EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/959475
World view The evolving MIGS landscape W hile glaucoma care settles into the MIGS era, quality of life enhancement opportunities for patients have multiplied. MIGS has brought glaucoma surgery earlier in the glaucoma treatment para- digm, and now it makes sense to look at com- bining premium cataract surgery with MIGS, a premium glaucoma surgical experience. In this issue of EyeWorld, we focus on the intersection between refractive surgery and MIGS and hone in on how to bring MIGS into our practices and choose the best options for our patients. Steven Sarkisian, MD, reminds us not to let a patient's glaucoma hold us back from seeking a premium outcome. Valerie Trubnik, MD, and Constance Okeke, MD, are generally bullish on MIGS and presbyopia-cor- recting IOLs, with only warnings for the use of multifocal lenses when contrast sensitivity is reduced or threatened by the possibility of future progression. My own observation here is that patients with reduced contrast sensitivity are, unfortunately, unhappy no matter what kind of IOL they have. Correcting astigmatism in MIGS patients, according to Dr. Trubnik is a "no brainer." The doctors further discuss the nuances of which MIGS proce- dure might fit best with different clinical refractive scenarios. As for where to start with MIGS, Linda Huang, MD, suggests we look to the angle and begin by refining our gonioscopy skills. Compre- hensive ophthalmologist and early MIGS adopter Michael Patterson, DO, reminds us that gonioscopy starts in the office and prepares you for the OR. Thomas Samuelson, MD, and Jacob Brubaker, MD, join the conver- sation on adopting MIGS, covering everything from surgical technique to navigating insurance coverage. One pearl: Procedures that go smoothly in the OR may have independent challenges postoperatively and vice versa, but generally speaking the skills from one MIGS procedure are transferable to the next. As for which procedures to choose and when, we hear from experts Dana Wallace, MD, Davinder Grover, MD, Arsham Sheybani, MD, and Dr. Brubaker on factors to consider, including glaucoma stage, lifestyle, reim- bursement, and safety. Looking toward the future, George Waring IV, MD, notes that refractive surgery and MIGS share the same lifestyle goals, and it is natural to combine them into a single conversation. Sean Ianchulev, MD, looks toward a day when refractive and MIGS solutions are cohesively combined. While fem- tosecond laser cataract surgery is often combined with MIGS, Drs. Waring and Ianchulev agree that the femtosecond laser itself has not been successful at executing any MIGS procedures. Gary Wortz, MD, notes that future IOL technologies may have upgrades that enhance glaucoma care, such as the provision of IOP measurement sensors in the lens capsule. The MIGS landscape has evolved, and our conversations around MIGS and refractive cataract surgery have evolved, bringing new synergies and shared goals of safety and excellence to our patients. I hope you enjoy read- ing this issue. EW Nathan Radcliffe, MD, Glaucoma co-editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S April 2018 Vol. 23 • No. 4 Publisher Donald Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. 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