Education Committee Highlights WGC-2019 – part 16

The Education Committee carefully selects presentations from the WGC-2019 for your benefit. This month Harsha Rao introduces the sessions: 1) European Glaucoma Society – Towards a consistent definition of glaucoma and care outcome measures; 2) Perfect your glaucoma clinical exam; and 3) Tubes: varied techniques.

European Glaucoma Society – Towards a consistent definition of glaucoma and care outcome measures

Dr. Ted Garway Heath began this interesting EGS symposium by summarizing the design and output from a meeting in 2017 that aimed to arrive at a consistent definition of glaucoma. Follow-up of the meeting also included questionnaires to determine the diagnostic criteria for glaucoma that most clinicians agreed upon. He also described the other major aim of the meeting which was to list the outcome measures that can be used to evaluate if the treatment for glaucoma does any good to the patients. He described these measures as direct and intermediate outcome measures, and discussed them separately from the patient, societal and clinician domains.

Dr. Anja Tuulonen gave a brief overview of eye care systems in Finland. She enumerated the modifications done to the standard eye care protocols and the economic impact of these modifications in her University. She concluded by emphasizing the need for System Impact Research (SIR) in eye care and a larger collaboration across the world towards this goal.

Dr. Ted Garway Heath ended the symposium by speaking on an initiative from EGS to put in place a mechanism to collect the outcome measures to look at the effectiveness and safety of glaucoma surgeries. He described that the idea of this initiative was to capture the real-world outcomes of glaucoma surgeries unlike that captured in clinical trials which can be biased as the patients in a clinical trial are selected in a particular way.

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Perfect your glaucoma clinical exam

Dr. Hon-Tym Wong started the course by speaking on perfecting the angle assessment. He described the diagnostic and therapeutic indications of gonioscopy. He also described in detail the technique of gonioscopy and the angle structures seen on gonioscopy. He also elaborated on the technique of indentation gonioscopy and differentiating appositional from synechiae angle closure.

Dr. Elena Bitrian spoke on perfecting the clinical assessment of pediatric patients. She spoke about the importance of history and external examination. She also described the clinical features and ocular measurements that have to be noted on examination both in the clinic and under anesthesia. She also spoke on documenting the clinical features using photographs and monitoring these children after surgery clinically, and also with visual fields and OCT examinations.

Dr. Andrew White spoke on looking beyond the eye in glaucoma. He spoke on systemic considerations in glaucoma; systemic drugs causing glaucoma and systemic disease associated with glaucoma. He also discussed the effect of general health (cardiovascular disease, diet, sleep apnea, irritable bowel syndrome, etc) on glaucoma and its progression.

Dr. Carroll Webers described the ways to perfect the IOP assessment. He spoke on the preferred tonometer in ‘normal’ and ‘special’ (like in children, corneal pathologies) situations. He also discussed the effect of corneal thickness on IOP measurement, and the importance of evaluating IOP fluctuations (short and long term) in the management of glaucoma.

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Tubes: Varied techniques

Dr. Henny Beckers spoke on the differences between a valved and a non-valved drainage device. In her talk, she focussed primarily on the Baerveldt and Ahmed device. She enumerated the differences in the design of both these devices and also discussed the results of the studies comparing the outcomes of Baerveldt and Ahmed devices.

Dr. Srinivasan Kavitha spoke on a cost effective alternative to the most commonly used drainage devices, the Aurolab Aqueous Drainage Implant (AADI). She described this non-valved device and its manufacturing in detail and also described the reasons for the reduced manufacturing cost of this device compared to the most commonly used non-valved device, i.e., the Baerveldt device. She also explained in detail the surgical procedure of implanting this device, indications for its use and discussed its surgical outcomes as reported by clinical studies.

Dr. Jaewan Choi discussed the tube location and sealing methods. He discussed the various locations of tube insertion and the importance of tube location to prevent endothelial decompensation after the surgery. He discussed in detail the possible reasons for endothelial decompensation and the ways to prevent this complication. He then spoke on the importance of preventing aqueous leak after drainage device surgery and the different sealing methods to avoid the leak.

Dr. Luis Pinto discussed the methods of early IOP control after the drainage devices. He discussed methods to avoid early postoperative hypotony in cases with non-valved and valved devices. He also discussed methods to address early postoperative high IOP.

The final speaker of this course, Dr. Jesus Roman spoke on the complication of conjunctival erosion and tube exposure. He discussed the techniques to prevent this complication with special emphasis on the scleral tunnel technique of burying the tube. He also compared the cost difference and success outcomes of drainage device with tube buried in the scleral tunnel versus tube covered with patch materials.

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