video transcript
Emily Kaiser:
Hey, guys. I’m Emily Kaiser from Optometry Times. Dr. Xiongfei, who is giving a talk titled “Effectiveness and Safety of Combination of Her Two Her MIGS Devices in Patients with Open-Angle Glaucoma” at ASCRS 2023 in San Francisco. I’m sitting with Liu. Diego, California. Welcome Dr. Liu. Thank you for your time.
Xiongfei Liu, MD:
Emily, thank you for inviting me here. And I would like to share some of the insights I gained from this research with everyone here.
Kaiser:
wonderful. So, could you tell us a little bit about the abstract you’re presenting?
Liu:
yes. Therefore, traditionally, the iStent inject W has been used in conjunction with cataract surgery to effectively control intraocular pressure and maintain a favorable safety profile. Last year, Glaukos introduced a new minimally invasive glaucoma device called the iAccess Precision Blade. This allows a modern surgeon to perform a goniotomy on her 200-micron size. Due to their very small size, they are called microgoniotomy. And the purpose of a goniotomy is to strip the trabecular meshwork from the eye, allowing more fluid to flow out of the eye and lower intraocular pressure.
With iAccess, the trabecular meshwork can be preserved as it is a small goniotomy. I would like to combine it with other minimally invasive glaucoma surgery with additional trabecular meshwork. Therefore, we are combining both iStent injection and iAccess to evaluate the safety and efficacy of patients undergoing cataract surgery.
We therefore conducted a retrospective, maskless, single-center, two-surgeon study of 31 eyes with open-angle glaucoma, all receiving cataract iStent and iAccess. And most of these patients have mild to moderate glaucoma, of which two of his eyes have severe glaucoma.
The results we found were preoperative, their pressure was 18.5, but they were taking 1.7 and 2.8 medications. One month after the operation, the intraocular pressure was 14.6, and three months after the operation, the intraocular pressure was 16. As such, their dosage has been significantly reduced.
And in terms of overall safety profile, it’s pretty safe, just like regular cataract surgery.
Kaiser:
So what does that mean for optometrists?
Liu:
Great question, Emily. So in our practice, we do a lot of work with her OD locally and collaborate through collaborations to provide next level care for our patients. So what we usually say is that we work primarily through referrals, right? .
So, in my referrals, I always tell them to look out for two types of patients. Based on this study, we find that patients of the first type are easy to identify. Their intraocular pressure is borderline uncontrolled and they are taking maximally tolerated eye medications. That is, there are 3, 4 medicines with a pressure of 18, pressures of 20, 22, 26, and so on. But they have advanced glaucoma. So these patients can easily be sent for minimally invasive glaucoma surgery. An earlier landmark study found that for every 1 point reduction in intraocular pressure, there was a 10% reduction in intraocular pressure. Glaucoma progression. Therefore, from a glaucoma perspective, it is definitely beneficial for patients.
Another group of patients is less likely to identify you if you don’t pay attention to them. But their blood pressure is probably 16, 15, or 17. They are well controlled but two or he is on three different medications. Our research shows that postoperative use of iStent/iAccess can reduce intraocular pressure to the same level. Their eye drops are significantly less.
And it’s such a great experience. Because I ask my patients. A really great experience for them. They say, “Oh, Dr. Liu, I don’t have to set a time to put my eye drops in and I can focus on my work.” Or, “If I forget to take my eye drops, I don’t feel too guilty because I really only need one drop.” As you can see, depending on which study you look at, 50-70% of patients forget their medications and are therefore not adhering to their medications.
Also, in other categories of drugs, the 3rd and 4th lines can be prohibitively expensive for patients. And if you can remove the two drops, it will be much cheaper for them if they are only in the first line of treatment. I am also satisfied.
Finally, 24-hour intraocular pressure trends have never been better controlled for eye drops than during surgery.Pressure is a little more controlled with a 24/7 hour cycle [following surgery].
Therefore, with all these benefits, attention should be paid to these two categories of patients. Also, as you can see from the safety of this procedure, it is very safe. Similar to cataract surgery. In his first week after surgery, he may have a few more microhematomas, but they all resolved on their own.For Optometrists, or Eye Care Providers Who Love Managing These Minimally Invasive Glaucoma Surgeries [patients] Postoperatively, it is not difficult to manage. It’s super easy, stress free and we all love it. A stress-free day.
Kaiser:
Thank you for taking the time to chat with us today. I look forward to meeting again.