EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/87458
October 2012 intraocular pressure, and two iStents performed better than one." The reason combinations of iStents were more effective is that using more than one device allows for aqueous to flow toward addi- tional collector channels and then downstream out of the eye, he ex- plained. "That matches very closely what others have reported in clinical studies," he said. "What we found was that there was an enhancement of aqueous outflow that was verified by the computer software as well as follow-up studies using human eye perfusion models." That same soft- ware, he maintains, can be used to predict the performance of other similar glaucoma devices. Dr. Kahook thinks the results indicate that the iStent may successfully enhance aqueous outflow in patients with glaucoma, which was the origi- nal intent in developing these. Imaging issues MIGS-related imaging was another hot issue discussed. Dr. Lewis envi- sions a time when it will be possible to use imaging to predict which procedure is best suited to a specific patient, akin to what is now possible in cardiology. "What we've always wanted in glaucoma was the 'angiogram' that cardiologists have," he said. "When someone has heart disease he comes in to have an angiogram, and it shows where and what specific stent or process should be used to treat that." Currently that is not possible with glaucoma. "We're putting in a treatment like a trabeculectomy that is a one-size- fits-all technique, and we would love to be able to customize it better," Dr. Lewis said. Meanwhile, at the meeting, E. Randy Craven, M.D., director, Glaucoma Consultants of Colorado, Denver, Colo., addressed what tech- nology is being used to view the angle in order to implant MIGS de- vices. Typically this requires a gonio- scope. However, Dr. Craven pointed out this is unfamiliar to cataract sur- geons who are not used to viewing the angle in the OR. "If you stay in the same spot without needing to tilt the microscope and use an endoscope to see during implantion, it would make your life a lot easier," Dr. Craven said. He added that visualization and this hands-free approach would help immeasurably. "With the current MIG procedures we have to have one hand on the gonioscope and one on the device (itself)," he said. "So if we were able to use something that let both of our hands be free and could view the angle, that would be ideal." Dr. Ahmed said the meeting also addressed new ways to potentially evaluate the success of glaucoma procedures. "We had some interest- ing discussion on intraoperative as- sessment," he said. This assessment involved injecting dye after a proce- dure such as MIGS to evaluate flow. In addition, the glaucoma mar- ketplace as a whole drew interest. "Bill Freeman [Market Scope, St. Louis] gave a nice talk on where he thinks the market is going to go now that the pharma market has been mostly genericized," Dr. Lewis said. As a result, companies are now looking to devices instead of drugs to fill the monetary gap. Overall, Dr. Ahmed heralded the collaborative nature of the meeting. "We have been able to bring to- gether scientists, researchers, indus- try, regulatory people, surgeons, and clinicians all at the same table," he said. "I think that's a pretty cool atmosphere to try to foster innova- tion, which is what is happening in this space." EW Editors' note: Dr. Ahmed has financial interests with AqueSys, Ivantis, Glaukos, and NeoMedix. Dr. Craven has financial interests with Transcend Medical, Ivantis, and Glaukos. Dr. Kahook has financial interests with Glaukos. Dr. Lewis has financial inter- est with Aquesys, Ivantis, and Glaukos. Contact information Ahmed: 416-625-3937, ike.ahmed@utoronto.ca Craven: 303-794-1111, ercraven@yahoo.com Kahook: 720-848-2500, malik.kahook@gmail.com Lewis: 916-649-1515, rlewiseyemd@yahoo.com