Eyeworld Daily News

16 | EYEWORLD DAILY NEWS | JULY 25, 2021 ASCRS ANNUAL MEETING DAILY NEWS T he "Glaucoma Essentials" symposium gave an over- view of the disease with a range of presentations covering diagnostics, monitoring, treatment, and more. Debbie Kuo, MD, presented on the types of glaucoma, followed by Nathan Radcliffe, MD, who addressed the clinical evalua- tion. There are several questions that occur with this first visit, Dr. Radcliffe presented. The patient wonders "Will I go blind?" The surgeon wonders "Does she need surgery?" Ultimately, the goal is to provide hope, excellent care, and prevent blindness, he said. You need to understand the patient's prior treatment history and perform a risk-factor assess- ment (age, CCT/hysteresis, family history, other eye, etc.), Dr. Rad- cliffe said. Then, stage the disease and determine disease velocity (if you have records). In the physical exam, Dr. Radcliffe listed several things to watch out for: angle closure, pigment dispersion syndrome, endothelial disease, brimonidine allergy, exfoliation, and assess prior surgeries. He reiterated importance of looking for angle closure, noting that it's "really hard to think of something more consequential to miss." If you suspect angle closure, perform darkroom gonioscopy, Dr. Radcliffe said. Turn lights, computers, phones off, wait 30 seconds, and examine with a small square of light. Medical management is low-hanging fruit, Dr. Radcliffe presented, but if surgery is need- ed, be decisive and make sure the patient understands what's at stake. In the session, Shane Havens, MD, offered pearls for interpret- ing visual fields. They included: • Consider the pupil size, espe- cially in patients on miotics. • Remember the effect of age-bracket changes. • Test the central field with 10-22, M-pattern, or 24-2C algorithms. • Consider patient fatigue that can occur with longer test times; also note inter-test vari- ability with shorter visits. • Correlate field changes with structure. • Consider the extent of current field loss, rate of progression, potential effect on quality of life, and life expectancy when advancing therapy. • Tape masks and discuss the effect of mask fogging with patients and techs. When it comes to treatment, Manjool Shah, MD, discussed three major clinical trials with broad impact on clinical glaucoma practice: the Laser in Glaucoma and Ocular HyperTension (LiGHT) trial, Effectiveness in Angle Clo- sure Glaucoma of Lens Extraction (EAGLE) study, and the Zhong- shan Angle Closure Prevention (ZAP) study. The LiGHT trial found that in 356 patients randomized to SLT vs. 362 to drops, there was no significant difference in qual- ity of life between the groups. But 74.2% of SLT patients were medication-free at 36 months, SLT patients were more likely to be at target IOP (93% vs. 91.3%), there were fewer cases of progres- sion, and none of the SLT patients required surgery, compared to 11 drop patients. The EAGLE study enrolled 155 patients with PAC and 263 with PACG, assigning 208 to lens extraction and 211 to LPI+meds. The study found the lens ex- traction group had a higher health status and lower IOP. Additional glaucoma surgery was performed in 1 patient in the lens extraction group and 24 patients in the LPI group. The ZAP study randomized 889 patients who were bilateral primary angle-closure suspects to receive LPI in one eye with the fellow eye as control, finding that PAC occurred in 2.19/1000 eye-years in the treated group and 7.97/1000 eye-years in the untreated group, indicating statis- tically significant, but perhaps not clinically significant, protection, Dr. Shah said. "Takeaways, we are in an interventional glaucoma era. SLT has become my primary treatment for open-angle glaucoma and ocu- lar hypertension," Dr. Shah said. Other presentations in the session included a review of pos- terior segment OCT by Amanda Kiely Bicket, MD, stratifying stage and risk by Douglas Rhee, MD, and a medication overview by Deborah Ristvedt, DO. Editors' note: Dr. Radcliffe has financial interests with several oph- thalmic companies. Dr. Havens and Dr. Shah have no relevant financial interests. Essentials symposium provides a comprehensive glaucoma overview

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