One can get the pulse of a specialty by watching for its meeting’s advertisements. Usually they follow a predictable course. The first time you see the ad, you wonder what focused group of people would attend such a unique session. Later you see the same subject offered more frequently until it seems to be offered everywhere, all the time. Then the invitations slow down and the momentum shifts elsewhere.

Consider, for example, all the notices you got on “Introducing Premium Implants in Your Practice!” It seemed like everyone who put in even one of these offered a course to explain how it was done.

I don’t see this topic as often nowadays. Maybe everyone who needed introduction got introduced.

Then came what’s been promoted as the scourge of modern civilization, dry eye. Suddenly more important than cataracts or macular degeneration or glaucoma, dry eye is to the eye what the absence of vitamin C does to so many bodily systems: It is the common link explaining many symptoms.

MIGS, THE CURRENT DARLING

Speaking of glaucoma, the disease is getting its turn in the meeting-topic sun: The promotions are coming in for MIGS [micro invasive glaucoma surgery; see “A (mini) tome on Trabectome,” page 16]. This is a publicity blitz I welcome — in fact, it’s about time. The poor glaucoma surgeons have been doing the same operation for 50 years now.

And the glaucoma surgeons are welcoming these new procedures: At the meetings, the MIGS sessions are always packed and often it is standing room only.

THE LAST MILESTONE

For you history buffs out there, Peter Watson (who just passed away in February) and John Cairns were appointed together as the first surgeons to Cambridge (United Kingdom) where they found a large number of glaucoma patients treated with pilocarpine and physostigmine. They were familiar with the glaucoma procedures of the time but decided a guarded filtration procedure was needed.

“With much thought and consumption of beer in the local pub,” Peter Watson would later say, they sketched out trabeculectomy and each did 100 before reporting them in 1968.¹ Fifty years later, it’s still the go-to glaucoma operation.

When I was in training, we did full thickness posterior lip sclerectomy for advanced glaucoma, cyclodialysis for aphakic glaucoma and trabeculectomy for moderate glaucoma. We did big incision intracapsular cataract surgery; phacoemulsification was in its infancy and so was vitrectomy.

PROGRESS WELCOME

Everything has changed over the course of my career. Now we do phacoemulsification through self-sealing incisions. Retina surgeons do sutureless vitrectomies. But until recently, glaucoma surgeons were still performing the ancient but revered trabeculectomy.

I am excited to see that they can give patients small-incision surgery, assuming of course that MIGS has comparable results to trabeculectomy. It does not matter to me which of the more than half-dozen procedures turn out to be the best performer; my interest lies in improving surgical results, even if only by reducing the litany of complications associated with the current procedure.

It’s not fair that micro-incisional procedures proliferated throughout our specialty and excluded glaucoma surgery for so long. I am thrilled that our colleagues are developing the same refinements seen elsewhere in ophthalmology. It’s been a long time and they deserve it. OM

REFERENCE

1. Watson PG; Trabeculectomy, Controversy in Ophthalmology. Brockhurst. Boruchoff S, Hutchinson T, Lessel S. W B Saunders, New York 1977.

Paul S. Koch, MD is editor emeritus of OM and medical director of Koch Eye Associates in Warwick, RI. His e-mail is pskoch@clarisvision.com.