Day 4 of the 36th AsiaPacific Academy of Ophthalmology Virtual Congress (APAO 2021)
hosted a fun format for talks: a back-and-forth debate on contentious topics in glaucoma.
The format of this symposium was quite refreshing, as one speaker would present an argument for a treatment
and the following speaker would present an argument against that same treatment.
This type of debate itself is one worth emulating in future conferences.
The point-counterpoint structure was very effective at helping the listener understand both sides of an argument.
Since poking holes in ideas is the very basis of the scientific method, ลาวสามัคคี วีไอพี
it makes perfect sense to apply such a format to an ophthalmic conference.
We’ll cover more of these debates in future articles, but for now we’ll focus on one argument that’s
been making the rounds at conferences for some time: the practice of clear lens extraction as a glaucoma treatment.
In support of clear lens extraction for PACG We’ve heard Prof.
David Friedman, co-director of the Glaucoma Center of Excellence at Massachusetts
Eye and Ear, USA, speak about clear lens extraction for primary angle-closure glaucoma (PACG) before, and we were happy to see him here again.
As he noted, the lens plays a huge role in causing angle-closure.
That’s hard to argue against. As he demonstrated, clear lens extraction (CLE) via phacoemulsification opens the angle, thus reducing IOP and helping a patient manage their glaucoma.
Compared to a laser peripheral iridotomy (LPI) group, a CLE group experienced a much lower rate of failure — with failure defined as an IOP of >21 off medications. For this study,
Dr. Friedman included patients with PACG with IOP ≥21 or PAC with IOP ≥30 mmHG, with at least 180 degrees of angle-closure, newly diagnosed (up to 6 months) and older than 50.
Exclusion criteria included patients with severe glaucoma, a symptomatic cataract in either eye, an axial length ≤19 mm, previous surgery, or previously diagnosed acute angle-closure attack. In the data Prof.
Friedman presented, quality of life and IOP improved in the phaco group relative to the LPI group.
Additionally, 60% of the phaco group was on no medications at all at 36 months, compared to 21% in the LPI group.
On top of that, very few of the phaco patients required extra surgery compared to the LPI group.
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