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Top-Ten of the Canadian Glaucoma Society and Canadian Ophthalmological Society meeting
June 16-17, 2013, Montreal, Canada
Hady Saheb and Cindy M.L. Hutnik
- OCT progression. Several key pearls help guide clinical OCT use to help determine if glaucoma has progressed. The first is to ensure adequate quality of the scan, including not only a good signal to noise ration (SNR > 6/10), but also reviewing the image itself to ensure no movement artefacts or different acquisition parameters are present, and that quality has been maintained throughout. The second is to obtain an adequate number of scans in order to detect the rate of progression earlier. The third is to compare the trend and event based analyses. Most importantly, remember to change your baseline exams after important clinical changes have taken place, e.g., large changes in IOP. (Paul Harasymowycz, Montreal, Canada)
- Uveitic glaucoma. The spectrum of anti-inflammatory medication options was reviewed, with an emphasis on minimizing steroid exposure and response without compromising inflammation control. Hypotensive medication options were discussed, including prostaglandin analogues, which are considered second- or thirdline agents given their possible pro-inflammatory effects in this group of patients. Peri-operative inflammation control is critical to surgical success and prevention of typical complications in these patients such as hypotony, choroidal effusions and reactivation of uveitis. (Mark Lesk, Gisele Li, Paul Harasymowycz, Ike Ahmed, Montreal, Canada)
- Lens vault and angle closure. Lens vault is a new concept in angle closure imaging. Lens vault represents the distance between the anterior lens capsule and a horizontal line connecting both scleral spurs on an anterior segment OCT. The mechanisms of angle closure after resolution of pupil block were reviewed, and the role of lens vault in these cases was described. A visually significant cataract is not required to have lens-related angle closure or lens vault, and progressive lens vault can lead to progressive angle closure over time. (Hady Saheb)
- Therapeutic options for angle closure. The randomized controlled trials comparing trabeculectomy to lens-based surgery in angle closure glaucoma were reviewed, showing similar efficacy and lower complication rates in the lens-based surgery groups. (Devesh Varma)
- Ex-PRESS Shunt. Prospective randomized control study with 33 subjects randomized to Ex-PRESS and 31 to trabeculectomy. After one year follow-up no difference was found between the groups in terms of success, mean intraocular pressure, number of glaucoma medications, complications, corneal health or surgical time. Although there was no difference in mean logMAR visual acuity between the groups, subjects in the Ex-PRESS group did recover vision faster than the trabeculectomy group. An economic analysis of the first 43 subjects completing one year found that the Ex-PRESS group cost significantly more than trabeculectomy. (Yvonne M. Buys, Toronto, Canada)
- iStent vs trabecome. This retrospective study compared the results of combined phacoemulsification with two iStents versus trabectome surgery. They showed significant reduction in IOP and medication use in both groups, with an excellent safety profile. The iStent group showed a significantly lower use of medications and a lower incidence of postoperative hyphema. (Michelle Khan)
- Cost analysis of MIGS. The direct cost of the Trabectome, iStent, and ECP versus glaucoma medications within the Ontario Health Insurance Plan (OHIP) over a projected six-year period was examined. Over six years, on a per-patient basis, the Trabectome yielded a $ 279.23 cost savings over topical monotherapy, ECP offered a $ 779.23 savings, while iStent was $ 20.77 more expensive. (Yiannis Iordanous)
- Glaucoma medications and erectile dysfunction (COS Award
of Excellence third place winner).
In a large nested case-control series of men in a Canadian healthcare database, glaucoma was found to be correlated with erectile dysfunction (ED), possibly due to common vascular pathways in both conditions. Topical beta-blockers, however, were not found to be causative of ED; this is consistent with recent literature and a meta-analysis published by the American Heart Association which did not find any correlation between oral beta-blockers and ED. (Nawaaz A. Nathoo) - Power settings for SLT and ALT. This meta-analysis combined data from all prospective studies evaluating the IOP reduction at 12 months after treatment with SLT or ALT. A meta-regression was conducted to assess for an association between the IOP reduction with variations in the treatment protocols described. It was found that for SLT, there was a significant association of average energy per shot with the IOP reduction. For ALT, there was a significant association of minimum energy level reported, number of spots, and degrees treated with the IOP reduction. As these various parameters were increased (energy level, number of spots, degrees treated), there was an improved effect, however the ideal level remains to be determined. (Sourabh Arora)
- Hydrus Schlemm Canal micro-stent. This study reported the one year outcome of 29 eyes that underwent combined phacoemulsification and implantation of Hydrus Schlemm Canal micro-stent and scaffold in patient with cataract and mild to moderate open angle glaucoma. The authors showed a trend for IOP reduction at one year and a significant reduction in medication use, with 80% of patients being medication-free at one year. (Hady Saheb)
