Eyeworld

67 EW MEETING REPORTER analyst and national editor of The Cook Political Report. Ms. Walter started by acknowl- edging that in her 20 years of expe- rience in politics, she's "never seen anything like this before." "It's not simply the pace and unprecedented-ness of what's happening, but it's the emotional rawness around politics that's at a level I haven't seen before," she said, adding that this makes rational conversations about politics very difficult. Part of the reason we are where we are, she said, is because the presidential campaign in 2016 was unlike anything before. Ms. Walter noted that people are in their own bubbles and it's getting harder to "bridge the divide." It's also hard to put this president into traditional historical context. There's nothing in the way he acts, speaks, or behaves that's anything like we've seen before, she said. However, Ms. Walter noted that she's trying to step back from the hype and look at the fundamentals, including looking at how to judge symptoms of dry eye disease. Dr. Asbell noted that although there was improvement, there was no signif- icant difference between the active and placebo groups. At 3 months, both groups improved when looking at the OSDI score, but there was no significant difference between the placebo and active groups. Looking at second- ary outcome measures, Dr. Asbell said that the signs were marginally improved, but this was equally true in both groups. Dr. Asbell noted the study's strengths, including its generalizabil- ity (use of real-world patients), com- parability of groups, compliance, treatment, and consistency. Editors' note: Dr. Asbell has no finan- cial interests related to her presentation. Government relations speaker highlights current political atmosphere The Special Joint ASCRS•ASOA Government Relations General Ses- sion featured Amy Walter, political Editors' note: Dr. Ahmed and Dr. Rhee have financial interests with various ophthalmic companies. DREAM study results presented at Cornea Day At the 2018 Cornea Day, Penny Asbell, MD, New York, discussed "Omega-3 Fatty Acid Supplemen- tation for Treatment of Dry Eye Disease: Dry Eye Assessment and Management Study (DREAM)." The DREAM study was a NEI/NIH-fund- ed trial. It had no pharmaceutical bias, was a randomized controlled trial, double-masked, and was 1 year long, with well-defined subjects and endpoints for signs and symptoms of dry eye and inflammation, Dr. Asbell said. It sought to look at the effectiveness and safety of omega-3 fatty acids for moderate to severe dry eye disease. The goal, Dr. Asbell said, was to include a broad spectrum of symp- tomatic patients with moderate or severe dry eye disease. The patients in the study were real-world pa- tients, who could continue their current treatment, had symptoms for at least 6 months, and had signs at the screening visit and eligibility confirmation visit. Dr. Asbell detailed the specific inclusion and eligibility criteria for the study and discussed the treat- ments. Participants had five softgels per day, and careful consideration was given to ensure that those used in the active and placebo groups were identical in size, color, and aroma. Patients were enrolled through 27 clinical centers in the U.S. from October 2014 to July 2016, with 923 patients screened and ultimately 535 randomized patients. The change in OSDI was the primary outcome measure, Dr. Asbell noted. The DREAM study showed that an oral omega-3 is no better than placebo in relieving signs and in pressure lowering but with better ease of use, he added. He also point- ed to the market data and said, "If trabs were so great, we wouldn't see a tiny section of the market being done." Dr. Ahmed didn't deny that a great surgeon could certainly do a great trabeculectomy procedure, but he said the need to follow the patient every few days, monitoring wound healing to determine the best time for suture lysis, is onerous. Similar to cataract surgery, which switched from a large incision with sutures to small incision suture- less surgery, so too, Dr. Ahmed said, is there a migration in glaucoma to less invasive procedures. "The 1960s called, they want your surgery back," Dr. Ahmed quipped to Dr. Rhee. "There is a war out there, guys; it's a battle for glau- coma surgery supremacy." "Enough with the challenger, enough with the foreigner that's come into our land to tell us that trabs are dead," Dr. Rhee said when he stepped up to the podium. "Trab- eculectomy is alive and well, and I'll tell you why." Dr. Rhee went on to show how the field has been trying to kill trabs for 50 years, and against all odds, it's still alive. Part of the reason, Dr. Rhee explained, citing government and sales data, as well as published studies, is efficacy (trabeculectomy can get to lower pressures than MIGS, he said); trabeculectomy can be used in nearly all clinical sce- narios; trabeculectomy is cheaper than other procedures; and market data shows that trabeculectomy procedures have been sustained over decades. "Trabeculectomy is still a viable procedure, even though we have lots of different options," Dr. Rhee concluded. Ultimately, the audience agreed and voted Dr. Rhee the winner. May 2018 continued on page 68 View videos from ASCRS•ASOA 2018: EWrePlay.org Zaina Al-Mohtaseb, MD, presents a difficult case in which she performed the double-needle Yamane technique for IOL fixation.

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