New-Generation MIGS: Which MIGS for Which Patient? Clinical Pearls for Selection and Technique (Archived CME Multimedia Program)
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Activity Description
Recent advances in the surgical management of glaucoma are changing treatment strategies, with safe and efficacious minimally invasive techniques and devices now available. Some minimally invasive glaucoma surgery (MIGS) techniques and devices must be used in conjunction with cataract surgery, whereas subconjunctival MIGS incorporates the filtering capacity of a bleb to increase the potential to reduce intraocular pressure. Subconjunctival MIGS has been shown to reduce intraocular pressure by at least 20% for most patients, while relieving drop burden. Common side effects include postoperative needling, nonpersistent loss of best-corrected visual acuity, and transient hypotony. Subconjunctival MIGS requires bleb formation, and antimetabolite treatment contributes to surgical success. The desired results of this activity are to prepare clinicians to competently incorporate MIGS into their surgical repertoire and develop the ability to select the best MIGS according to individual patient needs and desires.
MODULE 1: Introduction to MIGS
Sahar Bedrood, MD, PhD
MODULE 2: A 60-Year-Old Fortune 500 Executive
Jonathan Myers, MD
MODULE 3: A 69-Year-Old with Worsening Visual Fields After ALT
Joseph F. Panarelli, MD
MODULE 4: Two Cases Using an Ab Externo Approach
Brian A. Francis, MD, MS
MODULE 5: A 64-Year-Old with High Myopia and Visual Field Loss
Sahar Bedrood, MD, PhD
MODULE 6: Two Cases of Glaucoma Progressing on Maximal Medical Therapy
Arsham Sheybani, MD
Target Audience
This activity intends to educate glaucoma specialists and other ophthalmologists.
Learning Objectives
Upon completion of this activity, participants will be better able to:
- Compare the characteristics of established and new MIGS procedures
- Summarize the efficacy data of subconjunctival MIGS procedures
- Summarize the safety data of subconjunctival MIGS procedures
- Apply evidence to select appropriate subconjunctival MIGS procedures for a variety of patients
- Review appropriate antimetabolite use for bleb-based MIGS
Faculty
Ike K. Ahmed, MD, FRCSC (Chair) Professor University of Utah Salt Lake City, Utah Assistant Professor Director, Glaucoma and Advanced Anterior Segment Surgery (GAASS) Fellowship Research Director, Kensington Eye Institute University of Toronto Toronto, Canada Division Head, Division of Ophthalmology Trillium Health Partners Co-Medical Director, TLC Mississauga, Canada Medical Director, Prism Eye Institute Mississauga and Brampton, Canada | |
Sahar Bedrood, MD, PhD Ophthalmologist Acuity Eye Group Adjunct Clinical Assistant Professor USC Roski Eye Institute Los Angeles County + USC Medical Center Pasadena, California | |
Brian A. Francis, MD, MS Stieger Endowed Chair Professor of Ophthalmology Doheny and Stein Eye Institutes Department of Ophthalmology David Geffen School of Medicine University of California, Los Angeles Los Angeles, California | |
Jonathan Myers, MD Director, Glaucoma Service Wills Eye Hospital Associate Professor of Ophthalmology Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, Pennsylvania | |
Joseph F. Panarelli, MD Associate Professor of Ophthalmology Chief, Division of Glaucoma Services Glaucoma Fellowship Director NYU Langone Eye Center New York, New York | |
Arsham Sheybani, MD Assistant Professor of Ophthalmology Fellowship Director, Glaucoma and Anterior Segment Surgery Residency Program Director, Ophthalmology Washington University in St Louis St Louis, Missouri |
Disclosure Policy Statement
It is the policy of New York Eye and Ear Infirmary of Mount Sinai that the faculty and anyone in a position to control activity content disclose any real or apparent conflicts of interest relating to the topics of the educational activity in which they are participating. They are also required to disclose discussions of unlabeled/unapproved uses of drugs or devices during their presentations. New York Eye and Ear Infirmary of Mount Sinai is committed to providing its learners with quality CME activities and related materials that promote improvements in healthcare and not the proprietary interests of a commercial interest and, thus, has established policies and procedures in place that identify and resolve all conflicts of interest prior to the execution or release of its educational activities. Full disclosure of faculty/planners and their commercial relationships, if any, follows.
Disclosures
Ike K. Ahmed, MD, had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Advisory Board: Aequus BioPharma, Inc; Aerie Pharmaceuticals, Inc; Alcon; Allergan; ArcScan, Inc; Bausch & Lomb Incorporated; Beaver-Visitec International; Camras Vision, Inc; Carl Zeiss Meditec, Inc; CorNeat Vision Ltd; Ellex; ElutiMed; Equinox; Genentech, Inc; Glaukos Corporation; IanTECH; Injectsense, Inc; IRIDEX Corporation; iSTAR; Ivantis Inc; Johnson & Johnson Vision Care, Inc; Kelotec Inc; LayerBio, Inc; Leica Microsystems; MicroOptx; New World Medical, Inc; Omega Ophthalmics; Polyactiva Pty Ltd; Sanoculis Ltd; Santen Inc; ScienceBased Health; Sight Sciences; Strōma Medical Corporation; TrueVision; Vizzario; and W. L. Gore & Associates, Inc; Contracted Research: Aerie Pharmaceuticals, Inc; Alcon; Allergan; Camras Vision, Inc; Glaukos Corporation; Ivantis Inc; Johnson & Johnson Vision Care, Inc; New World Medical, Inc; and Santen Inc; Honoraria from promotional, advertising or non-CME services received directly from commercial interests or their Agents (eg, Speakers Bureaus): Alcon; Allergan; Carl Zeiss Meditec, Inc; and Johnson & Johnson Vision Care, Inc.
Sahar Bedrood, MD, PhD, had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Advisory Board: Allergan; Honoraria from promotional, advertising or non-CME services received directly from commercial interests or their Agents (eg, Speakers Bureaus): Allergan; and Glaukos Corporation.
Brian A. Francis, MD, MS, had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Advisory Board: Beaver-Visitec International; Diopsys, Inc; Glaukos Corporation; NeoMedix Corporation; and Valeant; Honoraria from promotional, advertising or non-CME services received directly from commercial interests or their Agents (eg, Speakers Bureaus): Bausch & Lomb Incorporated.
Jonathan Myers, MD, had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Advisory Board: Aerie Pharmaceuticals, Inc; Allergan; Glaukos Corporation; and MicroOptx; Contracted Research: Aerie Pharmaceuticals, Inc; Alcon; Allergan; Bausch & Lomb Incorporated; Diopsys, Inc; Glaukos Corporation; Heidelberg Engineering GmbH; Novartis Pharmaceuticals Corporation; Shire; Sight Sciences; and ZEISS; Honoraria from promotional, advertising or non-CME services received directly from commercial interests or their Agents (eg, Speakers Bureaus): Aerie Pharmaceuticals, Inc; Allergan; and IRIDEX Corporation.
Joseph F. Panarelli, MD, had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Advisory Board: Allergan; New World Medical, Inc; and Santen Inc; Honoraria from promotional, advertising or non-CME services received directly from commercial interests or their Agents (eg, Speakers Bureaus): Aerie Pharmaceuticals, Inc; Allergan; and Glaukos Corporation.
Arsham Sheybani, MD, had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Advisory Board: Allergan; and Katena Products, Inc; Honoraria from promotional, advertising or non-CME services received directly from commercial interests or their Agents (eg, Speakers Bureaus): Glaukos Corporation.
New York Eye and Ear Infirmary of Mount Sinai Peer Review Disclosure
Kateki Vinod, MD, has no relevant commercial relationships to disclose.
Editorial Support Disclosures
Erika Langsfeld, PhD; Cynthia Tornallyay, RD, MBA, CHCP; Kimberly Corbin, CHCP; Barbara Aubel; and Michelle Ong have no relevant commercial relationships to disclose.
Disclosure Attestation
The contributing physicians listed above have attested to the following:
- that the relationships/affiliations noted will not bias or otherwise influence their involvement in this activity;
- that practice recommendations given relevant to the companies with whom they have relationships/affiliations will be supported by the best available evidence or, absent evidence, will be consistent with generally accepted medical practice; and
- that all reasonable clinical alternatives will be discussed when making practice recommendations.
Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of New York Eye and Ear Infirmary of Mount Sinai and MedEdicus LLC. The New York Eye and Ear Infirmary of Mount Sinai is accredited by the ACCME to provide continuing medical education for physicians.
AMA Credit Designation Statement
The New York Eye and Ear Infirmary of Mount Sinai designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Grantor Statement
This continuing medical education activity is supported through an unrestricted educational grant from Allergan.
Off-Label Discussion
This CME activity includes discussion of unlabeled and/or investigative uses of drugs. Please refer to the official prescribing information for each drug discussed in this activity for FDA-approved dosing, indications, and warnings.
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CME Provider Contact Information
For questions about this activity, call 212-870-8127.
To Obtain AMA PRA Category 1 Credit™
To obtain AMA PRA Category 1 Credit™ for this activity, view the webinar modules and complete the posttest and evaluation. Upon passing, you will receive your certificate immediately. You must score 70% or higher to receive credit for this activity, and may take the test up to 2 times. Upon registering and successfully completing the post test, your certificate will be made available online and you can print it or file it.
Disclaimer
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of New York Eye and Ear Infirmary of Mount Sinai, MedEdicus LLC, or Allergan.
This continuing medical education activity is jointly provided by New York Eye and Ear Infirmary of Mount Sinai and MedEdicus LLC.
This CME activity is copyrighted to MedEdicus LLC ©2019. All rights reserved. 191