Refractive Considerations for Supraciliary Surgery

Surgically induced astigmatism tracks the corneal incision rather than the implant.

Reena Garg, MD

Glaucoma Today

Key Takeaways Supraciliary glaucoma surgery augments uveoscleral outflow through an ab interno clear corneal microincision and is frequently combined with phacoemulsification. Potential refractive errors may be a transient change from early hypotony or a sustained shift mediated by axial length changes. Because supraciliary surgery uses no scleral flaps, sutures, or bleb, surgically induced astigmatism tracks the corneal incision rather than the implant. Supraciliary glaucoma surgery augments uveoscleral outflow through an ab interno clear corneal microincision and is frequently combined with phacoemulsification. Potential refractive errors may be caused by two distinct processes: (1) a transient change from early hypotony and (2) a sustained shift mediated by axial length (AL) changes. Because supraciliary surgery uses no scleral flaps, sutures, or bleb, surgically induced astigmatism tracks the corneal incision rather than the implant. The effect is akin to that of microincisional cataract surgery alone if the wound is constructed in a similar fashion.1 CASE PRESENTATION A patient with mild to moderate primary open-angle glaucoma on three topical medications presented with a visually significant cataract and an IOP of approximately 24 mm Hg. The patient underwent uncomplicated phacoemulsification through a temporal clear corneal microincision and placement of a Light Adjustable Lens (LAL; RxSight) in the bag, followed by ab interno supraciliary outflow enhancement with bio-reinforcement using the AlloFlo system (Iantrek). Their visual acuity, IOP, and refraction with spherical equivalent were monitored for 3 months (Tables 1–3). Postoperatively, the IOP decreased to 15 mm Hg.

Inherited Retinal Disease in a Young Patient

Blurred central vision, lesions, and macular dystrophy lead to this diagnosis.

Eric Robertson, Osama Said, OD

Modern Optometry

Unlocking Clinical Trial Enrollment with AI Screening

It’s not a patient population problem. It’s a signal-extraction problem.

Sunil Gupta, MD, and Joshua Koo, MS, BS

Retina Today

KEY TAKEAWAYS Current clinical trial screening methods rely on physician memory or a manual pre-screener, often leading to missed eligible patients, high screen failure rates, and lagging trial enrollment. An investigational AI model can automatically flag eligible candidates, allowing the physician to initiate the trial conversation and potential formal screening on the same day. Using the AI system allowed the Retina Specialty Institute to bring a protocol live in about 4 weeks. Every practice that runs clinical trials knows a particular kind of frustration. You open a new protocol for geographic atrophy, wet AMD, or diabetic macular edema, confident that patient volume will fill it. And then you watch enrollment crawl. The reflex is to assume the shortfall is a supply problem: not enough patients. However, in a busy retina clinic, the eligible patients are there—the problem isn’t patient scarcity, it’s patient identification. On any given clinic day, dozens of patients have the conditions our open protocols were written to study, and the information needed to identify them as trial candidates is already in the record: acuity measurements, medical and treatment histories, laterality notes, and OCT scans. However, we still need a dependable way to identify that information quickly for each patient.