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18 | EYEWORLD DAILY NEWS | APRIL 6, 2024 ASCRS ANNUAL MEETING DAILY NEWS amount, including for glaucoma patients who want a range of vision but who aren't good candidates for multifocality. Dr. Greenwood later presented on laser refractive surgery in high- risk glaucoma suspects. He said there is a short and variable IOP increase during laser docking and flap/lent- icule creation. "This is not a reason to not do refractive surgery in these patients but definitely something to consider," he said. Postop there is risk for IOP increase due to steroid use and pres- sure-induced stromal keratitis. Dr. Greenwood said patients need to be educated about their continued life- long risk for glaucoma development. Taking IOP after refractive surgery is more complicated and, as such, Dr. Greenwood advised using a variety of measurements. Glaucomtecken This session focused on the latest and greatest in glaucoma diagnostic ad- vances. In one presentation, Michelle Butler, MD, delved into virtual reality visual field testing. She said prior to virtual reality visual fields there was little innovation in this diagnostic test since 1975 with the invention of standard automated perimetry. There are several advantages from a patient perspective to virtual reality visual fields: the headset elim- inates positioning issues; both eyes can be tested at the same time; it can bypass language and age barriers; and it increases availability in more remote areas. For the physician/busi- ness, there are advantages as well: the metrics are similar to automated perimetry; and it's portable, efficient, less technician-dependent, afford- able, and user friendly. Dr. Butler said one of the dis- advantages is that it can't directly compare data with prior tests taken on different devices. There is no es- tablished normative database, it's not accepted in clinical trials, and it can be internet-dependent. In another presentation, Inder Paul Singh, MD, described the use of intraoperative OCT (iOCT) for diagnostics. He showed how it can be used to check positioning of stents in the canal, to quantify the size of the canal after canaloplasty, to confirm opening and stretching the trabecular meshwork, to establish positioning of subconjunctival, and to check tube positioning. "What's also been nice is nee- dling," Dr. Singh said, showing a video where he couldn't see where the stent was in the subconjunctival space. A year after the initial sur- gery, he used iOCT to guide where he was needling. After the needling, iOCT showed a nice bleb forming as verification that the procedure was successful. Dr. Singh said he thinks iOCT is helpful as a diagnostic tool but can also help guide where we place our procedures. Editors' note: Dr. Harasymowycz and Dr. Singh have relevant financial inter- ests with various ophthalmic compa- nies. Dr. Greenwood and Dr. Butler do not have financial interests related to their presentations. Glaucoma Day: cataract surgery in glaucoma and tech advances T he ASCRS/AGS Joint Sym- posium led programming for Glaucoma Day with presen- tations that discussed various aspects of cataract and refractive surgery in patients with glaucoma. Following was Glaucomtecken, a ses- sion that brings in presentations on the latest in glaucoma technology. ASCRS/AGS Joint Symposium "It's been estimated that 20% of patients undergoing cataract sur- gery have comorbid glaucoma," the session's co-moderator Jella An, MD, said. This session, she continued, will cover how we can balance treating glaucoma, managing glaucoma, and opportunities for refractive IOLs and other refractive surgery in this patient population. One of the presentations fo- cused on multifocal, EDOF, and light adjustable IOLs in glaucoma patients. Paul Harasymowycz, MD, said when considering a premium IOL technol- ogy in the setting of glaucoma, the following should be considered: ocu- lar surface disease (80% of glaucoma patients have OSD post-cataract surgery), lens material (glaucoma patients' lenses are more likely to develop glistenings or calcification), contrast sensitivity, induced astigma- tism, shorter axial length, pupil size, zonular stability, and the likelihood of glaucoma progression. "Yes, this type of patient may benefit from different lens technolo- gies, but the more damage you have, stay away from EDOF … and trifocal lenses," he said, noting additional issues with contrast sensitivity. An audience question asked the panel about the Light Adjustable Lens (LAL, RxSight) for glaucoma patients. Michael Greenwood, MD, said his practice uses the LAL a fair "It's been estimated that 20% of patients undergoing cataract surgery have comorbid glaucoma." —Jella An, MD

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