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Should endocyclophotocoagulation be considered part of MIGS? Mr Ratnarajan delves in

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Mr Gokulan Ratnarajan recaps his 2022 ESCRS presentation: "A Real World Comparison Of iStent Combined With Phacoemulsification And Endocyclophotocoagulation (Ice2) With Preserflo And Xen-45 Implants In The UK; Short- And Long-Term Outcomes."

Video transcript

Caroline Richards: Thank you very much for joining me.

Mr Gokulan Ratnarajan: Thank you for having me.

Richards: It's great to see you. I know you presented yesterday on quality of life—yesterday afternoon. Could you tell me a bit more about the key takeaway points from your presentation?

Mr Ratnarajan: Yeah, so I'm a glaucoma specialist, and a cataract surgeon. And nowadays with advances in glaucoma surgery, there's a new type of glaucoma surgery that most ophthalmologists are familiar with called minimally invasive glaucoma surgery. And this is surgery that can be very easily and fits perfectly well when it's combined with cataract surgery.

Richards: Right.

Mr Ratnarajan: So, at the same time, as a patient having a cataract surgery, we can now do operations to better control or optimize their glaucoma.
I've been doing this for at least the last 10 years now. And what I've noticed—certainly in the last few years, as we're doing higher volumes of these patients—is that when patients come back to their post-op visit, the next day or one week later, you can see a big transformation in the patients. They are seeing better, so they're happy. The eye pressures are better controlled, they're taking less glaucoma medications, and they just feel less anxious about glaucoma.

Glaucoma is the leading cause of irreversible sight loss in the world. And a lot of patients worry about this in between the clinic visits, glaucoma can dominate their lives. And you see that once their pressures are better controlled, and you sort of told them their glaucoma is stable, that really allays a lot of their anxiety.

Then you've got the other patients, big group of patients, majority of patients that hate taking their drops. You know, imagine if you have to put drops twice a day for the rest of your life. That can isolate you, can limit your social interactions with others, and again, creates that insular approach that "I have a stigma of a disease or chronic disease."

Richards: Yeah.

Mr Ratnarajan: And they sort of dissociate themselves from society. So getting patients off glaucoma drops then frees them from that. So they have that sort of physical independence from not being on the drops. But on the other side, their eyes are a lot more comfortable.

Glaucoma drops are effective, or they can make the eyes red, sore, itchy, watery. So we've looked at a study essentially, as opposed to just seeing patients in the clinic, actually doing a study to look at patient-reported outcome measures, using some well-established patient reported outcome measures such as the glaucoma severity scale, glaucoma quality of life, the ocular surface disease index.

So we looked at all the these both before the surgery, four months after the surgery, and just recently 12 months after surgery. And we see a big improvement from before the surgery to four months. And that improvement has been maintained at 12 months.

Richards: Excellent.

Mr Ratnarajan: So and then when we examine their eyes, we look at the surface of the eyes, look at how healthy their tear film is, how healthy their eyes are in general. And that also has shown a big improvement.

So you know, it's nice to have post-op patients that are happy. They're—happy patients make happy doctors. And really, of course, glaucoma is about controlling the eye pressure, about preventing further visual field loss and keeping patients from visual disability in their lifetime.

But if patients are happier, more confident, less anxious, and have a better quality of life, then that's a that's a huge—

Richards: Win-win.

Mr Ratnarajan: A win-win. And it's something that probably as clinicians we underestimate, and hopefully these kinds of studies will help make it more commonplace to sort of start off thinking as there's a patient at the end of that eyeball.

Richards: Yes, yeah.

Mr Ratnarajan: So one step towards that. Lots of more work to do. But yeah, very happy with the initial results.

Richards: What would be the next steps for this research?

Mr Ratnarajan: So the next step would be to apply it to other glaucoma surgeries and not just the minimally invasive glaucoma surgeries but some of the bigger surgeries that we need to do for patients who are a little bit more advanced or the glaucoma is a bit more aggressive, and maybe potentially looking at at other types of surgery as well.

We know some stuff about cataract surgery, but you know, retinal surgery, and those sorts of things, so not just limited to glaucoma. And then within our own data, we've got 12-month data, but it'd be lovely to see whether this is maintained at two years, three years and five years. They're the next steps, really.

Richards: Yes. Oh, that sounds really good. Well, thank you very much for sharing your insights with Ophthalmology Times Europe.

Mr Ratnarajan: Thank you for having us.

Richards: Thank you.


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