Friday was Subspecialty Day at the ASCRS annual meeting, with a full schedule of programs of interest to corneal, glaucoma and refractive surgeons. Some of the highlights of the Glaucoma Day program, chaired by Nathan Radcliffe, MD, and Manjool Shah, MD, include:

• Tips on selecting the right IOL for patients with glaucoma, or who are at high risk of the disease, were provided by Paul Harasymowycz, MD, FRCSC, MSc, the founder and medical director of the Montreal Glaucoma Institute and Cliniques d'ophtalmologie Bellevue. “Contrast sensitivity has to be an important consideration,” explained Dr. Harasymowycz, noting that trifocal lenses will not function effectively without good contrast. “We have to be candid and tell patients, ‘You will not benefit from this technology.’ The more damage a patient has [from glaucoma], stay away from extended depth of focus [EDOF] or trifocal.” He also noted that if a toric IOL is selected, subsequent glaucoma procedures may increase astigmatism.

• Sahar Bedrood, PhD, MD, ABO, discussed the use of wavefront analysis, which maps light waves projected into a patient's eye, to optimize refractive outcomes in patients undergoing cataract surgery and minimally invasive glaucoma surgery (MIGS). In her practice, she uses the iTrace (Tracey Technologies) to measure aberrations prior to surgery; the technology provides a profile that includes higher- and lower-order aberrations, corneal topography and keratometry. “If you’re considering a multifocal lens, you need stromal coma values of less than 0.32 µm to prevent dysphotopsias,” she said. Intraoperatively, aberrometry systems like ORA (Alcon) calculate use wavefront to calculate sphere, cylinder and axis, which can be useful when implanting toric lenses or in post-refractive eyes. The design of the ORA machine makes it awkward when performing MIGS, however, and she’s largely replaced ORA in her practice with other technologies.

• After refractive surgery, some devices often underestimate IOP, noted Michael D. Greenwood, MD, a cataract, refractive and glaucoma surgeon with Vance Thompson Vision in West Fargo, N.D. This is because laser surgery changes the shape of the cornea, making it flatter, which throws off the measurements. He recommends checking IOP using a variety of tools, including the Goldmann applanation tonometer, the CATS tonometer prism (Reichert), and ORA. “Educate your patients on how corneal changes can affect their glaucoma,” he suggested.

• In the afternoon, Leon Herndon Jr, MD, a professor of ophthalmology and the director of the glaucoma service at Duke Eye Center in Durham, North Carolina, delivered the Stephen A. Obstbaum, MD, Honored Lecture.