europe is dwindling, and the population is aging quickly. The number of pa- tients with glaucoma is also skyrock- eting and is expected to reach 100 million by 2040. Additionally, half of glaucoma care costs are related to glaucoma care visits, even though the current care for patients is often ineffective. In a glaucoma special- ist's busy clinic, it is tough to detect patients who actually adhere to their medications, Dr. Friedman added. On the positive side, new technol- ogy has made it easier to detect glaucoma progression. Considering these factors, Dr. Friedman thinks a better model of glaucoma care is needed, one that will include more frequent glaucoma testing conduct- ed by ancillary personnel. The oph- thalmologist can step in only when a clinical change becomes necessary. An improved model of care could also include centralized testing sites that regularly upgrade their testing equipment and a review of tests in continued on page 76 View videos from AAO 2015: EWrePlay.org Eric Donnenfeld, MD, discusses the myths, misconceptions, and realities of LASIK surgery. December 2015 Sponsored by

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