Eyeworld Daily News

MAY 6, 2023 | EYEWORLD DAILY NEWS | 7 ASCRS ANNUAL MEETING DAILY NEWS acknowledged barriers. These in- clude our attitude, clinical evidence, access/cost, practice workflow con- siderations, and others. Editors' note: Dr. Ahmed has financial interests with various ophthalmic companies. Medication, he envisioned, would be- come bridges as the treatment went from one intervention to the next. Medications and trabeculectomy, Dr. Ahmed said later, are still important. When it comes to moving the subspecialty toward a mindset of interventional glaucoma, Dr. Ahmed He posited that the interven- tional glaucoma treatment algorithm would go from SLT to sustained drug delivery to one or two MIGS to microinvasive bleb surgery to trabeculectomy or tube. Dr. Ahmed discussed the options and data within each of these categories. continued from page 6 continued on page 8 L eon Herndon, MD, welcomed those in attendance to ASCRS Glaucoma Day. The committee has put together what we feel is a fantastic opportunity for you to get the latest and greatest in glau- coma care in 2023, he said. The first session of the program was a joint ASCRS/AGS session. Austin Fox, MD, discussed con- tact lens management after glaucoma surgery. Fitting contact lenses for the glaucoma patient has long posed a challenge for both contact lens and glaucoma specialists, he said. First, he noted that not every bleb is the same. Bleb morphology is hard to predict, and blebs may continue to model for years. Another potential issue is contact lens contamination. Contact lens use is not recommended after trabe- culectomy, he said, because of the potential point of friction between the bleb and the contact lens and contact lenses can serve as a depot for bacteria. He also mentioned the risk for endophthalmitis. He cited literature discussing contact lens use after glaucoma surgery and infec- tions that can occur. More recent studies, with more modern contact lenses, have indicated that contact lenses can be used after glaucoma surgery. Traditionally, Dr. Fox said contact lenses have been used for refractive error, but other indications are for irregular astigmatism and ocular surface disease. There are now many options in the specialty contact lens space, he added. There are options in soft contact lenses, corneal rigid gas permeable lenses, and scleral lenses. For soft contact lenses, Dr. Fox noted that the bleb or tube needs to be nearly flush with the surface of the eye, and the contact lens need to be of low mod- ulus. He suggested avoiding these after glaucoma surgery. Meanwhile, the corneal rigid gas permeable lens option is smaller and rigid, but Dr. Fox said excessive movement can cause mechanical trauma to blebs. He said maintain- ing centration can be difficult or impossible due to corneal pathology. Modifications can be made to mini- mize movement away from the bleb. These provide excellent vision and can be safe. He said if your glauco- ma patient can be fit and tolerate these rigid gas permeable lenses, you should go with this. Finally, scleral lenses are anoth- er option, with a vault over option or a notch that can be beveled into the lens. He noted the EyePrintPRO (EyePrint Prosthetics) for vaulting options with scleral lenses, and he said you want to vault completely over the bleb. Dr. Fox also discussed options with notching, emphasizing that you want to notch around the trabeculectomy. He said it's important to avoid over-hanging blebs and to preserve the limbus. Corneal patch grafts may allow for more consistent vault over a tube, Dr. Fox said. Dr. Fox stressed that it's import- ant to monitor contact lens wear. Prevention is key, he said, adding that it's important to always lift or lower the lid and to watch for blanching/compression over the tube. He added that you can also use OCT to monitor for thinning of tissue over tubes. Christine Larsen, MD, presented "Advanced Technology IOLs, Femto Laser and the Glaucoma Patient." She noted that up to 20% of pa- tients undergoing cataract surgery are estimated to have some form of comorbid glaucoma. It's important to determine the patient's goals and if the physician will reasonably be able to help achieve them. Factors that may come into play include the severity and stability of the disease, anatomical factors (like pupil size and zonular support), and refractive stability. One of the biggest concerns when considering advanced technol- ogy IOLs in the glaucoma space is their impact on contrast sensitivity, Dr. Larsen said. Glaucoma Day kicks off with joint session

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