EyeWorld India December 2013 Issue

22 EWAP CAtArACt/IOL December 2013 prescribed one or more ocular hypotensive medications daily to manage their disease. Significant increases in noncompliance, cumulative side effects, and out-of-pocket costs, as well as decreased quality of life, are strongly correlated with the increasing number of medications patients are prescribed. 9 For patients with combined cataract and glaucoma conditions, the iStent can significantly decrease medication use, thereby reducing the overall healthcare costs and time associated with traditional glaucoma management. 10 The iStent expands the treatment options that ophthalmologists can offer to their patients with combined cataract and glaucoma to improve clinical outcomes. EWAP references 1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol . 2006;90:262-267. 2. Centers for Medicare and Medicaid Services. 2002-2007 Medicare Standard Analytical File. Baltimore, MD: Centers for Medicare and Medicaid Services, US Dept of Health and Human Services; 2007. 3. Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol . 2005;140:598-606. 4. The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol . 2000;130:429-440. 5. Noecker RJ, Herrygers LA, Anwaruddin R. Corneal and conjunctival changes caused by commonly used glaucoma medications. Cornea . 2004;23:490- 496. 6. Samuelson TW. Prospective randomized trial of cataract surgery with iStent implantation and cataract surgery alone in mild-moderate open-angle glaucoma. Paper presented at: American Academy of Ophthalmology Annual Meeting; October 2009; San Francisco, CA. 7. Shingleton B, Tetz M, Krober N. Circumferential viscodilation and tensioning of Schlemm canal with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: One year results. J Cataract Refract Surg . 2008;34:433-440. 8. Fea AM. Phacoemulsification versus phacoemulsification with micro- bypass stent implantation in primary open-angle glaucoma. J Cataract Refract Surg . 2010;36:407-412. 9. McKinnon SJ, Goldberg LD, Peeples P, Walt JG, Bramley TJ. Current management of glaucoma and the need for complete therapy. Am J Manag Care . 2008;14:S20-27. 10. Cantor LB, Katz LJ, Cheng JW, Chen E, Tong KB, Peabody JW. Economic evaluation of medication, laser trabeculoplasty and filtering surgeries in treating patients with glaucoma in the US. Curr Med Res Opin . 2008;24:2905-2918. Editors’ note: Dr. Solomon has financial interests with Glaukos (Laguna Hills, Calif., USA). Contact information Solomon: Kerry.Solomon@carolinaeyecare.com The comprehensive - from page 20 accompanying blurred vision. To avoid these perils, mild to moderate patients are frequently prescribed ocular hypertensive medications to control glaucoma. This eliminates the risks of surgery, but brings with it a different set of complications. Compliance is a dominant issue with glaucoma eye drop medication. More than 90% of patients do not adhere to their ocular medication dosing regimens, and nearly 50% discontinue taking their medications before six months. 3 Non-adherence can result in large fluctuations in IOP, which are associated with a risk of vision loss that is higher than the risk associated with nonintervention. 3 , 4 For those patients who do administer their medications as indicated, long-term, compounded exposure to the preservatives found in many eye drop medications can cause corneal surface damage, 5 decreasing the success of subsequent surgical procedures, among other problems. There is a new space being created by novel technologies that will provide the comprehensive ophthalmologist a surgical means to reduce a patient’s dependence on glaucoma medications. One such example is the iStent (Glaukos, Laguna Hills, Calif., USA). The 1-mm long iStent is inserted into Schlemm’s canal and facilitates aqueous outflow through the trabecular meshwork. While it may be inserted in a standalone procedure, the iStent is most commonly inserted ab interno through the phaco incision and can be performed under topical anesthesia. Placement of the iStent is a microinvasive and astigmatically neutral procedure that works synergistically with cataract surgery. In clinical studies, 73% of patients who received the iStent remained medication free while sustaining target IOPs of ≤ 21 mm Hg versus only 50% of those who underwent cataract surgery alone, 6 and the mean reduction in IOP was 8.4 mmHg. 7 In addition, one year postoperatively 67% of patients who received the iStent remained medication free. 8 The postoperative recovery is virtually identical to cataract surgery alone, with studies showing no additional complications compared to cataract surgery alone. 6 The iStent achieves sustained target pressures while significantly reducing or eliminating the drug burden, with virtually no downside. There is no postoperative hypotony, fluctuating vision or shallowing anterior chamber, and the iStent in no way eliminates surgical options for the future, should a patient need further procedures. The continuous expansion of comprehensive cataract surgery can serve the patient, the practice, and the healthcare system. Most patients with glaucoma are