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73 EW GLAUCOMA November 2016 cannot be viewed, or to confirm any other retina abnormality that may impact visual acuity outcomes after surgery. EW for the long-term progression analy- sis since the hardware and software are always updated and are often not 'backward compatible,'" Dr. Chopra said. As an example, Dr. Chopra not- ed patients with primary open-angle glaucoma scanned on time-domain devices 10 years ago have a different dataset than that provided by the current generation spectral-domain OCT devices. "Before long, the even new- er swept-source OCT devices may provide datasets that are not fully comparable to the datasets from the current devices. For this reason, many glaucoma specialists still consider fundus/optic disc stereo photographs the 'gold standard' for long-term evaluation of glaucoma," Dr. Chopra said. A key pearl for successful use of OCT in cataract patients is to make sure the OCT is free from artifacts, Dr. Chopra said. "Many reports of the RNFL or the nerve fiber layer do show the raw image on the same page. You can see if the OCT software has cor- rectly identified the nerve fiber layer or if it has misidentified the bound- ary before you look at the report. Most people go straight to the red or the green, with green serving as nor- mal and red as highly abnormal," he said. "But did the software do a good job? Is there any other pathology on the surface of the nerve fiber layer that is causing a warped appearance? Maybe severe myopic changes—or maybe epiretinal membranes on the nerve fiber layer—can give a misin- terpretation by the software." Another pearl is to instill preser- vative-free artificial tears in patients' eyes before performing the scan, "especially in patients with ocular surface disease, which is highly prevalent in the glaucoma popula- tion," Dr. Chopra said. Although a majority of the time the OCT device can provide high quality scans in undilated eyes, there will be some patients who need to have a well-di- lated pupil to obtain a good scan. With the detailed imaging OCT can provide, cataract surgeons should not hesitate to use the diag- nostic tool in cases of suspected con- current glaucoma, when the macula Editors' note: Dr. Asrani has financial interests with Heidelberg Engineering (Heidelberg, Germany). Drs. Chopra and Rhee have no financial interests related to their comments. Contact information Asrani: sanjay.asrani@duke.edu Chopra: vchopra@doheny.org Rhee: DougRhee@aol.com 840 Walnut Street Philadelphia, PA 19107 www.willseye.org 1-877-AT-WILLS What Wills Eye is saying about complex glaucoma surgery. The highly regarded Wills Eye Glaucoma Service has been furthering the study and treatment of glaucoma worldwide for over 50 years. Visit willseyeonline.org to view these videos and more on current trends and treatments in ophthalmology. Knowledge Portal Routine and Complicated Surgical Cases - Video Marlene R. Moster, MD 1. Goniosynechialysis 6. Fornix Based Trabeculectomy with Mitomycin C 2. Argentinian Flag Syndrome 7. 8.0 Vicryl Closure 3. Fixing A One Piece Sinking IOL 8. Bleb Hole Repair 4. Gonio Assisted Transluminal Trabeculotomy (GATT) 9. Ex-Press Shunt 5. One and Done - iStent - A New Way 10. Baerveldt Tube Vision Graft Glaucoma Patients Requiring Cataract Surgery L. Jay Katz, MD Sixteen Top Pediatric Glaucoma Tips Alex V. Levin, MD, MHSc 68th Annual Wills Eye Conference Glaucoma Panel Discussion Moderator: Jonathan S Myers, MD Panel: L. Jay Katz, MD; Mary Jude Cox, MD; Michael J. Pro, MD; Scott J. Fudemberg, MD; Elizabeth A. Dale, MD

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