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4 | EYEWORLD DAILY NEWS | JULY 24, 2021 ASCRS ANNUAL MEETING DAILY NEWS Dr. Brown said when he was preparing to give the Charles D. Kelman, MD, Innovator's Lecture at the ASCRS Annual Meeting several years ago, he was review- ing his projects and thought to himself "Why didn't I quit?" "Ultimately, I think it's a great thing that we do in treating a blinding, incurable disease," he said, and that's what kept him going. Dr. Samuelson said for him it was "the passion of knowing we needed a better way." Editors' note: Dr. Lewis, Dr. Sam- uelson, Dr. Rhee, and Dr. Herndon have financial interests with various ophthalmic companies. Dr. Brown has financial interests with Sight Sciences. The key was the catheter but also the beacon of light because it told you where you were. … In the process of canaloplasty, you visco- dilate the canal but also tension the trabecular meshwork," Dr. Lewis said, noting how the latter was impactful for the procedure's efficacy. Dr. Lewis said that early comparative studies between trabeculectomy and canaloplas- ty showed impressive results in canaloplasty's favor, with pressure that remained for at least a year. A similar sustained IOP reduction can't be said for many modern MIGS procedures, Dr. Lewis said. Dr. Samuelson shared how he has been "honored to have been 'in the room where it happens.'" For much of his career, he said, he had patients who were miserable from bleb leaks, infections, toxici- ty from drops, and more. "It took a lot of us to call out trabeculectomy for being too invasive, too risky for mild to moderate disease. I'll grant that trab is a great opportunity for those with severe vision loss, but I think the MIGS mindset changed everything," he said. "It's the mindset that safety is as import- ant as efficacy that has changed the management of glaucoma forever." One of the things that allowed this to happen was research that showed cataract surgery is helpful in the management of glaucoma. He also said he was proud to be the FDA panel presenter for iStent (Glaukos). This device "launched a whole new mindset in the management of glaucoma," Dr. Samuelson said. He went on to speak about his involvement in the development of what's now the Hydrus Micro- stent (Ivantis). Dr. Rhee said one of the things he is most proud of is the dis- covery of SPARC, a protein that is a critical regulator of outflow resistance. Prior to this discovery, little was known about how outflow was regulated. With that, all treatments were not disease modifying, rather palliative, not addressing what's actually causing glaucoma, Dr. Rhee said. Through exploration and research, Dr. Rhee described how he and others worked out a lot of the mechanism, showing that TGFß-2 increases SPARC and a dual mech- anism to increase IOP, mostly by altering the extracellular matrix. One of the most significant dis- coveries was that mice that can't make SPARC don't get glaucoma. "We have elucidated a means by which IOP is regulated and likely discovered a new pathway by which disease modifying thera- py can be established," he said. In a Q&A with the panel, Dr. Herndon noted that each had faced naysayers. He asked what points they could give the audience when it comes to perse- verance in the face of that. Dr. Lewis said it was easy to persevere when they were work- ing toward a new procedure that was so much safer than trabe- culectomy. It would be tough, however, to compare canaloplasty to current MIGS procedures be- cause of how safe they are, even if they're not as efficacious. continued from page 1 Dr. Samuelson speaks about the shift in mindset that has changed the management of glaucoma. Source: ASCRS

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