Eyeworld

167 EW MEETING REPORTER Legislative Fly-In in Washington, D.C., coming up in July 2016. This year, ASCRS and the Young Eye Sur- geons (YES) launched a scholarship program to encourage involvement from residents and fellows. Five applicants will be chosen to receive travel reimbursement to attend the event, with the opportunity to speak with members of Congress and learn about some of the public policy issues affecting ophthalmology. "Things are changing so rapidly … you have to get involved," Dr. Solomon said. "People in the House and Senate, they want to hear from doctors who are treating patients. You are going to have a lot more credibility than a lobbyist or some- one else." Dr. Solomon also praised ASCRS' printed and online material that can be used for educational and infor- mational purposes, such as the dis- cussion forum eyeCONNECTIONS and various calculator tools. Encouraging young eye sur- geons to get involved, Dr. Solomon said, "You are the lifeblood of the society, you're the future of our profession." EW Editors' note: Dr. Solomon has no financial interests related to his comments. Dr. Noecker has financial interests with Alcon, Allergan, InnFocus (Miami), and Glaukos. Dr. Honkanen has no finan- cial interests related to his comments. A message from the incoming ASCRS President Incoming ASCRS President Kerry Solomon, MD, Mount Pleasant, South Carolina, spoke to attendees about the many opportunities to get involved in ASCRS, particularly for the young surgeon. "ASCRS has been the sole venue to allow people to speak freely peer- to-peer, to exchange information, [and] share ideas, where the good ideas rise to the top and the ideas that don't rise to the top don't nec- essarily survive," Dr. Solomon said. "We wouldn't have IOLs if ASCRS was not around to give us a forum to discuss and share ideas. Phacoemul- sification wouldn't be where it is. All of these things that you do routinely today, we take for granted." Dr. Solomon highlighted the importance the society places on education. The annual meeting of- fers a number of opportunities in its sessions, skills transfer labs, courses, and networking opportunities, but there are also opportunities year- round to get involved and benefit from the organization. One opportunity in particular that Dr. Solomon highlighted is the position both the patient's head and the microscope at about a 35-degree angle and advised residents and young eye surgeons in the audience to become comfortable with the device used to insert the implant. After inserting the 1 mm device into the canal, physicians can confirm it is in a good position if there is a small reflux of blood and overlying meshwork conceals the majority of the stent's arches. There is a learning curve for this implant, which Dr. Honkanen said "can be a humbling experience." Factors that can lead to inser- tion trouble include poor visualiza- tion through the gonioprism; unsta- ble location; hyphema, which occurs when the stent is not inserted at the correct angle; or a tear through the trabecular meshwork, which can oc- cur when the device is not released smoothly from the inserter. If these situations occur, the stent can be taken up again by the inserter and repositioned in neighboring tissue. Having knowledge of angle anatomy, famil- iarity with the inserter's button, and adhering to the proper insertion and confirmation steps will allow for successful placement of the stent, Dr. Honkanen said. Editors' note: This version has been edited from the original to reflect the correct length of the iStent to be 1 mm. ago was considered a "really nasty procedure," Dr. Noecker said that recent surgical advances and devices not only provide surgeons with a lot of treatment options, but also "we don't have to fear it anymore." Dr. Noecker said that with older glaucoma patients, just the act of cataract surgery alone could effec- tively lower IOP. "Cataract surgery in a glaucoma patient is a good thing," he said. There are cases where more than cataract surgery is required to manage glaucoma, but he called it the "baby step before the next level of intervention." The current trend is toward ca- nal-based procedures, which involve bypassing the dysfunctional trabec- ular meshwork. Other procedures, which are not yet available, include those going into the suprachoroidal space or bypassing the entire out- flow system. Choosing a procedure depends on the patient's glaucoma status. A mild to moderate patient, for example, would be a good candidate for a trabecular meshwork bypass procedure like the iStent (Glaukos), Dr. Noecker said. Robert Honkanen, MD, Stony Brook, New York, presented on the iStent, which he noted is the small- est of all implants placed in humans. After making corneal incisions, Dr. Honkanen said it is important to April 2016 View videos from YES ACT 2016: EWrePlay.org Eric Donnenfeld, MD, discusses refractive targets and surgical planning for femtosecond astigmatic keratotomy. View videos from YES ACT 2016: EWrePlay.org David Ritterband, MD, describes handling a complex cataract surgical case.

• Cover