EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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47 EW FEATURE April 2018 • Intersection of refractive surgery and MIGS options." However, the availability of trabeculotomy and goniotomy re- imbursement codes come in handy in those situations, he added. Lifestyle A patient's work and hobbies also play a role in selecting MIGS op- tions. For example, if a patient is a scuba diver, Dr. Grover is concerned about the rare potential of blood re- flux into the anterior chamber with the negative pressure induced by the scuba mask. "This could, theoreti- cally, result in recurrent hyphemas, especially when diving," he said. Additionally, if patients must hold their head in positions below the heart for prolonged time periods, Dr. Grover tries to avoid angle surgery because of the concern for blood reflux, a phenomenon he has seen in yoga instructors. "For these active patients, I may consider either a CyPass, XEN, or a traditional trab or tube shunt," Dr. Grover said. Looking forward Although MIGS offers a multitude of treatment options, surgeons look forward to additional future uses for underserved patients. "I think the biggest underserved area is low tension glaucoma," Dr. Brubaker said. "There are no MIGS options right now that are designed to achieve an IOP in the high single digits." The idea of using more than one MIGS device at a time—for instance, three iStents instead of one—and using certain MIGS as a standalone procedure without cataract surgery would open up treatment options for many patients, Dr. Brubaker added. Dr. Wallace also sees a need for MIGS without cataract surgery. "In particular, it would be nice to offer the CyPass to patients who have had multiple retinal surgeries in the past and thus have significant scarring, which makes any filtering procedure quite difficult. Because many of these patients are pseudophakic, this device is currently not available," she said. Recently, Dr. Grover has been using Cypass in refractory glaucoma patients with prior tubes, secondary glaucoma patients with conjunctival scarring, and in patients who have failed angle surgery with relatively good results. "I think this will be a great potential use for Cypass although currently off-label," he said. EW Editors' note: The physicians have no financial interests related to their comments. Contact information Brubaker: jbrubaker@saceye.com Grover: dgrover@glaucomaassociates.com Sheybani: sheybaniar@wustl.edu Wallace: danajwallace@gmail.com Beaver-Visitec International, Inc. Customer Service 866.906.8080 bvimedical.com ECP: A New Perspective on MIGS BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of Beaver-Visitec International ("BVI") © 2018 BVI "Combining ECP with a variety of other MIGS procedures allows me to offer a balanced therapy that is tailored to each patient." — Nathan Radcliffe, MD "Combined Phaco-ECP effectively lowers or maintains IOP and results in ocular hypertensive medication reduction up to 72 months."* *Khandan, Sarah; Siegel, Les., et.al. Long-term Follow-up of Combined Phaco and ECP in the Treatment of Mild to Moderate Glaucoma. AGS 2017