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34 EW SHOW DAILY Tuesday, April 23, 2013 Meeting Reporter continued from page 32 "Sometimes you hear criticism that this doesn't get the pressure low enough. Well, a lot of times, prostaglandins don't get the pressure low enough, but no one would argue that prostaglandins weren't an enormous advance in the management of glaucoma," he said. Drs. Solomon, Lewis, and Arregui said that before surgeons perform their first iStent cases, they need to practice elements of it. Dr. Arregui said that physicians should understand the logistics of the procedure before performing it. "You need to get practice turning the patient's head, using the gonioprism, tilting the microscope," he said. "In our particular center, before I tilt the microscope, the ocular is lower, and you can be all scrunched up and in a very uncomfortable position when you're doing the surgery, and that's the last thing you want before learning a new procedure." 800.787.5426 800.787. 5426 haag-streit-usa.com haag-streit-usa.com The source of more twinkling eyes. source more twinkling eyes. Haag-St reit LED. The Haag-Streit LED. Need to amp up the twinkle in your eye? Enter the Haag-Streit LED slit lamp powered by blue-shift illumination. It visualizes your subject in stunning detail with our celebrated optics. But don't take But don't just take our word for it. See for yourself. Call 800.787.5426 for it. yourself. 800.787.5426 more information, or visit haag-streit-usa.com information, haag-streit-usa.com © 2013 Haag-Streit USA. All Rights Reserved. 2013 Reser ved. Visit us at Booth #1618. it at Booth The Superior Practice. Dr. Chang recommended that physicians employ a "dress rehearsal" with patients before prepping them. "You find out what works. Sometimes you say, 'Look toward your right shoulder,' or something [like that], because I've certainly been in there and I say, 'Look to the right,' and they're looking all over. So sometimes a dry run is helpful," he said. Dr. Solomon emphasized that gonioprism and visualization techniques are vital in the procedure. According to Dr. Lewis, the best candidates for the procedure are patients with concomitant cataract and mild to moderate glaucoma who are being treated with an ocular hypertensive medication, and in those cases, gonioscopy is needed. "They have to have an open angle. That's critical. When I ask my cataract friends if they ever do gonioscopy, they don't even know where the gonioscope is. But in this particular situation, it's really important to do gonioscopy before you take the patient to surgery," he said. "We've got a very elegant, straightforward procedure [with the iStent]," said Dr. Ahmed, who coined the term "MIGS." "But as you can see here, the amount of planning and thinking before and during the procedure, as far as looking for all the different landmarks, and proceeding with the implantation—the procedure [isn't as quick] as phaco often is. So I would budget your time accordingly." EW