Novel Approaches to Minimally Invasive Bleb Surgery

Two technologies offer safer alternatives to traditional filtering procedures.

Shan C. Lin, MD, and Nir Shoham-Hazon, MD

Glaucoma Today

Key Takeaways Minimally invasive bleb surgery, or MIBS, has emerged as a distinct category within the MIGS spectrum to address a treatment gap for patients with glaucoma who have visual field loss and need enhanced IOP control but do not necessarily require extremely low IOPs. Two new technologies offer safer alternatives to traditional filtering procedures. An Implant-Free Path to Minimally Invasive Subconjunctival Filtration By Shan C. Lin, MD MIGS has allowed glaucoma surgeons to treat early glaucoma, including ocular hypertension and mild to moderate disease, often in conjunction with cataract surgery. For more advanced disease, such as moderate to severe glaucoma, or in eyes with very high IOP, filtration surgeries are the most effective procedures to lower pressure and prevent progressive vision loss. However, trabeculectomy and tube shunt surgery have relatively high rates of complications, including hypotony, bleb leak, infection, and tube erosion. Minimally invasive bleb surgery (MIBS) has emerged as a distinct category within the MIGS spectrum to address a treatment gap for patients with glaucoma who have visual field loss and need enhanced IOP control but do not necessarily require extremely low IOPs. A SAFER WAY TO ACHIEVE FILTRATION MIBS encompasses procedures that achieve substantial IOP lowering through the creation of a subconjunctival filtering bleb via a microinvasive ab interno or ab externo approach. These procedures result in limited tissue disruption and demonstrate a safety profile that is comparable to that of angle-based MIGS. The Aqualumen (PLU Ophthalmic) is a novel, implant-free surgical device that creates a controlled transscleral outflow pathway to reduce IOP in patients with glaucoma.

Refractive Surgery Candidacy and Geriatric Contact Lens Patients

Cecelia Koetting, OD, FAAO, Dipl ABO; Ranjani Panda, OD, FAAO; and Jason Chin, OD, FAAO

Eyetube

Podcast host Cecelia Koetting, OD, FAAO, Dipl ABO, talks with ODs who contributed to MOD’s recent cataract and refractive surgery issue. Ranjani Panda, OD, FAAO, discusses how to identify ideal candidates for refractive surgery. She notes that choosing the right procedure isn’t just about a patient’s refraction; rather, more emphasis should be placed on their expectations and whether a procedure will realistically be able to meet them. She highlights the importance of “underpromising and overdelivering” when it comes to patient education. Jason Chin, OD, FAAO, then chats about, “The Conundrums With Geriatric Patients and Contact Lenses.” He notes that his article was inspired by an elderly patient who had 16 contact lenses stuck in her eye. He adds that this is a common occurrence in older patients who experience memory issues, highlighting the necessity of honest conversation about contact lens use discontinuation or more frequent follow-up visits as a patient ages, sometimes even involving their family.

Designing a Successful Front Office

Thoughtful planning is essential.

Alan Winig

Retina Today

Opening an independent practice brings the freedom to shape it according to your vision, values, and standards of care. Ownership also expands your role beyond that of a clinician to that of an entrepreneur and CEO, and it creates opportunities to build long-term wealth. The primary asset is the ophthalmology practice itself, and a second potential asset is the real estate the practice occupies. Choosing to purchase your office building rather than lease space creates an additional investment and a future source of passive income. Owner-occupied real estate is common in our industry and can be a smart financial strategy when feasible. Once you have selected a location, thoughtful space planning becomes essential. One of the most important elements of office design is patient flow (ie, how patients move through the space and how efficiently they can complete their visit). Maximizing throughput without making your patients feel rushed creates a better experience for both them and your staff. Ophthalmology practices serve a large elderly population, and many of these individuals have mobility limitations or move slowly. The office layout should be intuitive, easy to navigate, and designed to minimize unnecessary walking.