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53 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, Los Angeles 2017 therapies usually pursued for glauco- ma patients. Her practice uses a survey to ask glaucoma patients about their glaucoma treatments and medica- tions, and the survey also has a box toward the end to promote MIGS clinical trials. This helps get patients thinking about a possible interest in MIGS. Cost is always an issue with treatment options, Dr. McCabe said. There are various MIGS choices now- adays, but the iStent (Glaukos, San Clemente, California) is the only approved MIGS device with a single CPT code that is covered 100% by Medicare, Medicare Advantage, and all national commercial payers, she added. In a talk on common iStent complications, Richard Lewis, MD, Sacramento, California, said that good surgical visibility is a key factor. "If you can't see well, you shouldn't be placing the iStent," he said. Surgeons should reassess the iStent immediately after it is placed. "If it's the next day and it's not in a good position, that shouldn't hap- pen. It doesn't move," he said. Although complications with the iStent are rare, Glaukos reps don't let surgeons perform surgery until they've practiced enough to help prevent complications, Dr. Lewis said. Lilit Voskanyan, MD, Yerevan, Armenia, focused on different types of MIGS devices available, such as those combined with cataract sur- gery, two-stent therapy, stents that access the secondary flow pathway, and extraocular versus intraocular drug delivery. "Future products will allow us to customize therapy for patient needs," Dr. Voskanyan said. Dr. Ahmed wrapped up the session by addressing the still-un- charted territory for MIGS. For example, he stated that only 20% of glaucoma surgeries are performing MIGS. "There's a large treatment gap for MIGS," he said. However, he sees it as a graceful, tissue-sparing, and minimally intrusive approach that surgeons should consider more often. He made the parallel of MIGS combined with phaco as having the same role that toric lenses have to IOLs. It offers a way to combine treatments that patients need while balancing safety and efficacy, he said. EW Editors' note: This EyeWorld event was supported by an educational grant from Glaukos. by Vanessa Caceres EyeWorld Contributing Writer more glaucoma medications are not compliant. "That jives well with the literature," he said. The same survey found that an average of 20% of cataract surgery patients are potential MIGS candi- dates, he added. During the session, Cathleen McCabe, MD, Bradenton, Florida, addressed incorporating MIGS into a comprehensive ophthalmic practice. She has found that adding MIGS adds minimal risk and optimal out- comes for patients. "Patients want a one-stop experience for all of their needs if possible," she said. Benefits from MIGS include a decreased IOP, decreased costs associated with medications, and reduced risks associated with other T here's more buzz around microinvasive glaucoma surgery (MIGS) these days than cataract surgery and IOLs, thinks Ike Ahmed, MD, Toronto. "That says a lot about where we are right now," he added. Dr. Ahmed and fellow presenters at "MIGS in the New Era: Treatment Algorithms, Complicated Cases, and What's on the Horizon" helped guide attendees on the future of MIGS. A few factors leading more pa- tients to MIGS include the constant problem with glaucoma medication compliance, Dr. Ahmed said, citing data from the 2016 ASCRS Clinical Survey, which found that physicians think that 43% of patients on two or MIGS provides surgical options to eliminate medication compliance problems, offer maximum treatment Dr. Lewis shares pearls for handling MIGS complications.

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