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EW SHOW DAILY 7 T he ASCRS Opening General Session featured the Binkhorst Lecture, given by Iqbal "Ike" K. Ahmed, MD, Toronto, on "Microinvasive Glaucoma Surgery: An Idea Whose Time Has Come." Dr. Ahmed discussed a topic that he said is dear to his heart, and his lecture was unique because Binkhorst Lectures have typically focused on cataract and refractive topics. He began by highlighting the contributions of Cornelius Binkhorst, MD, who he said perse- vered by educating colleagues and publishing high quality research. Dr. Ahmed's lecture focused on glaucoma surgery, why it needs to change and how to accomplish that change. There is a big gap between medications and lasers and tra- beculectomy and tubes in terms of safety, he said. This is where MIGS has promise for filling this major gap, he said. Traditional glaucoma surgery tends to be thought of as a "last re- sort" for refractory cases, and there are a number of serious and long- term risks with these surgeries, Dr. Ahmed said. Additionally, there is intense postop recovery and vari- ability in healing and predictability. However, MIGS offers a number of advantages. It is an ab interno ap- proach that is minimally traumatic, offers at least modest efficacy, and has an extremely high safety profile and rapid recovery. "This is predi- cated by extreme safety," he said. dergoing phaco combined with a MIGS device as a "zero loss game." A synergy with MIGS makes a lot of sense, he said. There is established benefit for additional IOP-lowering and medication reduction, as well as improved adoption and surgical techniques, Dr. Ahmed said. Additionally, Schlemm's canal or suprachoroidal space devices could be used for mild to moderate disease, while subconjunctival space devices could be used for full-spectrum disease. Dr. Ahmed also discussed 3 main MIGS outflow targets: conventional outflow system, ASCRS SYMPOSIUM, SAN DIEGO 2011 Dr. Ahmed also went into detail on current patient profiles for MIGS and trabeculectomy. MIGS patients typically include those with mild to moderate disease, with a modest IOP target and who are able to tolerate some meds if needed. Trabeculec- tomy patients are usually those with advanced disease, with a low IOP target and who are intolerant of meds. The outcome measures physicians look at are reducing medication burden in addition to lowering pressure, Dr. Ahmed said. "We see the merger of cataract and glaucoma surgery," he said, describing a glaucoma patient un- ASCRS•ASOA SYMPOSIUM & CONGRESS, BOSTON 2014 Dr. Rutherford holds a PhD from University College London. "He is a well-known speaker in Europe and a well-published author, and his latest book, Creation, has received praised from numerous publications, including The Wall Street Journal, Smithsonian Magazine, L.A. Times, and The Observer," Dr. Holland said. "We're very excited to have him and think he will be of great interest to our audience." 60 Minutes The new "60 Minutes: Future Direc- tions in Anterior Segment Surgery" will be moderated by Dr. Holland and feature a panel of experts including Eric D. Donnenfeld, MD, New York, and Bonnie An Henderson, MD, Boston. Dr. Holland said this session in The Sunday Summit will be based on the television news show 60 Minutes and will feature parts of the show familiar to viewers. The program will showcase a series of talks on the future of anterior continued from page 6 by Ellen Stodola EyeWorld Staff Writer Dr. Ahmed delivers Binkhorst Lecture Dr. Ahmed spoke about MIGS in the 2014 Binkhorst Lecture. suprachoroidal outflow mechanisms, and the scleral subconjunctival mechanisms. The iStent (Glaukos, Laguna Hills, Calif.) is the first approved MIGS device in the U.S. Dr. Ahmed also talked about a number of other products and strategies he's using in his work, like specifically targeted iStent placement and using multiple iStents. He also discussed how there is now movement on looking into solo procedures, meaning using the iStent on its own in phakic or pseudophakic patients. "I think the promise of MIGS is that we can intervene earlier in the disease, reducing the morbidity of progression." He thinks MIGS will become an option for solo procedures and that trabeculectomy will be retired soon. Dr. Ahmed expressed his opti- mism about the future of MIGS and said that it's an idea that is so strong and makes so much sense that he believes nothing will stop the momentum of this process. EW Editors' note: Dr. Ahmed has financial interests with Abbott Medical Optics, Accelerated Vision Group, ACE Vision Group, AdeTherapeutics, Alcon, Allergan, AqueSys, Carl Zeiss Meditec, Clarity Medical Systems, Endo Optiks, Eyelight, ForSight Labs, Glaukos, Ian Tech, InnFocus, IRIDEX, Ivantis, Liquidia Technologies, Mastel Precision Surgical Instruments, MST, NeoMedix Corporation, New World Medical, ONO Pharmaceutical, Sensimed, SOLX, Stroma Medical, Transcend Medical, and TrueVision Systems. segment surgery by experts in numerous aspects of the field. "They will discuss the state of the art of each major subspecialty in ophthalmology and give their predictions for future trends in the next 3 to 5 years," he said. Donald TH Tan, FRCS, Singapore, will present the "Cornea Surgery" portion of the program; Thomas Kohnen, MD, PhD, Frankfurt, Germany, will present the "Presbyopia Correction" portion; Reay H. Brown, MD, Atlanta, will present the "Glaucoma Surgery" portion; Roger Steinert, MD, Irvine, Calif., will present the "Refractive Surgery" portion; David F. Chang, MD, Los Altos, Calif., will present the "Cataract Surgery" portion; and Kent Stiverson, MD, Denver, will present "An Alternative Model for Eye Care Delivery." "'60 Minutes' brings together world-class experts who will give their predictions of what's going to happen in the next few years, where we should all be in our practice in anterior segment surgery, so I think this information will be vital to ophthalmologists planning for the future," Dr. Holland said. EW

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