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NAVIGATING THE BUSINESS OF GLAUCOMA A n EyeWorld Cor- porate Education event at the 2024 American Acad- emy of Ophthal- mology (AAO) Annual Meet- ing featured presentations on "Navigating the Business of Glaucoma." The event was sponsored by AbbVie, Alcon, Bausch + Lomb, Glaukos, Nova Eye Medical, Sight Sciences, Théa, ViaLase, and Zeiss. Diagnostics and 'how doers get more done' In her presentation on diag- nostics, Lorraine Provencher, MD, first asked audience members, "What is your most valuable commodity?" She answered that for most, it's our time. "Constantly rushing to save time can feel like it's in direct opposition to the quality of care we provide," she said. Dr. Provencher noted that AAO recommends visual field testing once a year, but she said that some evidence indicates twice a year visual field testing may be the sweet spot. Unfortunately, more than 75% of patients with open angle glaucoma are getting less than one visual field a year. This is happening for a variety of reasons, including patient avoidance, clinic flow/staffing/space/time, and uncertainty with insurance/reimbursement. Dr. Provencher said that virtual reality perimetry has been a game changer for her practice to create efficiencies in visual field testing. "I have happier technicians with this; they love the improved workflow, and patients love it, too." There are better ergonomics for patients, she added. "It's often a faster test, and they're not moving around in the clinic." It also has a small footprint in the clinic, is often more affordable, and is more efficient. She called it a "slam dunk" for better care and better business. In terms of picking a virtual reality perimeter, she shared several considerations, including the battery life and weight, the validation population, background luminance, glaucoma staging accuracy, upfront vs. ongoing costs, soft- ware updates, warranty, and practice development tools. Her preference is the RadiusXR, which is a tablet-based headset. You can conveniently get an accurate visual field, interpret a familiar printout, and confidently make surgical decisions. There's a dashboard/portal to have open in the workroom to run multiple fields at once. What about OCT and optic nerve photos? Dr. Provencher likes data management systems. She noted the Zeiss Glaucoma Workplace, which integrates structure-func- tion from the CIRRUS, HFA, fundus images, and IOP. It also has at-a-glance summaries, you can add clinical events, and you can tailor it to add new baselines. It gives you a quick visual of what's been going on with the patient, she said. SLT: gateway to interventional glaucoma Manjool Shah, MD, discussed SLT. "The LiGHT Trial is the most [talked about] in my clinic on any given day," he said, adding that this showed that SLT works. 1 At 3 years, 74.2% of patients remained medication-free in the laser group; laser patients were more likely to be at IOP target at office visits (93% vs. 91.3%); disease progression was shown in 33 drop patients vs. 23 laser patients; glaucoma surgery (trabeculectomy) was required in 0 laser patients but 11 drop patients; and there was less visual field progression in the SLT group. You're capturing field progression across the spectrum, Dr. Shah said. DSLT lowers IOP in an efficient procedure that is comfortable for both patients and physicians. Improved procedure flow could help ophthalmology practices via word of mouth by increasing patient satisfaction and outcomes, Dr. Radcliffe said. Source: Nathan Radcliffe, MD Sahar Bedrood, MD, PhD Advanced Vision Care Los Angeles, California Lorraine Provencher, MD Vance Thompson Vision Omaha, Nebraska Nathan Radcliffe, MD New York Ophthalmology New York Eye Surgery Center New York, New York Manjool Shah, MD Kellogg Eye Center University of Michigan Ann Arbor, Michigan Inder Paul Singh, MD The Eye Centers of Racine and Kenosha Racine and Kenosha, Wisconsin About the physicians

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