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EW SHOW DAILY 6 ASCRS News Monday, April 16, 2018 In his presentation, Dr. Radcliffe noted the various issues with glauco- ma drop regimens, including patient non-compliance, cost, and side effects. He also hailed the efficacy of surgical options, including selective laser trabeculoplasty and microinva- sive glaucoma surgery (MIGS). From the panel, Dr. Braga-Mele said she doesn't think surgical man- agement will take over medications because traditional surgical options have the risk of complications and "for trabecular bypass MIGS and suprachoroidal MIGS the goal is not to get off drops," just to decrease the patient's number of medications. Michael Patterson, DO, Cross- ville, Tennessee, spoke about multi- focal IOLs and how he thinks new innovations in the premium market would result in an increased market share for advanced IOLs. Dr. Don- nenfeld, Dr. Yeu, and Dr. Berdahl turned to partner with Dr. Patterson, and he chose Dr. Donnenfeld. Zaina Al-Mohtaseb, MD, Houston, presented on femtosec- ond laser-assisted cataract surgery (FLACS), which she said has reached its peak and is on the decline. Dr. Al- Mohtaseb shared data from a variety of studies that showed little to no difference in terms of outcomes and safety between FLACS and conven- tional cataract surgery. Dr. Ahmed partnered with Dr. Al-Mohtaseb, af- ter both he and Dr. Berdahl turned. Preeya Gupta, MD, Durham, North Carolina, partnered with Dr. Berdahl after presenting her case that topical drops will soon be eliminated in favor of intracameral options, injectable depots, ionto- phoresis, and drug eluting inserts and plugs. Dr. Lindstrom and Dr. Thompson took issue with Dr. Gup- ta and Dr. Berdahl's perspective that drops would be eliminated "soon." Finally, Quentin Allen, MD, Stuart, Florida, spoke about consol- idation in ophthalmology with pri- vate equity. Dr. Allen partnered with Dr. Donnenfeld on this front. From the counter panel, Dr. Braga-Mele compared her perspective of work- ing under Canada's publicly funded healthcare system to that of partner- ing with private equity. "You're just selling your soul to a different devil here," she said, explaining that these partnerships limit ophthalmologists in their power of choice. EW Editors' note: The physicians have financial interests with a variety of ophthalmic companies. the contestant if they agreed with their position and wanted to men- tor/team-up. If more than one judge turned, they were given the oppor- tunity to share why they should be chosen as mentor. From there, the contestant-judge duo faced a panel, which included Vance Thompson, MD, Sioux Falls, South Dakota, Richard Lindstrom, MD, Minne- apolis, Mitchell Jackson, MD, Lake Villa, Illinois, and Rosa Braga-Mele, MD, Toronto, Canada, who provid- ed counter arguments. After all contestants had com- peted, the audience voted for the contestant-judge team who they thought had the best presentation. Ultimately, contestant Blake Wil- liamson, MD, Baton Rouge, Louisi- ana, and Dr. Yeu were the winners. Dr. Williamson presented on "Pres- byopia in the Farsighted Future." Dr. Williamson said he thought that ophthalmologists would be treating presbyopia with surgical or topical options within the next decade. Dr. Williamson said near vision has become more valuable over time with dependence on the computer and now the ubiquitous smart- phone. Yet there hasn't been much change in modes of presbyopia correction; the most common way is reading glasses and bifocals. But there's good news; we're in a renaissance for presbyopia, Dr. Williamson said. There were five options for surgical presbyopia cor- rection 5 years ago; now there are up to 30 options that could be available in the near future. Dr. Williamson gave a brief overview of the few he thinks will be most transformative. These included allogenic inlays and onlays (Allotex, Zurich, Switzerland), the Light Adjustable Lens (RxSight, Aliso Viejo, California), and refrac- tive indexing (Perfect Lens, Irvine, California). Dr. Williamson said he sees a future in the "topical presby-lution," mentioning several topical drops that are in clinical testing that use different modes of action. Dr. Wil- liamson thinks the cost will be the only remaining barrier, but he men- tioned an expected 17% growth in a population with economic means to purchase these solutions. All the judges ended up turning for Dr. Williamson, but he ultimate- ly picked Dr. Yeu to be on his team. Dr. Yeu added some brief thoughts to Dr. Williamson's perspective, then they faced the panel. Dr. Braga-Mele joked that while she might be of presbyopic age, "these young'uns can't read much, and they can't count either." "Five to 10 years? Have you worked with the FDA? … These are not coming out in 5–10 years," Dr. Braga-Mele said, noting that they are still in the earlier stage of trials. Dr. Yeu defended the current research. She said that efficacy and safety data has been good, which lends promise to it having a faster pace at getting to market. Nathan Radcliffe, MD, New York, argued that surgical manage- ment of glaucoma would take over medical management. Dr. Radcliffe ultimately selected to partner with Dr. Ahmed, despite having Dr. Ber- dahl and Dr. Donnenfeld showing interest. "We are in an area of interven- tional glaucoma … drops are not do- ing it for our patients," Dr. Ahmed said. "Surgical management is here … this is the future of glaucoma." 'The Voice' continued from page 1 © 2016 Novartis 2/16 US-VIS-16-E-0527 DISCOVISC ® OVD IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician. INDICATIONS: DisCoVisc ® Ophthalmic Viscosurgical Device is indicated for use during surgery in the anterior segment of the eye. It is designed to create and maintain space, to protect the corneal endothelium and other intraocular tissues and to manipulate tissues during surgery. It may also be used to coat intraocular lenses and instruments during cataract extraction and IOL insertion. WARNINGS: Failure to follow assembly instructions or use of an alternate cannula may result in cannula detachment and potential patient injury. PRECAUTIONS: Precautions are limited to those normally associated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly purified biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material. ADVERSE REACTIONS: DisCoVisc ® Ophthalmic Viscosurgical Device was very well tolerated in nonclinical and clinical studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to affect such a rise. It is therefore recommended that DisCoVisc ® OVD be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. ATTENTION: Reference the Directions for Use for a complete listing of warnings and precautions. Advancing CATARACT SURGERY DisCoVisc ® OPHTHALMIC VISCOSURGICAL DEVICE US-VIS-16-E-0527_PI_EWDN.indd 1 4/6/18 2:03 PM

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