GLAUCOMA 50 EWAP JUNE 2023 do.” Jullia Rosdahl, MD, PhD, also spoke about how personalized visual aid recommendations need to be. She stressed early referrals to vision rehabilitation services. Dr. Rosdahl offered a few simple helpful elements for patients depending on their stage of vision. For patients at an earlier stage of vision loss, she said it’s helpful for glasses prescriptions to be kept up to date, with lined bifocals or separate single-vision glasses being used instead of progressive lenses. Tints can be used to reduce glare and improve contrast, and attention should be paid to ocular surface optimization. Dr. Rosdahl said task lighting at this stage can be useful. For patients with more advanced vision loss, especially if the vision loss is in the inferior visual fields where falls could be more of an issue, Dr. Rosdahl said a walking stick might be needed, and it’s important for the physician to review strategies for the patient to move their head and neck instead of just their eyes when walking around. Dr. Rosdahl, Dr. Kaleem, and Mr. Mohiuddin mentioned the resources on Hadley.edu, which is a website with learning opportunities for patients dealing with vision loss or blindness. Topics on the website cover daily living, technology, adjusting to vision loss, working, and more. EWAP Reference 1. Deemer AD, et al. Approaching rehabilitation in patients with advanced glaucoma. Eye. 2022. Online ahead of print. Editors’ note: Dr. Kaleem is Associate Professor of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland. Mr. Mohiuddin is an Occupational Therapist at Duke Eye Center, Duke University, Durham, North Carolina. Dr. Rosdahl is Associate Professor of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina. None declared any relevant financial interests. Lens options - from page 43 after surgery.’” Commonly, if the IOP is very high, Dr. Sarkisian avoids cataract surgery and addresses the IOP alone, waiting to perform cataract surgery under more controlled circumstances. “When I speak with my patients about trabecular micro-bypass, I counsel them that it does not have further side effects than cataract surgery alone, other than the slightly increased risk of hyphema,” Dr. Sarkisian said. “In the more extensive canal-based procedures, I always have a conversation about hyphema that may cause delayed visual recovery but say that it is not necessarily a complication but rather a good prognostic sign.” With the cataract talk, if patients have full visual fields and glaucoma, Dr. Sarkisian’s IOL conversation is the same as it would be with any patient. “I strongly encourage bilateral implan-tation of the PanOptix IOL in those patients,” he said. “Moreover, just like in my non-glauco-matous patients, if patients are concerned with nighttime glare and starbursts, I would direct them to the Vivity IOL.” He added that in glaucoma patients with visual field loss but good central vision and whose IOP is controlled to borderline, he recommends fixing their astigmatism and usually also the placement of the Vivity IOL. In Dr. Sarkisian’s experience, there is no clinically significant reduction in functional contrast with the Vivity IOL compared to a standard monofocal IOL. “IOL technology and MIGS have evolved simultaneously, as has our thinking regarding the use of premium lenses in patients with glaucoma. We owe it to our patients to always offer the best technology available,” Dr. Sarkisian said. “We should not let our patients’ glaucoma hold us back from presenting an appropriate spectrum of premium IOL technology.” EWAP Editors’ note: Dr. Ristvedt practices at Vance Thompson Vision, Alexandria, Minnesota, and has interests with Allergan and Glaukos. Dr. Sarkisian is in practice with Oklahoma Eye Surgeons, Oklahoma City, Oklahoma, and has interests with Aerie, Alcon, Allergan, Allysta Pharmaceuti-cals, Bausch + Lomb, Beaver- Visitec International, Elios, Glaukos, iCare, iSTAR Medical, Karena Products, MST, Ocular Science, Ocular Therapeutix, Santen, Sight Sciences.
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