EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/959475
49 EW FEATURE April 2018 • Intersection of refractive surgery and MIGS of the other issues associated with drops, such as the periorbital fat atrophy," Dr. Waring said. Gary Wortz, MD, Lexington, Kentucky, said pairing multifocal IOLs—not refractive surgery gener- ally—and MIGS is like putting an upgraded engine on an old trans- mission in a car. "In order to truly enjoy the benefits of refractive surgery, we need a healthy eye," Dr. Wortz said. "While MIGS may mitigate disease, we are still talking about an eye at risk for significant loss of vision over time. I think the correction of astigmatism is extremely helpful in these patients. However, I would still consider glaucoma a relative contraindication to multifocality." Moving into the future, oph- thalmology needs to address re- fractive challenges of the glaucoma patient who has significant de- mands in terms of contrast sensitive and IOL optimization, said Sean Ianchulev, MD, professor of oph- thalmology, New York Eye and Ear Infirmary, Icahn School of Medicine at Mount Sinai, New York. "We need a cohesive refractive glaucoma surgery solution where we provide both IOP control and a maximized refractive outcome," Dr. Ianchulev said. New technology Among the new MIGS technolo- gy that most interests Dr. Wortz is the Hydrus Microstent (Ivantis, Irvine, California). With the iStent (Glaukos, San Clemente, California) he has had mixed results—likely because of his inability to target collector channels—but the Hydrus is a much larger stent that gives him a better chance of putting it in the right spot. Additionally, suprachoroidal and bleb-based devices are still finding their place and have a big potential upside, he said. "I'm taking a wait-and-see-ap- proach to them at the moment, but I am excited about their potential," Dr. Wortz said. Gonio picture of the CyPass post-implantation Source: Sean Ianchulev, MD continued on page 50 Poll size: 102 For presbyopic correction in my mild/moderate glaucoma patients, I use: Accommodative IOLs High add MFIOLs Low add MFIOLs EDOF IOLs Monovision None of the above One technology in my practice I do not offer to the mild/moderate glaucoma and cataract patient is: Femtosecond laser cataract extraction Toric IOLs Accommodative IOLs EDOF IOLs MFIOLs Monovision