RHOS: The Orbiter
"We Circle the Globe!"
Volume 4 Issue 2
Greetings RHOS members!!
Welcome to the most recent edition of our newsletter! Just as time has sprung forward so too have we moved in a new fresh direction with our communications. The Orbiter was once a paper newsletter that was mailed out to our members, allowing them to RSVP to CE via fax. In an effort to be green and cost efficient, we explored a new means of reaching out to our members with the help of Microsoft Publisher. Publisher was great and kept true to the essence of what a traditional newsletter was like but it also came with limitations. Now, we move to a new digital platform with a newsletter that provides quicker access and allows our members to read this without having to open a document. So if this doesn't display well on your browser, phone, or tablet, that's really too bad... just kidding. We appreciate your patience as we make this transition and welcome any feedback you may have as we "spring forward." A few more announcements...
I really hope you are taking advantage of the great CE we have to offer! Last month was a change of scenery for our members as we had to travel down the 5 freeway to Buena Park while our usual spot in La Mirada gets a makeover. Dr. Gaur, a glaucoma specialist, educated us on glaucoma surgeries and complications. She was kind enough to write a small article exclusively for The Orbiter so keep reading below!
For any NEW members reading this, welcome to YOUR society! We hope you join us at our next meeting and get to meet your fellow colleagues! I am really proud to be a part of this group and I always look forward to our general meetings. They are a great opportunity to catch up with one another, share information, and enjoy great food and CE!
Finally... if there are any Rio Hondo members who would like to attend legislative day to support and represent the profession, RHOS will generously reimburse your travel! Please contact me if you are interested in participating. You will also find a link below to register.
Thanks for reading and enjoy!
Fabian Corona, MS, OD
South Whittier School District Students Receive Free Vision Screening
For our society project, RHOS partnered with Charity Vision, VSP, and the Essilor Vision Foundation to perform vision screenings, free eye exams, and glasses to the students in the South Whittier School District. We were able to screen 1,504 students and perform 267 exams at the school sites and provide 185 students with free glasses! -Dr. John Larcabal
An Eye Opening Trip
This was my first time attending the House of Delegates. I was a little nervous since I didn't really know what to expect, but the thought of a few days in San Diego was appealing. I'm glad I went because it was an eye opening experience into how we can help shape our profession's future.
I got to see some former clinical instructors and classmates, some doctors whose names I've only read in optometric journals and articles, and some doctors who graduated a few years after me. It was inspiring to see how optometrists from all modes of practice in California gather in one place to share their invaluable experiences and opinions. I think every member of our society should experience HOD at least once!
-Dr. Jane Lo
RHOS March CE
This month's CE is titled "Saving Generations of Future Myopic Eye Disease" by Dr. Justin Kwan. Dr. Kwan is the chief of contact lens services at MBKU. Click here to RSVP Free for RHOS Members!
$45 for non-RHOS members
MIGS: Expanding Options for Glaucoma Treatment
by Dr. Avneet Sodhi Gaur
Director of Glaucoma Service & Cataract Surgeon, Assil Eye Institute
Since the advent of micro-invasive glaucoma surgeries (MIGS), the field of ophthalmology has grown rapidly. There are several reasons for the growing interest: better compliance due to reduction of medications, improved quality of life, less medication burden, and lower monthly costs of medications. The earlier MIGS are implemented in disease management, the less we need to rely on medications and the happier patients ultimately are.
A number of MIGS studies have shown favorable safety profiles but modest efficacy. The modest results of IOP reduction in earlier trials of MIGS, particularly iStent, was that investigators had minimal experience with the device and knowledge of its best placement to maximize its efficacy. Overall MIGS were initially designed for its high safety profile and over time the efficacy has been honed upon by focusing on the design, placement, and identification of ideal candidates – those patients on 1 to 3 glaucoma drops with IOP in the mid-teens range and classified as having mild to moderate POAG who are undergoing cataract extraction. There are some MIGS that can be done as a stand-alone procedure such as Viscocanaloplasty, Goniotomy assisted transluminal trabeculotomy (GATT), endocyclophotocoagulation (ECP), and XEN 45 Gel Stent to name a few.
These procedures share 3 key characteristics:
1. ab interno microincision through a clear corneal approach with minimal trauma
2. Favorable safety profile, avoiding the serious complications with filtering surgeries
3. Rapid post-operative recovery similar to cataract surgery alone.
The iStent was the first MIGS device approved by the FDA in July 2012 and since then, a number of MIGS procedures have become available. The simplest way to differentiate the MIGS procedures is to understand which areas are targeted. Majority target the outflow pathways – iStent, Hydrus, Cypass, XEN 45 Gel Stent, Trabectome, Kahook Dual Blade, GATT (Goniscopy-assisted transluminal trabeculotomy), Ab interno canaloplasty (ABiC). One mainly focuses on the production pathway – ECP (Endocyclophotocoagulation). Knowing what ophthalmologists are offering and performing on patients allows for improved patient management and care.
MIGS Targeting Outflow:
1. The iStent (Glaukos) was FDA approved in 2012 and is a 1 mm titanium implanted stent inserted in the trabecular meshwork allowing increased flow through the juxtacanalicular system into the Schlemm’s canal. Glaukos recently received approval for the iStent Inject that deploys 2 stents in the angle to target more collector channels.
2. Hydrus Microstent (Ivantis) is not approved in the US yet but worth mentioning as the company has submitted a final premarket approval to the FDA in the hopes of FDA approval in 2018. It is an 8-mm biocompatible alloy device called “nitinol”, made of two components, nickel and titanium, inserted into the Schlemm’s canal, and due to its increased length – targets more collector canals.
3. Cypass Microstent (Alcon) was FDA approved in 2012 and is implanted in the supraciliary space allowing suprachoriodal aqueous outflow.
4. Trabectome (NeoMedix) was FDA approved in 2004. Electrocautery, irrigation, and aspiration are used to selectively ablate the trabecular meshwork and the inner wall of Schlemm’s canal to allow aqueous free, access to the canal and its collector channels.
5. Kahook Dual Blade (New World Medical) is a relative inexpensive single use disposable hand piece that employs two parallel blades to remove a strip of TM to improve outflow without the need for expensive electrocautery or irrigation/aspiration system.
6. Gonioscopy-assisted transluminal trabeculotomy (GAT) is a minimally invasive ab interno circumferential trabeculotomy that is performed through two 1.0mm corneal incisions and employs either a microcatheter or 5-0 Prolene suture. After cannulation of the Schlemm’s canal, the entire trabecular meshwork is unroofed. The major advantage is the entire drainage system is accessed, rather than just a small portion.
7. Ab Interno canaloplasty (ABiC) is a procedure that does 360 degrees viscodilation of the Schlemm’s canal using either the iTrack microcatheter or VISCO360 handpiece and viscoelastive material.
8. XEN 45 Gel Stent (Allergen) was FDA approved in 2016 and was termed “MIGS – plus” as it offers more aggressive IOP lowering and is approved for use as either a stand alone or in conjunction with cataract surgery. It is a soft, collagen-derived gel device that creates a new pathway for aqueous flow from the anterior chamber into an ab interno bleb in the subconjunctival space.
MIGS Targeting Aqueous Production
1. Endoscopic cyclophotocoagulation (ECP) is an endoscopic probe inserted either through a corneal incision or pars plana incision to ablate a selected portion of the ciliary epithelium under direct endoscopic visualization.
Overall I have found micro-invasive procedures to be very effective in meeting my patients’ needs. In those requiring further reduction in IOP, when appropriate, I initially try a MIGS procedure or a combination of MIGS procedures before considering filtering procedures due to better recovery and reduced trauma to the eye. They spare conjunctival tissues from incisions and scarring allowing better outcomes if traditional glaucoma surgery is required in the future. The overall beauty with MIGS is we can individually choose procedures for each patient without compromising safety or patients’ post-operative recovery.
Anyone who is need of ophthalmic instruments or supplies should contact
Dr. Jim Cohen who is closing one of his offices. Act now before it’s too late!
For term of four to six months leading to possible partnership in group practice
For practice information please visit - www.beachvisioncenter.org
Prestigious / Professional Practice / Up Scale Facility / Great Area / Community
Large outstanding facility noted for one of the most attractive offices in the Southern California Area. Managed by full staff. Two current optometrists
Applicants apply to
Beach Vision Center
Los Alamitos, California
Call for interview 562-431-1301
Fax resume to 562-594-0624