Eyeworld Daily News

EW SHOW DAILY 66 Meeting Reporter Saturday, May 7, 2016 Dr. Lewis highlights tools that can be used to help diagnose glaucoma patients, define their disease, and track progression. by EyeWorld staff In addition to outstanding live content and discussion, a special handout has been developed for all attendees. This will include phaco setting recommendations from the faculty, as well as a comprehensive chapter from Dr. Chang's Phaco Chop textbook on phacodynamics. Another unique component of this symposium is the Q&A that will take place live during and after the program. Every question submitted at this program is guaranteed to be answered by the faculty either from the podium or via email shortly after the symposium. This EyeWorld CME sympo- sium will take place in La Nouvelle Ballroom ABC tomorrow. Registra- tion will start at 8:00 a.m., and the program will start at 8:30 a.m. The program is supported by educational grants from Abbott Medical Optics, Alcon, and Bausch + Lomb. Onsite registration is available. EW Dynamic content and specialized handout targets residents, fellows, and physicians interested in evolving phaco techniques T omorrow morning, David Chang, MD, and Elizabeth Yeu, MD, will lead a symposium on optimizing phaco machine settings for standard, complex, and femto-phaco cataract cases. The pro- gram is titled "Phaco Fundamentals: Modifying & Advancing Machine Settings for Routine, Complex, and Femto-Phaco Cases," and the faculty includes Berdine Burger, MD, Bonnie Henderson, MD, and Surendra Basti, MD. These physi- cians are recognized as top resident phaco educators in the country. Optimizing machine settings is an important factor in success- ful cataract surgery, but it is often overlooked or underemphasized in phaco education. This program will highlight key principles for opti- mizing fluidics and power modula- tion for different stages of nuclear removal. The faculty came together to develop a series of presentations and video case discussions designed to overview phaco settings and techniques for routine to complex cataract surgeries. Additionally, with the increased adoption of laser-as- sisted cataract surgery, there will be a dedicated section on how to adjust phaco settings specifically for femto- phaco patients. The symposium is designed to maximize key takeaways for the intended audience: young ophthal- mologists and those physicians who are interested in optimizing their phaco settings and evolving their techniques. The overall goal is to in- crease physician confidence through understanding the science behind phacodynamics and the alteration and adjustment of phaco settings. The Alcon (Fort Worth, Texas), Bausch + Lomb (Bridgewater, New Jersey), and Abbott Medical Optics (Abbott Park, Illinois) phaco ma- chine platforms will be discussed in the program. The first section will include a slide overview of the principles of phacodynamics, with the faculty sharing principles that are universal- ly important to understand. Topics will include peristaltic and venturi pumps and flows, vacuums, power modulation throughout surgery, and post-occlusion surge. Drs. Henderson, Cohen, and Basti will also provide setting recommenda- tions based on each of the phaco platforms. Following a discussion of phacodynamics, the faculty will then present videos of dense cataract cases and various complications, and discuss recommendations on how to alter the parameters of each platform to take advantage of its features for routine cases. Faculty will also share how to adjust phaco settings for venturi and peristaltic pumps for femto-phaco cases. Pearls for routine, complex, and femto-phaco cases Nathan Radcliffe, MD, New York, highlighted some of these nov- el drug delivery systems in his pre- sentation. These systems, in varying phases of development and clinical trials, include implants, rings placed under the eyelids, and punctal plugs. He also mentioned some new medical therapies coming down the pipeline; he said he was particularly excited about 1 possibility. "I think a fixed combination prostaglandin analogue plus a Rho kinase inhibitor … I see that as the most paradigm changing," Dr. Radcliffe said, explaining earlier in his presentation that "we've nev- er had a fixed combination FDA approved in the United States that included a prostaglandin analogue." Ike Ahmed, MD, Toronto, de- scribed by Dr. Brown as the "closest thing we have in glaucoma to a rock star," talked about how the gap between drops and more invasive surgeries like trabeculectomy and tube shunts is being served now by the growing MIGS market. One of the topics within Dr. Ahmed's address was "to bleb or not to bleb," or to drain internally or externally. He said a lot of that decision depends on whether the glaucoma procedure will stand alone or be coupled with cataract surgery. "Combining phaco with inter- nal MIGS procedures has good syner- gy," he said, noting that cataract surgery and a MIGS procedure could be done at the same time with a bleb procedure being performed later, if needed, to avoid risks of doing it before phaco or at the same time. Blebs are more efficacious and safe as a standalone procedure, Dr. Ahmed said. "When we're looking to com- bine glaucoma surgery and cataract surgery, safety is paramount," he said. "I think the canal space is the idea space for safety. The canal space is where I go when I'm looking for safety and a modest amount of efficacy." He also said that choosing the right location for a stent, near aque- ous veins for example, will enhance the efficacy of the implants. EW Editors' note: This event was support- ed by educational grants from Aerie Pharmaceuticals, Alcon, Allergan, and Bausch + Lomb. continued from page 65 it, and monitor progression, he also said he finds it particularly valuable to view the angle, using it to show a patient what angle closure looks like. As for patient noncompliance with medication, Dr. Lewis said simple things like having a conver- sation to explain the disease and the effect therapy will have is 1 thing, while prescribing a "simple, easy, and minimally expensive" medica- tion can also enhance compliance. Some other patient compliance issues could result from the side effects caused by the drugs, such as ocular surface disease. "One of the goals in the future will be new forms of drug delivery, which will help avoid exposure to the ocular surface," Dr. Lewis said.

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