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EW SHOW DAILY 60 Meeting Reporter by Rich Daly EyeWorld Contributing Writer (OCT) or Heidelberg Retina Tomo- graph [HRT, Heidelberg Engineering, Heidelberg, Germany] and if there is a classic visual field and suspicious optic nerve, it probably is glaucoma." Dr. Rhee has switched in recent years from solely focusing on visual field changes in glaucoma detection to equally weighing visual field and structural changes. In terms of detection, the most popular tool to detect visual field changes has changed from HRT to OCT systems in recent years, accord- ing to the results of the 2014 ASCRS Clinical Survey, which included responses from more than 1,500 ophthalmologists. Additionally, patient compli- ance with medical regimens remain a challenge, said Nathan Radcliffe, MD, New York. Compliance ob- stacles include lost prescriptions, "bounce backs" that prevent filling of e-prescriptions, patients leaving paper prescriptions unfilled, and misapplied medicated eye drops. "If you look just at how well pa- tients do at the pharmacy, the data is grim," Dr. Radcliffe said about research findings that only 10% of patients over a year ever obtain enough refills to adhere to their prescribed dosing regimen. Such non-adherence is associated with progressive visual field loss. Forty-two percent of sympo- sium attendees polled said that non-adherence among their patients prescribed 1 glaucoma medication ranged from 21% to 40%. Possible responses to glaucoma medication adherence challenges include use of the most powerful prostaglandin available, according to Dr. Radcliffe. Seventy-four percent of attend- ees said a prostaglandin analogue was their first-line therapy for glau- coma patients, provided there are no contraindications. Other responses to adherence problems include implantable drug delivery systems, which are in clin- ical trials to obtain Food and Drug Administration regulatory approval. Trial participants much more readily accepted implantable drug delivery systems than the use of laser-based treatments, Dr. Rhee said. "There still seems to be this cultural impression that lasers are much more invasive even than in- jecting something into the eye," Dr. Rhee said. In contrast, surveys of ophthal- mologists indicate many are reluc- tant to use injections for glaucoma treatment, said Richard Lewis, MD, Sacramento, Calif. Another possible way to improve compliance is through performing glaucoma surgery earlier among mild and moderate glaucoma patients, instead of waiting for them to progress to advanced stages of the disease, said Brian Francis, MD, Los Angeles. And compliance frequently worsens as more medications are added to a patient's dosing regimen. Dr. Francis noted that although microinvasive glaucoma surgery (MIGS) is not necessarily curative or does not always produce target intra- ocular pressures, the combination of surgery and medication has benefits. "If instead of 4 medications [I can] have the patient be on 1 medication plus 1 of these glaucoma surgeries, that may help improve compliance and produce better out- comes," Dr. Francis said. EW Editors' note: This event was supported by unrestricted educational grants from Aerie (Bedminster, N.J.), Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), Carl Zeiss Meditec (Jena, Germany), and Glaukos (Laguna Hills, Calif.). Saturday, April 18, 2015 Early glaucoma detection underscored D espite a growing number of treatment options avail- able to ophthalmologists, early detection remains the most important deter- minant for eventual blindness. Published studies have shown glaucoma rates of legal blindness in at least 1 eye range from 7% to 14%, or an average of 10%, over a 20-year span. "The only thing they agree on, in terms of what determines wheth- er someone will be in the 10% or the 90%, is how early you diagnose the glaucoma," Douglas Rhee, MD, Cleveland, Ohio, said about glaucoma blindness studies during an EyeWorld CME Educational Symposium, "Innovating Advanced Treatments to Increase Compliance and Improve Outcomes for Glau- coma Patients: Diagnostics, Novel Therapies, and Surgical Options." The increasing sensitivity to optic nerve damage as glaucoma progresses means ophthalmologists need to diagnose it as early as possi- ble. In terms of detection, Dr. Rhee underscored that the first defect identified is a visual field change in 50% of cases and a structural change in the other 50% of cases. "That gets lost sometimes be- cause we focus so much on pre-pe- rimetric glaucoma, and we forget that 50% of the time the first defect is a visual field change," Dr. Rhee said. "So you can have all green on your optical coherence tomography Dr. Rhee addresses the need for early detection to prevent glaucoma-induced blindness. Watch ASCRS•ASOA Today in many San Diego hotels from the latest convention highlights Hotel Channel Courtyard by Marriott San Diego Downtown 30 Declan Suites San Diego 1 Hard Rock Hotel San Diego 59 Hilton San Diego Bayfront 59 Hilton San Diego Gaslamp 46 Hotel Solamar 43 Manchester Grand Hyatt San Diego 42 Omni San Diego Hotel 43 San Diego Marriott Gaslamp Quarter 51 San Diego Marriott Marquis & Marina 86 Sheraton San Diego Hotel & Marina 2 W Hotel San Diego 68 Westgate Hotel 1 Westin Gaslamp Quarter, San Diego 42 Westin San Diego 44 Wyndham San Diego Bayside 34

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