September 2019

GLAUCOMA

Best of ASCRS 2019: Glaucoma


by Liz Hillman EyeWorld Senior Staff Writer


Dr. Sheybani shares
his choices for the best
papers in the Glaucoma
category.
Source: ASCRS

 

The Best of ASCRS 2019 is a general session at the ASCRS ASOA Annual Meeting where members of the EyeWorld Editorial Board select what they think were the best papers in different categories from the meeting. They chose from the papers that were awarded Best Paper of Session in each individual paper session throughout the meeting and explain why they made their selections.
Here we recap the selected papers in the Glaucoma category and why Arsham Sheybani, MD, a member of the EyeWorld Glaucoma Editorial Board, thought they were noteworthy. “I wanted to look at how we split it up between some of these treatment paradigms, and I want to start with the least invasive then go most invasive in terms of these papers,” Dr. Sheybani said, introducing his first topic.

Intraocular pressure response to negative pressure applied to the anterior periocular icroenvironment

Russel Swan, MD, John Berdahl, MD, Ike Ahmed, MD, Richard Lindstrom, MD, Nathan Radcliffe, MD, Vance Thompson, MD, and Michael Greenwood, MD

Dr. Sheybani described this paper as taking a “different approach to how we lower intraocular pressure.” The study looked at the effect of ocular goggles (Balance Goggles, Equinox) that lower intraocular pressure by decreasing the atmospheric pressure around the eye. Pressure was measured by use of a pneumotonometer within a minute of removing the goggles and via an excursion port where the pneumotonometer could be used to measure pressure while wearing the goggles. All 51 patients in the study showed pressure lowering through use of the goggles.
“Here’s a novel way to lower pressure that was very low on the invasiveness level,” Dr. Sheybani said. “This was just an hour of treatment, but I think it is paradigm shifting.”

Outcome of two second generation trabecular bypass implants combined with cataract surgery in cases of medically controlled glaucoma

Sebastien Gagne, MD

Dr. Sheybani said this study looked at the iStent inject (Glaukos) in medically controlled glaucoma patients who were having cataract surgery. Dr. Sheybani said this is interesting because most data shows patients with pressures that are out of control at baseline followed by surgical treatment.
The study showed a mean 16.4 mm Hg preoperatively and 15.6 mm Hg postop day 1. While this IOP dip might be modest, Dr. Sheybani said physicians need to pay attention to what medications are doing. Patients in the study used significantly fewer glaucoma medications over a 12-month period (68% reduction in medication at 1 year). Fifty-eight percent of patients were medication free at 1 year.
Overall, Dr. Sheybani said he thinks this study is “more real world than what the typical studies show.” From a quality of life standpoint, IOP has almost no bearing, Dr. Radcliffe, said while medication has a “massive financial, comfort, and general quality of life impact.”

A 2-year pooled analysis of the MicroShunt in patients with
primary open-angle glaucoma

Juan Batlle, MD, Henny Beckers, MD, Isabelle Riss, MD

This research, Dr. Sheybani said, helps get at the questions: Should we be doing trabeculectomies and can devices start slowly replacing this procedure? It included multicenter, prospective, non-randomized single-arm studies that evaluated the InnFocus MicroShunt (Santen Pharmaceutical) in a more advanced glaucoma population than what Dr. Sheybani said is usually seen in MIGS studies.
Dr. Sheybani said that while these devices are not enhancing physiology, they have safety, control, and significant pressure lowering. The study showed a reduction from a mean baseline IOP of 22.4±4.2 mm Hg to 13.8±4.0 mm Hg at 2 years postop. Patients ended up on fewer medications years out as well.

Editors’ note: The session is available on demand at ascrs.org/clinical-education/2019ondemand for those who attended the 2019 ASCRS ASOA
Annual Meeting.


About the doctor

Arsham Sheybani, MD
Assistant professor of ophthalmology and visual sciences
Washington University School of Medicine
St. Louis

Relevant financial interests

Sheybani: Allergan, Glaukos, Katena, Ivantis

Contact information

Sheybani: sheybaniar@wustl.edu

Best of ASCRS 2019: Glaucoma Best of ASCRS 2019: Glaucoma
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