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11 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, Los Angeles 2017 by Liz Hillman EyeWorld Staff Writer ered wirelessly by the patient walk- ing in proximity of a salt shaker-size pod for a few minutes at least once every 48 hours. The data is down- loaded during this time as well. Dr. Moster said researchers and engineers are currently working with the sensor in mouse eyes, which she noted is 5 µl, 1/10th the volume of a single drop, significantly less than the human eye. Dr. Moster envisioned this sen- sor being attached, for example, to a capsular tension ring or even a MIGS implant. If the latter, not only could the procedure lower pressure but the physician could accurately know, via the sensor's measurements, what happens with IOP moving forward. Taking it a step further, what if a drug delivery system were added to the sensor? Dr. Moster asked. "If these devices were able to be combined with a drug delivery system that was attached to the static [MIGS] device, the intraocu- lar pressure, when elevated, would be able to be responded to in real time," she said. In other words, communication between the sensor on the MIGS implant with a pump could release nanoparticles of medication when IOP is elevated. "Sensors will change the way everyone in this room will practice within the next few years. We will better understand glaucoma and better understand how we treat patients," Dr. Moster said. Following Dr. Moster's lecture was "Surgical Glaucoma Spot- light—Making Sense of the MIGS Revolution: A Practical Guide to the Surgical Treatment of Glaucoma." Presenters discussed trabecular mi- crobypass, supraciliary microbypass, gonioscopy-assisted transluminal trabeculotomy (GATT)/ab-inter- no trabeculectomy, ab-interno canaloplasty, 360-degree gonioto- my and the trabecular meshwork excision blade, and subconjunctival filtration systems, followed by sever- al relevant case discussions. EW Editor's note: Dr. Moster has financial interests with Qura. Marlene Moster, MD, thinks sensors will help physicians "better understand glaucoma and better understand how we treat patients" A highlight of Friday's ASCRS Glaucoma Day was the 2017 Stephen A. Obstbaum, MD, Honored Lecture presented by Marlene Moster, MD, Philadelphia. In his introduction, in addi- tion to listing Dr. Moster's dozens of professional accolades, Douglas Rhee, MD, Cleveland, program chair of Glaucoma Day, described her as someone he saw as "courageous, fearless … and just a touch of great crazy—and I said, I wanted to be just like her." Dr. Moster focused her presenta- tion on "the holy grail," that being 24/7 IOP monitoring. How much does IOP fluctuate over the course of the day? Does it follow a pattern? Does it fluctuate at night? The ques- tions continue and, as Dr. Moster put it, there is a lot we don't know. Studies have shown, at least, that IOP is higher at night. "Generations of ophthalmol- ogists have been trained to rely on single IOP measurements for the development of treatment target goals and evaluation of treatment strategies. Measuring IOP just once every 3 months doesn't cut it," Dr. Moster said. "So, what do we need to do? We need to measure pressure all the time, but how are we going to do this?" Triggerfish (Sensimed AG, Lausanne, Switzerland) was the first 24-hour monitoring system worn by the patient as a contact lens with wireless transmission of data to an antenna worn by the patient. Triggerfish doesn't measure IOP directly, rather changes in volume of the eye and other ocular biome- chanical properties of the cornea. Dr. Moster presented several studies that have received valuable infor- mation using Triggerfish, but is the system design and its measurements, good enough? "Probably not, but it is certainly a start," Dr. Moster said, answering her own question. Dr. Moster said what the field needs is a sensor that measures pres- sure directly and does so through an internal, continuous device. Imp- landata Ophthalmic Products Gmbh (Hannover, Germany) is developing the wireless intraocular pressure transducer (WIT), which is placed after phaco in the capsular bag. The incision to implant this device is large—5.5 mm—initial inflamma- tion occurs, and in a small study, all patients experienced pupillary distortion. "If we're going to have some- thing in the eye, I think we all understand, it has to fit perfectly … and be small enough so that it makes sense and doesn't cause any inflammation," Dr. Moster said. This is where she introduced a sensor in development by Qura (Medway, Massachusetts). This device is designed to be implantable for 24/7 IOP monitoring. It is pow- Stephen A. Obstbaum lecturer describes the future of 24/7 IOP monitoring Dr. Moster receives a plaque in honor of her 2017 Stephen A. Obstbaum, MD, Honored Lecture.

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