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3 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, San Diego 2015 Visit us in booth # 3060 Natural Tear Drops www.CrocTears.com 1 (855) 880-9538 the Santa Casa de Misericórdia in São Paulo, Brazil. Dr. Ventura did his fellowship training in retina and cataract surgery at the University of Puerto Rico. He obtained his masters degree and doctorate from the Feder- al University of São Paulo. The Opening General Session takes place today from 10 a.m. to noon in ballroom 20ABC of the San Diego Convention Center. EW Obstbaum, MD, and Emmanuel Rosen, MD, Dr. Sourdille helped to merge the ESCRS and ASCRS jour- nals into what is now the Journal of Cataract & Refractive Surgery (JCRS). In 1974, Dr. Sourdille helped to organize a symposium at which Charles D. Kelman, MD, performed the first phacoemulsification proce- dure. At the Société d'Ophtalmol- ogie de Paris in 1978, he presented an evolution of the extracapsular cataract extraction technique. Three years later, Dr. Sourdille and his University of Nantes colleagues helped to pave the way for the intra- capsular placement of IOLs with the "in-the-bag"/Nantes technique. Marcelo Ventura, MD, PhD, is cofounder and CEO of the Altino Ventura Foundation, a nonprofit organization in Recife, Brazil. The foundation has performed more than 220,000 eye surgeries, pro- vided care for more than 7 million patients, and trained more than 229 residents, 128 Brazilian fellows, and 28 international fellows. Dr. Ventura cofounded and is on the board of directors for the HOPE Hospital (Pernambuco Eye Hospital) in Recife, Brazil. He has served as past president of the Latin American Society of Cataract & Refractive Sur- geons [ALACCSA-R (LASCRS)] and the Brazilian Cataract Society. Dr. Ventura has published several papers and book chapters. He is a graduate of the Med- ical School of the University of Pernambuco in Recife, Brazil, and completed his residency training at Drs. Sourdille and Ventura continued from page 1 overcome compliance challenges, he said. Additionally, the development of future glaucoma surgeries will be a game changer, he said, refer- ring to a new trabecular meshwork treatment (Eye Sonix, Long Beach, Calif.), a new pars plana treatment that may improve outflow (Iridex, Mountain View, Calif.), procedures that go beyond microinvasive glau- coma surgery, and gene therapy. Lens extraction in PACG, pigment dispersion glaucoma An avant-garde leader for early lens extraction for primary angle closure glaucoma, Clement C.Y. Tham, BM BCh (Oxon), Hong Kong, said that this approach can deepen the anteri- or chamber and widen the drainage angle. An ideal window for lens extraction is 3 to 4 weeks after IOP control and iridotomy, he said. Treatment options for patients with primary and secondary pig- ment dispersion glaucoma were the focus of a talk from Reay H. Brown, MD, Atlanta, and other Glaucoma Day presenters. The risks associated with trabeculectomy highlight the need for treatment alternatives in this patient population, Dr. Brown said. Although cataract surgery, mi- otics, and laser peripheral iridotomy may treat the disease mechanism, they may not lower the IOP, he added. Douglas J. Rhee, MD, Cleve- land, discussed the diagnosis and treatment of uveitis-glaucoma-hy- phema (UGH) syndrome, which he said in recent times has been associ- ated with poorly positioned posteri- or chamber IOLs. Ophthalmologists should suspect UGH if the patient has a history of a spiked IOP, a low grade anterior chamber reaction, or a darkly pigmented trabecular meshwork. Ultrasound biomicrosco- py can be helpful for imaging in this group of patients, Dr. Rhee said. The typical treatment involves pilocar- pine, palliative care, lasers, and a surgical approach with IOL rotation or exchange. "The surgical approach is what you want to do to fix the issue, but if it's been more than 6 to 12 months, I recommend combin- ing IOL rotation or exchange with a glaucoma procedure," Dr. Rhee said. Editors' note: Dr. Brown has financial interests with Ivantis (Irvine, Calif.), Glaukos (Laguna Hills, Calif.), Rhein Medical (St. Petersburg, Fla.), and other ophthalmic companies. Dr. Rhee has financial interests with Aerie Pharma- ceuticals, Alcon (Fort Worth), Glaukos, and other ophthalmic companies. Dr. Samples has financial interest with Aerie Pharmaceuticals, Alcon, Allergan (Irvine, Calif.), and other ophthalmic companies. Dr. Tham has financial interests with Abbott Medical Optics (Abbott Park, Ill.), Alcon, Allergan, and other ophthalmic companies. Has imaging refined enough to drive surgery? Some surgeons have seen refine- ments in imaging—particularly the resolution available for retinal nerve fiber layer examination—reach the point where it is sufficient to drive decisions to operate on glaucoma patients. "I think we are there, but it is all in the interpretation of the optical coherence tomography (OCT)," said Nathan Radcliffe, MD, New York. Dr. Radcliffe has found prob- lems in his own practice with obtaining reliable visual fields. For instance, he sometimes sees cataract patients who are prescribed several glaucoma drops but who have mar- ginal or poor intraocular pressure control, and he has to rely on assess- ing the extent of their nerve damage to determine whether surgery is justified. "All I've got to make the deci- sion about whether this is a micro- invasive glaucoma surgery (MIGS) patient or a tube shunt patient is basically how much nerve damage they have because the functional data just can't be reliable for all pa- tients," Dr. Radcliffe said. "And I cer- tainly will look at the retinal nerve fiber layer and make a decision on which therapeutic intervention to pursue." Thomas Samuelson, MD, Minneapolis, agreed that the day has arrived where ophthalmologists can decide whether to operate based on images. However, images may not be enough to drive a choice between using a trabeculectomy or a tube shunt. In cases where a patient has a 6-micron change in the spectral domain OCT, Dr. Samuelson is much more likely to increase medical therapy or use selective laser tra- beculoplasty in response instead of undertaking a "huge" surgical step. Garry Condon, MD, Pittsburgh, underscored the need to be patient with the imaging and to look for consistent imaging quality to allow detection of change. "I see too many patients who are referred on a first-time basis because they are marginally of any concern in terms of glaucoma but their OCT is not normal," Dr. Condon said. "The point is, that's the baseline; that's the start and it is looking for the change that is so important." EW Editors' note: Dr. Radcliffe has fi- nancial interests with Alcon, Alimera (Alpharetta, Ga.), Allergan, Carl Zeiss Meditec (Jena, Germany), Endo Optiks (Little Silver, N.J.), Glaukos, Iridex (Mountain View, Calif.), and Transcend Medical. Dr. Samuelson has financial interests with Alcon, AqueSys, Glaukos, Ivantis, and Transcend Medical (Menlo Park, Calif.). Dr. Condon has financial interests with Alcon, Allergan, and MicroSurgical Technologies (Redmond, Wash.). Glaucoma Day continued from page 1

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