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39 EW SHOW DAILY 2018 ASCRS•ASOA Annual Meeting, Washington, D.C. by Erin L. Boyle EyeWorld Contributing Writer Quantify retinal function. Manage retinal disease. Check out the most advanced electroretinography (ERG) systems for the ophthalmic practice, including the NEW Diopsys® RETINA PLUS™ and Diopsys® mfERG (multifocal electroretinography) vision test. ASCRS BOOTH #1220 In the talk that Douglas Rhee, MD, Cleveland, gave on "Stratify- ing Stage & Risk for Glaucoma," he said knowing the stage of disease is key for next steps, plus billing and coding purposes. He recommended following the "rule of 5s" from the Ocular Hypertension Treatment Study: • Cup to disc ratio >0.5 • Central corneal thickness thinner than 555 μm • IOP higher than 25 When to refer Knowing when to refer your glau- coma patient to a specialist is based on numerous factors, Reay Brown, MD, Atlanta, said in his talk "When to Treat?/When to Refer?" Among those are when you don't know what to do with the case or don't feel comfortable performing the surgery needed. When you do refer, it's import- ant to emphasize hope, not fear. "Nothing frightens a patient more than a doctor who is afraid," Dr. Brown said. If not glaucoma, what? Dr. Zhang closed the session with five cases in "Is it Really Glauco- ma? (Differential Diagnosis)." The majority of the audience got the audience participation question correct: "Which of the following neuro-ophthalmological disease most commonly gets misdiagnosed as glaucoma?" The answer: Ischemic optic neuropathy. EW Editors' note: Drs. Brown, Giovingo, Oats, Patrianakos, and Zhang have no financial interests related to their comments. Drs. Francis, Radcliffe, and Rhee have financial interests related to their comments. W ith cataract surgery shown to lower IOP, treatment of the disease is not just for glaucoma specialists, so some glaucoma specialists shared their knowledge Monday at the Es- sentials in Glaucoma symposium. "With the introduction of new techniques and devices, which may be utilized during cataract surgery, a better understanding of the under- lining glaucoma is helping in coun- seling patients with regard to their options when undergoing cataract surgery," said Michael Oats, MD, Boston. Cataract surgeons need to be aware of these options, as well as the basics of glaucoma. Dr. Oats, along with Amy Zhang, MD, Cleveland, and Thomas Patrianakos, MD, Chi- cago, moderated the session, which was designed as a comprehensive overview of the disease. Glaucoma classification Classifying glaucoma type is im- portant to understanding each type and how to treat it, Dr. Patrianakos said in his presentation "Classifica- tions of Glaucoma." He outlined the differences between open and closed angle glaucomas, starting with open angle glaucoma. "Here we have aqueous humor being introduced into the ciliary body," he explained. "It travels into the posterior chamber around the lens iris diaphragm, into the chamber, and there's some inherent dysfunction of the trabecular mesh- work. But the trabecular meshwork is open." Diagnostic and staging vitals Nathan Radcliffe, MD, New York, presented "Dissecting Visual Fields." Among his pearls, he advised physi- cians to ensure the visual field that they're examining is in the correct electronic medical record—it's not uncommon for the "medical record to be wrong or the medical record number is right but the patient's name is wrong. Start at the top." Foveal sensitivity, "right in the middle, sitting under our noses," is the single most important point in the visual field, he said. Why? Because a visual field test could be normal, but if the foveal sensitivity is zero, that's an issue that wouldn't be caught without that measure- ment. Check to see if the field test has foveal sensitivity turned off (a common occurrence), and if it has, turn it back on. "It takes 30 seconds, if that, at the beginning of the test [to turn on]," Dr. Radcliffe said. Michael Giovingo, MD, Chi- cago, discussed the "Essentials of Pachymetry and Gonioscopy." Go- nioscopy is important for numerous reasons, he said, including identify- ing glaucoma patients who would benefit from cataract surgery alone. Brian Francis, MD, Pasadena, California, gave two talks: "OCTs in Glaucoma (NFL, GCL)" and "An- terior Segment Imaging (AS-OCT, B-Scan, Ultrasonography)." In his second talk, he said that both ante- rior segment optical coherence to- mography (AS-OCT) and ultrasound biomicroscopy (UBM) are "valuable in diagnosis, follow-up, and surgical planning and postop." "AS-OCT has fantastic resolu- tion. It's best for the anterior cham- ber and the angle," Dr. Francis said. "UBM has greater tissue pene- tration. It's best for things posterior to the iris, for instance the ciliary body, pars plicata all the way to pars plana, or looking at the lens, or IOL, if you might be planning lens exchange or some such procedure." What should you know about glaucoma? Dr. Radcliffe discusses visual fields and how to use them in the Essentials in Glaucoma symposium.

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