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EW SHOW DAILY 4 Major goals of sustained drug delivery are to deliver drugs to the site of action, increase efficacy, and improve clinical outcomes, Dr. Ahmed said. However, questions re- main regarding how difficult it will be for patients to use sustained delivery systems and how long the various alternatives will deliver the target medication. Nanotechnology to deliver drugs throughout specialties has seen a large surge recently, including in ophthalmology and glaucoma, Dr. Ahmed said. Dr. Ahmed informed attendees of various drug delivery systems in development, including a la- tanoprost-eluting contact lens, a drug-eluting punctal plug system, mucus penetrating nanoparticles, and the Durasert Glaucoma Implant (pSividia, Watertown, Mass.). Performing cataract surgery in glaucoma patients Kuldev Singh, MD, Stanford, Calif., said in a presentation that early cataract surgery in glaucoma pa- tients will likely become more com- mon. He said such an approach is already becoming more common in Asia. By Dr. Singh's estimate, the 3.5 million cataract surgeries performed annually in the U.S. include patients with primary open-angle glaucoma or ocular hypertension 15% to 20% of the time. Reasons to perform phacoemul- sification in a glaucoma patient include sustained IOP lowering, no adverse impact on future trabeculec- tomy, reduced lens-related tra- beculectomy complications, improved vision, and eliminating the risk of trabeculectomy failure related to future cataract surgery. "It will be challenging to con- vince regulators of the value of The second lesson is to take the stress off the surgeon and the zonule. He discussed different op- tions available to do so: "Use the best capsule support you can," he said. The third lesson is that in PEX cases, a ring is not always the best option. He showed surgical video of capsular tension rings (CTR) causing issues that sabotage the very point of using them. "I would suggest to you that if you are approaching patients with pseudoexfoliation and cataract, be- cause they have weak zonules to start with, I would avoid using a standard CTR … at the outset of the case because of the evidence that these can actually cause loss of zonular support prior to starting the [phacoemulsification]," he said. He said lesson four, in turn, is "know when you've met your match" and plan your surgical plan accordingly. Surgical options New ab interno procedures are pre- senting additional options—and challenges—while existing filtrating procedures can be enhanced by techniques for closure and address- ing overfiltration, surgeons said. Following the Honored Lecture, the remainder of ASCRS Glaucoma Day 2013 was dedicated to a Surgical Glaucoma Spotlight and video pre- sentations on specific cases and approaches, as well as techniques. In addition, Warren E. Hill, MD, Mesa, Ariz., discussed cataract surgery for glaucoma patients, including recommendations for changes in axial length and IOL power calculations. "If the plan is for a combined procedure, and the IOP is going to be very low, certainly do not target plano, rather pick a myopic refrac- tive outcome," he said. "Hitting the refractive target really may not be possible." EW Editors' note: Dr. Ahmed has financial interests with Abbott Medical Optics (Santa Ana, Calif.), Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), and other ophthalmic companies. Dr. Singh has financial interests with Alcon, Allergan, Bausch + Lomb (Rochester, N.Y.), and other ophthalmic companies. Dr. Rhee has financial interests with Alcon, Allergan, AqueSys (Irvine, Calif.), and other ophthalmic compa- nies. Drs. Condon and Hill have finan- cial interests with Alcon. [early cataract surgery], but I think it will be worth it," Dr. Singh said. Reviewing preservatives Douglas J. Rhee, MD, Boston, addressed facts behind the use of preservatives such as benzalkonium chloride (BAK) and nonpreserved medications. The debate over preser- vatives in medications is a common one in glaucoma practices because 30% to 70% of glaucoma patients are believed to have ocular surface problems, and preservatives can irri- tate eyes with ocular surface disease (OSD), Dr. Rhee said. Considering many glaucoma patients are older, the prevalence of OSD likely trends toward the higher side, he added. Factors influencing OSD in glaucoma patients include age, the number of eye drops used, IOP, and duration of topical treatment. In addition, the medications themselves—not just the preserva- tives—may irritate the ocular sur- face, Dr. Rhee added. Other morning sessions at Glau- coma Day focused on pearls for using imaging devices, a judged presentation of possible best ap- proaches to challenging cases, pros and cons of endocyclophotocoagula- tion with cataract extraction, and controversies in medical and laser treatment. Lessons in pseudoexfoliation Knowledge of different aspects of treating pseudoexfoliation (PEX), in- cluding its major risk factor of weak zonules, can assist in best outcomes in these difficult cases, said Garry P. Condon, MD, Pittsburgh. In the 2013 Stephen A. Obstbaum, MD, Honored Lecture, "Pseudoexfoliation: My Life as a 'Zonulist'—What We Know, Don't Know, and Shouldn't Show," Dr. Condon outlined lessons that can assist in these cases. "[PEX] is everywhere. It sur- rounds me in my day-to-day practice and it affects more than 70 million people, and it's growing," he said. "It spans the entire anterior segment and posterior segment and it's a big- ger challenge for all of us everyday in clinical practice." His first lesson is that PEX "pro- duces the meanest form of [open- angle glaucoma]." PEX patients require lower IOL, closer monitoring and typically more surgery than OAG cases. PEX also has a higher tolerance to medical therapy, but does respond to laser treatment, Dr. Condon said. Saturday, April 20, 2013 ASCRS News Today David Tanzer, MD, named new chief medical officer, Abbott Medical Optics D avid Tanzer, MD, has been named divisional vice president, medical affairs, and chief medical officer at Abbott Medical Optics (AMO, Santa Ana, Calif.) with responsibility for medical affairs, product safety, and the development and dissemination of scientific educational materials to the medical community. He is additionally responsible for pro- viding medical input into AMO's clinical strategy, innovation, and business development activities. Dr. Tanzer is a retired captain in the United States Navy and is the director emeritus of the Navy Refractive Surgery Center, Department of Ophthalmology, Naval Medical Center San Diego. He attended Georgetown Medical School and completed his internship and ophthalmology residency at the Naval Medical Center, San Diego. He completed fellowship training in cornea, external disease and refractive surgery at the Doheny Eye Institute, University of Southern California. Dr. Tanzer has held faculty positions as associate professor of oph- thalmology at Loma Linda University, assistant professor of ophthal- mology at the University of California, San Diego's Shiley Eye Center, and assistant professor of surgery at the Uniformed Services University in Bethesda, Md. He has authored or co-authored more than 40 peer-re- viewed articles and book chapters on various topics in ophthalmology, is a medical reviewer for several peer-reviewed journals, and has been involved in more than 70 clinical protocols evaluating the latest tech- niques in corneal and refractive surgery. "We are delighted to have Dr. Tanzer join us," said Murthy Simhambhatla, president, AMO. "He is a well-published scientific con- tributor and is recognized for his keen insights into a broad variety of ophthalmology related subjects. The addition of Dr. Tanzer will greatly enhance the capabilities of the clinical sciences and medical affairs functions at AMO." Breaking news continued from page 1

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