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Ocular Surgery News Symposium to expand beyond glaucoma in 2006
This year’s meeting drew more than 200 ophthalmologists to Las Vegas for discussions of the latest advances in glaucoma diagnosis and management.
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LAS VEGAS - During a successful third annual meeting here, meeting organizers announced that next year the Ocular Surgery News Symposium will expand beyond glaucoma.
![Louis B. Cantor, MD [photo]](/~/media/images/news/print/ocular-surgery-news/2005/07_july_15/cantor_70_90_5994.jpg) Louis B. Cantor |
In 2006, the Ocular Surgery News Symposium will expand from a 2-day to a 3-day format, and sessions covering cataract and both lens-based and cornea-based refractive surgery will be added, according to Louis B. Cantor, MD, one of the course directors for this year’s meeting.
Dr. Cantor noted that in organizing this year’s meeting a grand rounds section was added at the suggestion of previous meeting attendees. The grand rounds proved to be one of the meeting’s hot sessions. Now, again in response to meeting attendees’ requests, the meeting will be expanded both in scale and scope, he said.
“This meeting will expand in order to address the wide variety of anterior segment problems faced by comprehensive ophthalmologists, optometrists and specialists in eye care,” Dr. Cantor said in an interview.
Dr. Cantor said that next year his co-course-director, Richard L. Lindstrom, MD, will moderate sessions on cataract and refractive surgery.
Dr. Lindstrom “will bring with him an outstanding faculty,” Dr. Cantor said. “This will be another outstanding meeting.”
The expanded meeting will be held here June 8-10, 2006, at the Venetian Resort Hotel and Casino.
Dr. Cantor said he and Dr. Lindstrom plan to cover topics that will “improve the surgeon’s odds of achieving the best care for patients.”
“Join us for another year of education, camaraderie and entertainment in Las Vegas, where what happens in Vegas goes home with you,” Dr. Cantor said.
Following are some of the highlights of this year’s meeting.
Earlier detection
An updated, faster version of frequency doubling technology (FDT) perimetry is effective for detecting pre-perimetric glaucoma, according to a physician who has clinical experience with the technology.
Image: Stiglich JM, OSN |
“For the last few years, we have searched for a technology that allows us to identify early field loss when we are just starting to see changes in the optic nerve,” said Steven T. Simmons, MD. He described his own clinical experience with FDT on the Humphrey Matrix from Carl Zeiss Meditec.
Noting that full-field perimetry is arduous for patients, Dr. Simmons said “FDT has changed the way we practice glaucoma in these patients with early glaucoma.”
According to Dr. Simmons, the Humphrey Matrix uses the same technology as previous FDT perimetry, but the target size is reduced from a 10° field to a 5° field. The new technology also features the ZEST algorithm, which can gather twice the amount of data in the same amount of test time, he said.
“With those changes it has become much better at detecting progression of change over time and reduces the variability that we saw with standard frequency doubling technology,” Dr. Simmons said.
He said the Matrix is a great screening tool that is specific in determining who is normal and who is abnormal.
“But it is also a valuable tool to look at those patients you are concerned about who may have normal inferior fields,” he said. “Nothing affects the patient’s quality of life more than damage in the inferior field.”
Beyond CCT: Other factors
Central corneal thickness is just “the tip of the iceberg” in the true measurement of IOP, said one surgeon. Other factors such as corneal elasticity, scleral thickness and genetic variability will likely also play important roles in attaining a full understanding of IOP, said Jess T. Whitson, MD, FACS.
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![Jess T. Whitson, MD, FACS [photo]](/~/media/images/news/print/ocular-surgery-news/2005/07_july_15/whitson_70_90_5994.jpg)
The Ocular Hypertension Treatment Study concluded that central corneal thickness (CCT) varies in patients and may mask a true IOP reading, Dr. Whitson said. But despite the availability of nomograms, none gives a truly accurate IOP correction factor, he added.
“Take these test results with a grain of salt,” he advised.
Rather than use a nomogram that was developed based upon a few studies with a limited range of corneal thicknesses, Dr. Whitson suggested, the physician should perform pachymetry in all glaucoma patients and glaucoma suspects and then categorize the cornea readings as thin, average or thick.
“Beyond CCT, other factors should be considered when determining IOP,” Dr. Whitson said. Corneal curvature, corneal edema, keratoconus and corneal elasticity are all factors that should be taken into account when looking at a patient’s IOP reading, he said.
“I really believe that we are at just the tip of the iceberg in terms of the CCT story,” he said.
Access to Schlemm’s canal
Two new devices for use in non-penetrating glaucoma procedures may help the surgeon perform delicate manipulations of Schlemm’s canal, according to Thomas W. Samuelson, MD.
Dr. Samuelson said one of the devices, the iStent by Glaukos, helps to lower IOP by shunting aqueous from the anterior chamber directly into Schlemm’s canal.
“I like procedures that provide a direct conduit into Schlemm’s canal,” he said.
The other device, the iScience microcatheter, helps to guide the surgeon while performing combined procedures.
“It not only helps you to access Schlemm’s canal easily, but it helps you to see where you are,” he said. He added that the device allows 360· dilation around the canal.
Both devices are currently under investigation for Food and Drug Administration approval, Dr. Samuelson said.
Bleb survival: ‘Primary goal’
A low bleb profile and low IOP after filtering surgery are complications that must be addressed immediately by the surgeon to assure a good result, said Eydie Miller-Ellis, MD.
In glaucoma filtering surgery, “bleb survival is our primary goal,” she said.
She advised surgeons always to treat low bleb profile and low IOP aggressively, “to aid visual recovery and to preserve bleb function.”
Dr. Miller-Ellis said that in managing low IOP after filtration, antimetabolites should be used cautiously, and the patient’s medications should be reviewed carefully. She said inflammatory responses should be evaluated and treated promptly, and the surgeon should always check for conjunctival leaks.
Bleb leaks offer clues
Bleb leaks are “the single-most important predictive factor for blebitis and endophthalmitis,” according to Gregg Heatley, MD. Therefore, he said, surgeons must tell patients to call the practice if they notice any symptoms of bleb leakage.
“This will help you to protect your patients from the ultimate demise,” Dr. Heatley said. “Earlier treatment is always better.”
Dr. Heatley advised that fluoroquinolones should be administered preoperatively, but he warned that prophylactic antibiotics “may not prophylax.”
He said aggressive surgical treatment may be indicated in patients with blebitis.
Drugs and angle closure
Cold relief medications or sulfa drugs can be the cause of acute angle closure in patients who do not have typical risk factors for the condition, according to Ronald L. Gross, MD.
“Don’t be surprised if someone comes in with bilateral acute angle closure who doesn’t make sense. They are young. They are not hyperopic,” Dr. Gross said.
“The treatment is to stop the drug, and in fact [pupil] dilation will be of more benefit to the patient than constriction,” he said.
Use of topimirate for the treatment of headaches and migraines has increased, Dr. Gross said. Topimirate is a risk factor for acute angle closure because it is sulfa drug, and “all sulfa drugs have the potential to precipitate acute angle closure,” he said.
Other precipitating factors for acute angle closure include dim illumination and the use of anticholinergics, adrenergics and pseudoephedrine, he added.
Hypotony, flat chamber
Hypotony associated with a flat chamber after filtration surgery should be treated “in a timely manner,” according to Marlene R. Moster, MD.
“Try conservative treatment first,” Dr. Moster said. She advised physicians to move on to surgical intervention if necessary.
She spoke about what might cause hypotony after filtering surgery and how to avoid overfiltration.
“Why are we getting too much of a good thing?” she asked rhetorically.
Hypotony could be caused by cutting flap sutures too early with a laser, by removing sutures too early, by not tying the flap down tightly enough or because of a snapped suture, she said.