Eyeworld

EW GLAUCOMA 82 February 2017 Robert Noecker, MD, Fairfield, Connecticut, highlighted the best glaucoma papers at the "Best of ASCRS" session at the 2016 ASCRS•ASOA Symposium & Congress. The papers were chosen from the Best Paper of Session winners. The session was moderated by Eric Donnenfeld, MD, with panelists Reay Brown, MD, Clara Chan, MD, David F. Chang, MD, and Boris Malyugin, MD. Here are the abstracts from the studies, with comments regarding the selections from Dr. Brown, EyeWorld's Glaucoma section editor. Prevalence of glaucoma in a cataract surgery population Anurag Shrivastava, MD, David Friedman, MD, Kuldev Singh, MD, Jyoti Aggarwal, MHS Purpose: To use insurance claims to determine the estimated proportion of cataract surgery patients with concomitant glaucoma. Estimates of glaucoma prevalence among cataract surgery patients in the U.S. varies from 2–20%. Insurance claims can be used to more accurately deter- mine the prevalence of coexistent glaucoma in those undergoing cata- ract surgery. Methods: A structured literature re- view using the terms "cataract" and "glaucoma" compared published rates of glaucoma prevalence among those undergoing cataract surgery with data from the 2010 Medicare Carrier Standard Analytic File (SAF) with preoperative look back periods of 24 and 36 months. Almost 500 articles were analyzed and reviewed to determine the estimated preva- lence of glaucoma. Medicare fee for service claims were used to calculate the number of patients with primary and secondary glaucoma diagnoses in the same quarter as a cataract surgery claim. The data was analyzed to calculate multiple prevalence estimates of concomitant glaucoma in cataract surgery patients. Results: Estimated glaucoma preva- lence among cataract surgery patients is between 8 and 11.2% based on a systematic literature review. Of the original 496 papers reviewed, 17 met criteria and were abstracted accord- ingly. There were no papers specifi- cally addressing glaucoma prevalence in a cataract surgery population in North America. Analysis of the Medicare 5% SAF data set demon- strated 95,934 cataract surgeries, which extrapolates to approximately 3,757,697 cataract surgeries per- formed in the U.S. in 2010. The calculated prevalence of glaucoma among patients in the SAF undergo- ing cataract surgery was estimated to be approximately 20%. Conclusion: The prevalence of glaucoma among cataract surgery patients may be higher than report- ed in prior studies. Cataract surgery offers a unique opportunity for clini- cians to manage intraocular pressure as well as refractive outcomes. Dr. Brown: Ophthalmologists are usually surprised to find that large studies show that up to 20% of patients undergoing cataract surgery have a concurrent diag- nosis of glaucoma. This paper reviews the data leading to that conclusion. This information is critical to MIGS. If there are 3.5 million patients having cataract surgery each year, as many as 700,000 may benefit from combining their cat- aract surgery with MIGS to lower their pressure, get them off medications, or both. This data also demonstrates why industry is increasing its investment in glaucoma surgery and why it is import- ant for comprehensive cataract surgeons to learn MIGS techniques. Management of IOP through 3 years with two ab interno trabecular stents or prostaglan- din in newly diagnosed OAG: Prospective randomized study Steven Vold, MD Purpose: Present updated findings through 36 months from prospec- tive, randomized study by the Microinvasive Glaucoma Surgery (MIGS) Study Group to compare two ab interno trabecular micro-bypass stents vs. prostaglandin to manage IOP in patients with newly diag- nosed open-angle glaucoma (OAG). Best of ASCRS: Scan to watch video!

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