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EW SHOW DAILY 8 ASCRS News Saturday, April 14, 2018 by Vanessa Caceres EyeWorld Contributing Writer Shire Pharmaceuticals, Lexington, Massachusetts), punctal occlusion, and amniotic membrane treatment. More recently, Dr. Vold has add- ed LipiFlow (Johnson & Johnson Vision, Santa Ana, California) and intense pulsed light treatments to maximize the ocular surface, both of which appear to work well for his patients. He also uses punctal cau- tery more often than before. Regarding 20/20 or better UCVA, Dr. Vold believes in going big for glaucoma patients. "Why must glaucoma patients give up the dream of great vision?" he asked. He discussed how modern toric IOLS are a good option that do not com- promise contrast sensitivity. With more than 35% of the population having a diopter or more of astigma- tism, "this is no small number," he said. "We can help them with their quality of life." Dr. Vold said he has heard many specialists address why presbyopic IOLs cannot be used in glaucoma pa- tients. However, newer IOLs do not compromise contrast sensitivity, and there are reduced glare and halos compared with previous IOLs. These IOLs are helping patients achieve better refractive outcomes as well. However, be careful with patient se- lection, he warned. Presbyopic IOLs can be a potentially great option for mild to moderate but not advanced glaucoma. Newer available technology such as intraoperative aberrometry and wavefront treatment with re- fractive surgery also helps surgeons and patients reach higher visual expectations, Dr. Vold said. EW Editors' note: Dr. Vold has financial interests with Aerie Pharmaceuticals (Irvine, California), Alcon, Glaukos (San Clemente, California), and other ophthalmic companies. T o give glaucoma patients a "20/20" experience, surgeons should optimize glaucoma control, aim for a pristine ocular surface, and set a goal of 20/20 or better uncorrected visual acuity (UCVA), said Steve Vold, MD, Fayetteville, Arkansas, giving the 2018 Stephen A. Obstbaum, MD, Honored Lecture at the 2018 ASCRS Glaucoma Day. Dr. Vold briefly discussed the primitiveness of glaucoma treat- ments a couple of decades ago, when he did not even think he wanted to work with glaucoma pa- tients. Fast forward to today, and he said he has devoted the last 20 years to how to make life easier for glau- coma patients, who often struggle with quality of life issues once they are diagnosed. These issues include managing eye drops, experiencing medication side effects, suffering from depression, and managing the fear of going blind along with the financial burden of care. The burden of glaucoma is not a small one, he added. By 2020, an estimated 80 million people around the globe will have glaucoma. For these reasons, Dr. Vold praises more recent advancements in care and thinks glaucoma specialists have an important role in improving patients' lives. Within the realm of optimal glaucoma control, Dr. Vold discussed the low compliance rate when patients must use one or more glaucoma drops. Although microin- vasive glaucoma surgery (MIGS) may not completely eliminate medi- cation use, it can help lower the medication burden, he said. It also helps with patient comfort and con- venience and can be cost effective in the long run. Surgeons can combine it with cataract surgery as well. For surgeons who are new to MIGS, Dr. Vold advised getting familiar with one to two trabecu- lar bypass procedures, at least one of which should be a standalone procedure. Surgeons should also become familiar with a supraciliary device; the only one available now is the CyPass Micro-Stent (Alcon, Fort Worth, Texas), he said. Regarding the second goal of ocular surface issues, these prob- lems are often underdiagnosed and underappreciated, Dr. Vold said. Glaucoma medications common- ly irritate the ocular surface, and surgeons should discuss the variety of treatments available for them. To help maximize a pristine ocular sur- face, Dr. Vold advised using a multi- faceted approach. These can include artificial tears, lid cleaners, cyclo- sporine (Restasis, Allergan, Irvine, California) or lifitegrast (Xiidra, Achieving better vision, quality of life for glaucoma patients Dr. Vold speaks about better goals for glaucoma patients.

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