Eyeworld Daily News

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 No need to reinvent the wheel Some of the biggest challenges in delivering healthcare are cost, access to care, and variations in clinical practice, Dr. Kraft said. In addition, physicians are unable to harness the wealth of healthcare data stuck in paper records. In the United States, physicians face challenges with the Food and Drug Administration (FDA) not knowing how to acceler- ate new technologies and challenges with payers not knowing how to reimburse or cover costs. The good news is that physi- cians can leverage existing tech- nology to overcome some of those challenges and can help shift our system from a reactive system to a proactive one, Dr. Kraft said. When Apple debuted the iPod in 2001, the technology for digital music already existed, but Apple's genius was in bundling those tech- nologies into the right package, he said. The same idea can be applied to healthcare to provide better, pre- ventive, personalized, proactive care. "The future is already here, it's just not evenly distributed," he said. Medicine going mobile One of the easiest things physicians can do today is to use smartphones and tablets to their advantage. Smartphones have driven a wealth of development into mobile di- agnostic tools, such as otoscopes, blood pressure cuffs, and even reti- nal imagers. These tools drive down costs, increase portability, and allow data to be shared with patients at a moment's notice. This has the added benefit of empowering patients with knowing their health status and providing op- portunities for physicians to engage with patients in a new way. "The new drug is the empow- ered, engaged patient," Dr. Kraft said. Harnessing these tools will give physicians more control over their own practices and the progression of healthcare delivery. "Think about using design in your practices and how we layer all these exponential new technologies, because it's not one technology, it's how they blend together," he concluded. "That's how we can shift healthcare from being episodic and reactive to a realm that's more con- tinuous and proactive." EW Editors' note: Dr. Kraft has no financial interests related to his comments. Leveraging technology continued from page 1 trabeculectomies, Dr. Lewis said. "I want postop control," he said. "After a trab, I still never know what the pressure's going to be on day one. Nothing is more frustrating." EW Editors' note: Dr. Donnenfeld has financial interests with Abbott Med- ical Optics (AMO, Abbott Park, Ill.), AcuFocus (Irvine, Calif.), Alcon (Fort Worth Texas), Allergan (Irvine, Calif.), AqueSys (Aliso Viejo, Calif.), Bausch + Lomb (Bridgewater, N.J.), Elenza (Roanoke, Va.), Glaukos, Icon Biosciences (Sunnyvale, Calif.), Kala Pharmaceuticals (Waltham, Mass.), Katena (Denville, N.J.), Mati Therapeu- tics (Austin, Texas), Merck (Whitehouse Station, N.J.), Mimetogen Pharmaceu- ticals (Gloucester, Mass.), NovaBay Pharmaceuticals (Emeryville, Calif.), Odyssey Medical (Memphis, Tenn.), Omeros (Seattle), Pfizer (New York), PRN (Plymouth Meeting, Pa.), RPS (Sarasota, Fla.), Shire Pharmaceuticals (Lexington, Mass.), Strathspey Crown (Newport Beach, Calif.), and TearLab (San Diego). Dr. Koch has financial interests with AMO, Alcon, i-Optics (the Hague, Netherlands), ReVision Optics (Lake Forest, Calif.), TrueVision (Santa Barbara, Calif.), and Ziemer (Port, Switzerland). Dr. Braga-Mele has financial interests with AMO, Alcon, and Allergan. Dr. Lewis has financial interests with Glaukos. really don't like taking drops, he said. Ocular surface toxicity, cost, and penetration into the eye are also issues that can be directly addressed with a dropless drug delivery regi- men. In addition to intracameral or intravitreal drug injection, sus- tained-release drops, punctal plugs, and external inserts show promise as dropless therapies. Reimbursement remains a challenge, however, and Dr. Donnenfeld called on physicians to lobby for adequate reimburse- ment for these therapies. Immediately sequential surgery Rosa M. Braga-Mele, MD, FRCSC, Toronto, shifted the topic to imme- diately sequential bilateral cataract surgery. Dr. Braga-Mele doesn't believe it's the right time for this yet, but believes surgery is slow- ly moving in that direction. For patients that must undergo general anesthesia, it should definitely be considered, she said, and possibly for patients who are travelling long distances to the clinic. If individual surgeons do choose to offer immediately sequential surgery, patient choice and informed consent are essential, she said. The second eye must always be option- al, there must be separate consent forms for bilateral surgery, and the surgeon must have complete aseptic separation of the right and left eyes, she said. Femtosecond laser-assisted cat- aract surgery complicates the issue, Dr. Braga-Mele added. Should both eyes be docked and lasered before going to the OR? What happens if there are complications during pha- co in the first eye? These issues will need to be addressed before moving forward, she said. Dr. Yeu asked Dr. Braga-Mele if now is not the right time, then when? Dr. Braga-Mele answered that for her, it will happen when both types or procedures can be reim- bursed equally and when surgeons have FDA-approved intracameral antibiotics ready to use. "I'm waiting for it to make sense for me, for my patients, and for my center," she said. Improving IOL design Douglas D. Koch, MD, Houston, presented "IOL Design—Is This the Best We Can Do?" The IOL features available now are high quality op- tics, toric IOLs that meet our needs, improving pseudoaccommodative designs, and square edges that retard posterior capsular opacification (PCO), but some features are still missing, he said. His "wish list" of IOL design includes elimination of PCO, elimination of dysphotopsias, a more precise definition of IOL power, true accommodative designs, and drug delivery. While we are making strides in these areas, it may be time for an entirely new approach, Dr. Koch said. "Why are we still either pre- scribing drops or injecting drugs through the zonules?" he asked. Having the lens elute drugs would reduce the need for both of these therapies. When it comes to a truly accommodative IOL, the ultimate solution is a long way down the road, he concluded. Combined or staged glaucoma surgery The topic of combined or staged cataract and glaucoma surgery has always been controversial, said Richard A. Lewis, MD, Sacramento, Calif. Glaucoma surgeons have see- sawed back and forth on this issue over the years, Dr. Lewis said, and the advent of MIGS has complicat- ed the issue. Cataract surgery alone lowers IOP and may be the safest intraocular glaucoma procedure, he said, but MIGS plus cataract surgery shows a greater IOP reduction. Today, Dr. Lewis bases his surgi- cal approach on the type of glauco- ma and the status of the patient's visual field. For mild to moderate open-angle glaucoma, he combines phaco with an iStent (Glaukos, Laguna Hills, Calif.). For advanced disease, he'll still do phaco plus an iStent but will follow up with a trab- eculectomy if necessary, he said. Despite the controversy, there has been a consensus among glaucoma surgeons to perform fewer Resolving controversies continued from page 1

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