EyeWorld India December 2017 Issue

September 2017 3 EWAP EDITORIAL Dec Cataract+ “ Historically, glaucoma surgery was practiced widely by anterior segment surgeons...It is interesting to speculate that with the advent of new MIGS devices the paradigm will again change and I suspect that glaucoma surgery will once again become widely practiced by cataract and anterior segment surgeons and not limited to the glaucoma subspecialty. ” –Graham Barrett, MD T he treatment of glaucoma poses a major challenge for patients and ophthalmologists alike. Although the underlying pathogenesis is a neuropathy and there are several factors contributing to ongoing field loss, manipulating the intraocular pressure (IOP) remains the mainstay of treatment of the disease process. New pharmacological agents, particularly prostaglandin agonists, have transformed the medical treatment of glaucoma and the majority of patients can be controlled with a daily dose of a single agent or combination treatment. Successful management of the disease, however, requires ongoing treatment over several decades with continued observation to ensure the medical regime is adequate. Laser trabeculoplasty has a modest effect, which may not be long- lasting, and surgical options, particularly trabeculectomy or tubes, have been the most effective surgical procedures to control IOP when medical treatment is inadequate. The dawn of a new age of microinvasive glaucoma surgery (MIGS) in the last decade has opened a new avenue for safer surgical treatments. MIGS devices such as the iStent have been used in a complementary fashion combined with cataract surgery to improve control and possibly reduce the number of medications required after cataract surgery. Newer MIGS devices, however, appear to be more effective. In addition to the trabecular micro-stents, alternative routes of drainage such as the suprachoroidal space with the CyPass device are becoming available. In addition, the XEN device is a new alternative to true subconjunctival drainage, with reduced risks compared to conventional trabeculectomy. As we gain more experience, the clinical situations which are best suited to individual devices will become apparent as discussed in this issue of EyeWorld Asia-Pacific . Historically, glaucoma surgery was practiced quite widely by anterior segment surgeons and early on in my career I often performed either trabeculectomy or combined phaco/trabeculectomy. As the efficacy of medical treatment improved, the frequency of glaucoma surgery declined and these procedures largely became the preserve of glaucoma specialists. It is interesting to speculate that with the advent of new MIGS devices the paradigm will change again and I suspect that glaucoma surgery will once again become widely practiced by cataract and anterior segment surgeons and not limited to the glaucoma subspecialty. EWAP I t gives me great satisfaction to present the new issue of the scientifically enriched EyeWorld Asia-Pacific to you. Our December 2017 issue contains articles on the latest trends in cataract and corneal surgeries. An overview of the pre- and postoperative precautions to be taken in a diabetic patient undergoing cataract surgery has been included. Multifocal IOLs, however tempting, may not be a good choice for them as they reduce contrast sensitivity. Cataract with glaucoma is a common scenario in our OPDs. Here we have highlighted the fact that phaco with MIGS offers better visual recovery and IOP control, although at the same time trabeculectomy still holds an important place in glaucoma treatment. Our next focus is the importance of optimal corneal health before cataract surgery. Dry eye, lid margin disease and endothelial dysfunction are commonly seen in the cataract age group, and their parallel management has been described. A dementia patient may not be easy to handle, and it is here that the ophthalmologist needs to take certain special but simple precautions, to make the surgery smooth for both. Ensuring a reliable caregiver, using less anesthesia and a simple postop regimen are the keys. Corneal crosslinking is discussed at length, with experts opining on what is best for the patient—epi on or epi off. This issue also discuss the recent trend of combining customized crosslinking (targeted to the area of maximal corneal weakness) with LASIK for refractive errors. This issue also addresses another nightmare for the cataract surgeon— small pupil, along with its management with the latest pupil expanders and mydriatics. This issue also includes an update on accommodating and toric IOLs in the pipeline. We end this issue with an enlightening article on the newest anti-glaucoma medications. In summary, this issue of EyeWorld Asia-Pacific is filled with the latest advances in the world of ophthalmology. Looking forward to your valuable feedback. I would like to conclude with a quote from chapter 95 of the Tirukkural : An erudite doctor offers healing remedy after heeding The patient’s nature, the disease’s nature and the time of year. The habitudes of patient and disease, the crises of the ill These must the learned leech think over well, then use his skill. EWAP S. Natarajan, MD Regional Managing Editor EyeWorld Asia-Paci c Graham Barrett Chief Medical Editorial EyeWorld Asia-Paci c EDITORIAL Cataract + [photo] S. Natarajan, MD Regional Managing Director EyeWorld Asia-Pacific It gives me great satisfaction to present the new issue of the scientifica to you. Our December 2017 issue contains articles on he l est trends i An overview of the pre- and postoperative precautions to be taken cataract surgery has been included. Multifocal IOLs, however tempti them as they reduce contrast sensitivity. Cataract with glaucoma is a common scenario in our OPDs. Here we h with MIGS offers better visual recovery and IOP control, although at t holds an important place in glaucoma treatment. Our next focus is the importance of optimal corneal health before cat disease and endothelial dysfunction are commonly seen in the cata management has b en describ d. A dementia patient may not be easy to handle, and it is here that t certain special but simple precautions, to make the surgery smooth for using less anesthesia and a simple postop regimen are the keys. orneal crosslinking is discussed at length, with experts opining on wh epi off. This issue also discuss the recent trend of combining customize of maximal corneal weakness) with LASIK for refractive errors. is i sue also addresses a ot er nightmare fo the cataract sur management with the latest pupil expanders and mydriatics. is sue also includes an update on acc mmod ting and toric IOLs with an enlightening article on the newest anti-glaucoma medications. In summary, this issue of EyeWorld Asia-Pacific is filled with the ophthalmology. Looking forward to your valuable feedback. I would like to conclude with a quote from chapter 95 of the Tirukkural : urrān aLavum piNiyaLavum kālamum karrān karutic ceyal