EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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July 2012 Pseudoexfoliation February 2011 EW FEATURE 35 who do well the first time will likely do well on subsequent treatments." Statistically, SLT is most successful in patients with higher pressures and when it's used earlier in the treat- ment algorithm, he said. If he's at all concerned about pressure spikes, "we'll only treat 180 degrees in one session and follow the patient closely," Dr. Noecker said. In those staged treatments, patients may be retreated more often but with less laser energy in each session. Combining procedures When this group of patients has other morbidities—especially cataract—combining procedures makes sense or staging the proce- dures, depending on how well con- trolled the patient is, Dr. Francis said. "If they're not too out of con- trol, I would remove the cataract first, see what the pressure response is just from the cataract surgery, and then add the laser if necessary," he said. However, zonular laxity in these patients leads to a lens "that can be more mobile and results in some pa- tients having a degree of angle clo- sure," Dr. Noecker said. That may result in difficulty with a complete treatment (versus 180). "If the angle is wide open on gonioscopy, I don't think it matters if you do SLT or cataract removal first. But if the angle is somewhat compromised, and it's going to be hard to get the laser applications to the trabecular meshwork, then get the lens out of the way to widen the angle," he said. Also, to prevent pressure spikes, "we are a little more aggressive about prophylaxis," he added. Dr. Francis argued there is no compelling data to suggest one needs to come before the other. If the goal is to stop the prostaglandin use, "I might try SLT before cataract surgery," he said. "But cataract sur- gery alone can sometimes reduce the pressure to acceptable levels." In general, he makes the decision on a case-by-case basis. EW Editors' note: Dr. Francis has financial interests with Endo Optiks (Little Silver, N.J.), Lumenis (Yokneam, Israel), and NeoMedix (Tustin, Calif.). Dr. Gedde has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), Lumenis, and Merck (Whitehouse Station, N.J.). Dr. Katz has financial interests with Glaukos (Laguna Hills, Calif.) and Lumenis. Dr. Noecker has financial interests with Lumenis. Contact information Francis: 323-442-6454, bfrancis@doheny.org Gedde: 305-326-6435, sgedde@med.miami.edu Katz: 877-289-4557, ljaykatz@gmail.com Noecker: 203-366-8000, noeckerrj@gmail.com An ASCRS Membership For every stage of your career Whether you're just beginning or experienced in cataract and refractive surgery, ASCRS is the professional society that's right for every stage of your career. Young Ophthalmologists & Residents When you're the newest member of the team, things can be a little overwhelming. ASCRS can help with the transition. Our monthly Journal of Cataract and Refractive Surgery, Annual Symposium, and online educational initiatives work to continuously augment your formal training. Through them you'll meet like-minded young ophthalmologists facing similar challenges and concerns, along with those who've successfully navigated the waters and can provide the guidance to answer your clinical, financial, and practice management questions. For young practitioners, ASCRS is where the anterior segment ophthalmology community comes together. ASCRS offers U.S. residents and fellows an unmatched opportunity to experience anterior segment ophthalmology beyond your training program—all at no cost! Resident and fellow membership, which includes the Annual Symposium, is free during your training. ASCRS makes it easy to gain real-world experience and education with no added cost. Join ASCRS today! The Society for Surgeons AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY 4000 Legato Road, Suite 700, Fairfax, VA 22033 • 703-591-2220 • www.ASCRS.org