JULY 2019 # 67 Upfront In My View Feature Sitting Down With The outcome-altering FLACS in Can a glaucoma diagnosis Vitreoretinal surgeon, power of anxiety complicated cases do more harm than good? Robert MacLaren 8 12 34 – 41 50 – 51 The Art of Eyes 2019 A selection of beautiful, thought-provoking and inspiring images with one common theme: ophthalmology 14 – 21 www.theophthalmologist.com B:8.875” T:8.3” S:7.8” Enhanced vision within reach. T:10.5” B:11” S:10” A new generation of monofocal IOLs See the Passion • Improved intermediate vision1 in Each Patient. • 20/20 distance vision1* Give them more ING INNOV Enhance your patients’ intermediate vision by AD AT E IO L N | | N H O I using TECNIS Eyhance IOL I G T H C - Q A F U S A I T Reference L I A T S Y L 1. Data on File, Johnson & Johnson Surgical Vision. Inc. Sep 2018. DOF2018CT4015. O A U N T O C I O * Based on a clinical study, N= 134 achieved mean 20/20 monocular pooled distance BCDVA. T P M E E C S X | E For healthcare professionals only. Please read the Directions for Use for Important Safety Information and consult our specialists if you have any questions. TECNIS and TECNIS Eyhance are trademarks of Johnson & Johnson Surgical Vision, Inc. © Johnson & Johnson Surgical Vision, Inc. 2019 | PP2019CT4156 Bring Vision to Life. The Ophthalmologist - EU PP2019CT4156 Ad #: M19JJVS02_01 Bleed: 8.875” x 11” AD: None Headline: Enhanced vision within reach. Trim: 8.3” x 10.5” CW: None Visual: Doctor/patient Live: 7.8” x 10” CD: None Space/Color: CMYK Gutter: None AP: None Publication: Ocular Surgery News PP2019CT4510 PP: Sam Buttrick Project #: PR18477 Document Name: CNY_M19JJVS02_01_01.indd AQR Client: JOHNSON & JOHNSON Document Path: CPNY:ME Production:Johnson_and_Johnson:JJ_Surgical Production:_2019 Magazines: M19JJVS02:CNY_ Studio QA Division: JJV Surgical US M19JJVS02_01_01.indd Product: IOLs US Font Family: Gotham (Medium, Bold, Book; OpenType), Trade Gothic (Bold Condensed No. 20; Type 1) Proofreader Job #: None Ink Name: CMYK Print/Export Time: 6-18-2019 11:42 AM Link Name: CNY_PR18477_Doctor’s_Office_973986222_SWOP_V1.tif (CMYK; 760 ppi; Up to Date; 39.44%), Lines.bmp Art Director CRAFT MagNwp Print Scale: None (Gray; 513 ppi, -514 ppi; Up to Date; 58.38%, -58.38%), Tecnis Eyhance_CMYK.ai (Up to Date; 51.35%), 2017 TECNIS CopyWriter User Name: Ng, Brian (NYC-CWW) Logo Sheet.ai (Up to Date; 30.06%, 28.71%), jnj_Vision_logo_horizontal_cmyk.ai (Up to Date; 57.21%) Proof #: 1 Acct Exec Slug Name: PM: None Release QA InDesign Version: CC 2019 Print Prod B:8.875” T:8.3” S:7.8” Image of the Month Enhanced vision within reach. T:10.5” B:11” S:10” A new generation of monofocal IOLs See the Passion • Improved intermediate vision1 in Each Patient. • 20/20 distance vision1* Give them more ING INNOV Enhance your patients’ intermediate vision by AD AT E IO L N | | N H O I using TECNIS Eyhance IOL I G T H C - Q A F U S A I T Reference L No Magic Bullet I A T S Y L 1. Data on File, Johnson & Johnson Surgical Vision. Inc. Sep 2018. DOF2018CT4015. O A U N T O C I O * Based on a clinical study, N= 134 achieved mean 20/20 monocular pooled distance BCDVA. T P M This month’s image, taken at the slit lamp, shows YAG laser iridotomy with dysphotopsia. E E C S X | E Credit: Julio César Atencio Gutierrez, Ophthalmic Surgeon, Medellin, Colombia For healthcare professionals only. Please read the Directions for Use for Important Safety Information and consult our specialists if you have any questions. TECNIS and TECNIS Eyhance are trademarks of Johnson & Johnson Surgical Vision, Inc. © Johnson & Johnson Surgical Vision, Inc. 2019 | PP2019CT4156 Do you have an image you’d like to see featured in The Ophthalmologist? Contact [email protected] Bring Vision to Life. www.theophthalmologist.com The Ophthalmologist - EU PP2019CT4156 Ad #: M19JJVS02_01 Bleed: 8.875” x 11” AD: None Headline: Enhanced vision within reach. Trim: 8.3” x 10.5” CW: None Visual: Doctor/patient Live: 7.8” x 10” CD: None Space/Color: CMYK Gutter: None AP: None Publication: Ocular Surgery News PP2019CT4510 PP: Sam Buttrick Project #: PR18477 Document Name: CNY_M19JJVS02_01_01.indd AQR Client: JOHNSON & JOHNSON Document Path: CPNY:ME Production:Johnson_and_Johnson:JJ_Surgical Production:_2019 Magazines: M19JJVS02:CNY_ Studio QA Division: JJV Surgical US M19JJVS02_01_01.indd Product: IOLs US Font Family: Gotham (Medium, Bold, Book; OpenType), Trade Gothic (Bold Condensed No. 20; Type 1) Proofreader Job #: None Ink Name: CMYK Print/Export Time: 6-18-2019 11:42 AM Link Name: CNY_PR18477_Doctor’s_Office_973986222_SWOP_V1.tif (CMYK; 760 ppi; Up to Date; 39.44%), Lines.bmp Art Director CRAFT MagNwp Print Scale: None (Gray; 513 ppi, -514 ppi; Up to Date; 58.38%, -58.38%), Tecnis Eyhance_CMYK.ai (Up to Date; 51.35%), 2017 TECNIS CopyWriter User Name: Ng, Brian (NYC-CWW) Logo Sheet.ai (Up to Date; 30.06%, 28.71%), jnj_Vision_logo_horizontal_cmyk.ai (Up to Date; 57.21%) Proof #: 1 Acct Exec Slug Name: PM: None Release QA InDesign Version: CC 2019 Print Prod Contents 50 In My View 12 In Favor of FLACS Boris Malyugin makes the case for lasers, showing the benefits of FLACS in challenging cases 13 Mitigating the MIGS Fear Factor New-generation MIGS devices demonstrate remarkable predictability, argues William Wiley 11 Feature 14 The Art of Eyes 2019 What does a watercolor of 03 Image of the Month Upfront fovea have in common with a photograph taken in rural 08 Sick with Worry Uganda, and a raincloud 07 Editorial doodle? They can all be found in State of the Art(ificial), 09 Bitesize Breakthroughs this year’s edition of our annual by Aleksandra Jones ophthalmic image gallery 10 Shingle White Female 34 Physician, Heal Thyself 11 A Benevolent Action As Raymond Radford claims On The Cover that most patients labeled as JULY 2019 # 67 “glaucoma suspects” carry the Upfront In My View Feature Sitting Down With The outcome-altering FLACS in Can a glaucoma diagnosis Vitreoretinal surgeon, power of anxiety complicated cases do more harm than good? Robert MacLaren 8 12 34 – 41 50 – 51 The captivating image from Carissa burden unnecessarily for many The Art of Eyes 2019 A selection of beautiful, thought-provoking and inspiring images with one common theme: ophthalmology 14 – 21 Hurdstrom uses the human eye to years, five glaucoma specialists represent astronomical objects. respond, discussing unconscious www.theophthalmologist.com bias and surgery risks ISSUE 67 - JULY 2019 Editor - Aleksandra Jones [email protected] Associate Editor - Phoebe Harkin [email protected] Content Director - Rich Whitworth [email protected] Publishing Director - Neil Hanley [email protected] Business Development Executive, America- Ross Terrone [email protected] Associate Publisher- Sam Blacklock [email protected] Business Development Executive- Paul Longley [email protected] Head of Design - Marc Bird [email protected] Designer - Hannah Ennis [email protected] Designer - Charlotte Brittain [email protected] Digital Team Lead - David Roberts [email protected] Digital Producer Web/Email - Peter Bartley [email protected] Digital Producer Web/App - Abygail Bradley [email protected] Audience Insight Manager & Data Protection Officer- Tracey Nicholls [email protected] Traff ic & Audience Database Coordinator - Hayley Atiz [email protected] Project Manager - Webinars - Lindsey Vickers [email protected] Traffic Manager - Jody Fryett [email protected] Traffic Assistant - Dan Marr [email protected] Events Manager - Alice Daniels-Wright [email protected] Event Coordinator - Jessica Lines [email protected] Marketing Manager - Katy Pearson [email protected] Social Media Manager - Joey Relton [email protected] Marketing Executive - Sarah Botha [email protected] Financial Controller - Phil Dale 14 [email protected] Accounts Assistant - Kerri Benson [email protected] Senior Vice President (North America) - Fedra Pavlou [email protected] Chief Executive Officer - Andy Davies [email protected] In Practice Sitting Down With... Chief Operating Officer - Tracey Peers [email protected] 44 Inside Out or Outside In? 50 Robert MacLaren, Change of address/ General enquiries [email protected] Advanced Glaucoma Vitreoretinal Surgeon, Professor Hayley Atiz, The Ophthalmologist, Texere Publishing Limited, Booths Park 1, Chelford Technologies Forum panelists of Ophthalmology, University Road, Knutsford, Cheshire, WA16 8GS, UK www.texerepublishing.com discuss the pros and cons of ab of Oxford, UK +44 (0) 1565 745 200 [email protected] interno and ab externo MIGS Distribution procedures The Ophthalmologist (ISSN 2051-4093), is published monthly by Texere Publishing Limited, Booths Park 1, Chelford Road, Knutsford, Cheshire, WA16 8GS, UK 46 Perspectives: Femtosecond Single copy sales £15 (plus postage, cost available on request [email protected]) Lasers in Cataract Surgery Non-qualified annual subscription cost is £110 plus postage Five cataract experts answer Reprints & Permissions – [email protected] the question: why do some The opinions presented within this publication are those of the authors and do not reflect the opinions of The Ophthalmologist or its publishers, Texere Publishing. ophthalmologists choose to employ Authors are required to disclose any relevant financial arrangements, which are presented at the end of each article, where relevant. FLACS, and some do not? © 2019 Texere Publishing Limited. All rights reserved. Reproduction in whole or in parts is prohibited. www.theophthalmologist.com BIOM® Optic Set – Single-use lenses for BIOM® systems • Ideal for 3D Heads-up surgery Single-use means no scratches or opacities • Maximum precision Superb depth of field even under high magnification • Cost effective No reprocessing costs and reduced O.R.