Eyeworld Supplements

SUPPLEMENT TO EYEWORLD DAILY NEWS, MAY 6, 2023 | Supported by Alcon 5 Refer to page 8 for Important Product Information about the Alcon products described in this supplement. continued on page 7 MIGS and cataract surgery: How to define success Lauren Blieden, MD C ataract surgery can increase quality of vision. 1,2 It also is an opportunity for patients with glaucoma to be offered a MIGS procedure. More than 3 million people in the U.S. have been diagnosed with glaucoma, 3 and while cataract surgery can restore blurred or clouded vision, it can also lower IOP. 4 It is also a unique opportunity for additional IOP lowering when the patient is a candidate for a MIGS procedure that might only be approved in combination with cataract surgery. "I think any patient being treat- ed medically for glaucoma deserves to be considered for MIGS at the time of phaco," said Lauren Blieden, MD. Dr. Blieden explained that she'll consider an angle-based procedure to potentially decrease a glaucoma patient's drop bur- den. "I traditionally have always done goniotomy, however, with the presentation of the 5-year HORIZON data at the American Academy of Ophthalmology Annual Meeting in October 2021, I started to include Hydrus Microstent [Alcon] in my algorithm," Dr. Blieden said. "I have found it to have good results." The 5-year HORIZON study, which was published in 2022 as the largest MIGS trial to date, found that 66% of the 369 eyes randomized to receive Hydrus (187 eyes received cataract surgery alone) were medication-free, compared to 46% in the control group. 5 The study also showed there was a 55% relative reduction in incisional secondary surgical interventions (SSIs) for Hydrus Microstent patients compared to cataract surgery alone (2.4% in Hydrus vs. 5.3% in cataract surgery only). 4 * There was no signifi- cant difference in the rate of endothelial cell loss between the two groups from 3–60 months. 5 All Alcon IOLs are now available on the Clareon platform, which also features STABLEFORCE Haptics technology for better rotational and axial stability compared to other platforms. 11,12 ‡¶ In Dr. Mathews' practice, optimizing the use of these IOLs includes both patient education and advanced technologies. She said by understanding what activities are most important to patients, she can have a meaningful discussion with them preop about what their life would be like with and without glasses postop. During this discussion, Dr. Mathews also educates on the possibility for visual aberrations and postop LASIK enhancement to achieve the desired visual goals, if necessary. Editors' note: Dr. Mathews is the director of Cornea and Ocular Surface Disease and a cataract, LASIK, and corneal surgeon at the Center for Sight in Sarasota, Florida. She can be contacted at priya.m.mathews@gmail.com. *Based on mean value of binocular defocus curve at near, intermediate, and distance at 6 months (n=127). †Snellen VA was converted from logMAR VA. A Snellen notation of 20/20-2 or better indicates a logMAR VA of 0.04 or better, which means 3 or more of the 5 Early Treatment Diabetic Retinopa- thy Study chart letters in the line were identified correctly. ‡ Response to the following question on IOLSAT questionnaire (Version 1.0, December 20, 2018) at 6 months post-op: "Given your vision today, if you had to do it all over, would you have the same lenses implanted again?" †Results from a prospective, randomized, parallel group, subject- and assessor-masked, multisite trial of 107 subjects bilaterally implanted with the AcrySof IQ Vivity Extended Vision IOL and 113 with the AcrySof IQ IOL with 6 months' follow-up. ‡ Snellen VA was converted from logMAR VA. A Snellen notation of 20/20-2 or better indicates a logMAR VA of 0.04 or better, which means 3 or more of the 5 ETDRS chart letters in the line were identified correctly. **The safety and efficacy of Vivity IOLs has not been established in eyes with ocular pathology. Clinicians should use sound clinical judgment for individual patients. ***Defined as modified Miyata grade 0, <25 mv/mm 2 over 3 years (n=138), and over 9 years (n=20), respectively. ¶ Mean absolute difference between achieved lens axis at surgery and visit 5 (12 months), ±5.8°. References 1. Alcon Introduces AcrySof IQ PanOptix Trifocal IOL in the U.S., the First and Only FDA-Approved Trifocal Lens. Press Release. August 27, 2019. 2. Clareon PanOptix Trifocal Hydrophobic Acrylic IOL Model CNWTT0 2021. 3. Kohnen T, et al. Visual performance of a quadrifocal (trifocal) intraocular lens following remov- al of the crystalline lens. Am J Ophthalmol. 2017;184:52–62. 4. Carson D, et al. Optical bench performance of 3 trifocal intraocular lenses. J Cataract Refract Surg. 2016;42:1361–1367. 5. Clareon PanOptix Trifocal Hydrophobic Acrylic IOL Model CNWTT0 2021. 6. Alcon Announces Launch of AcrySof IQ Vivity, the First and Only Non-Diffractive Extended Depth of Focus Intraocular Lens in the U.S. Press Release. Jan. 7, 2021. 7. AcrySof IQ Vivity Extended Vision IOL DFU. Alcon Laboratories Inc., 2020. 8. Werner L, et al. Evaluation of clarity characteristics in a new hydrophobic acrylic IOL in compari- son to commercially available IOLs. J Cataract Refract Surg. 2019;45:1490–1497. 9. Oshika T, et al. Mid-term and long-term clinical assessments of a new 1-piece hydrophobic acrylic IOL with hydroxyethyl methacrylate. J Cataract Refract Surg. 2020;46:682–687. 10. Maxwell A, Suryakumar R. Long-term effectiveness and safety of a three-piece acrylic hydro- phobic intraocular lens modified with hydroxyethyl-methacrylate: an open-label, 3-year follow-up study. Clin Ophthalmol. 2018;12:2031–2037. 11. Alcon Data on File, 2017. 12. Lane S, et al. Evaluation of intraocular lens mechanical stability. J Cataract Refract Surg. 2019;45:501–506. continued from page 2

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