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(upbeat funky music)

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Welcome to MIGS Unplugged.

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Here we are onsite in Panama.

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Joe Panarelli here with Ike Ahmed.

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I'm Arsham Sheybani.

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And you know, Joe finally got to experience what

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it's like to be Ike's fellow for a case.

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I did.

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I got to tell you that the juices were flowing.

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I was trying to control the nerves.

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I was hoping that I had taken my morning dose

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of a beta blocker or something to control the anxiety,

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but it was a blast and I could see why so many

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go to work with the legend.

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It was really a fun time.

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It was fantastic.

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And Joe, we've talked about this.

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We don't do a lot of angle surgery.

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The population's a little bit different.

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A lot of times people have already worked in

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the angle before.

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How was it for you and maybe just kind of tell us,

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we just did ab interno canaloplasty

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with the new iTrack catheter.

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It's a 3D heads-up display.

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I think it's a tough question for all of us.

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We're always trying to figure out,

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when are we comfortable to take that next step

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to push the envelope?

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And I think that's what makes us better.

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It's what makes all of us better.

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We would all tell you that.

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We don't want to tackle too many things at once,

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but for me personally, I got really comfortable

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doing more traditional glaucoma surgery early in my career,

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tried to really perfect my trabeculectomy

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and tube shunt skills.

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I did a good amount of angle surgery,

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not nearly as much as you guys, but it was really nice.

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One of the reasons I wanted to come down here

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was really to sort of learn from the best

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and really kind of get back into it

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because you hear more and more about how this approach

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probably really is beneficial for some of our patients

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who have more mild disease and how we need to treat

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a little more aggressively early on,

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and you want to have the proper tools to do this.

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So for me, canaloplasty makes sense and it was really nice

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to get to have this experience today.

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So Joe, so much of our focus in glaucoma surgery

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is the devices and instrumentation,

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but I think sometimes

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I forget visualization.
Yeah.

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Right, the setting up.

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So, you literally were not going to do 3D surgery today.

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And in fact-

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I had no plan.

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I had never watched 3D surgery.

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Exactly.

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And in fact you were-

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In fact when they would turn it on in the OR,

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I would be like, "I'm out of here."

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Yeah.

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And in fact, many times you're about to, not,

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you're backing away, right?

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But you jumped in there and did it,

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so what advances do you see, whether it's 3D

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or something else, that you may think allow us

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to harness the power of what MIGS can do?

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I think definitely the visualization is key.

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I think when you're talking about any sort of surgery

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in the angle, you want to really have,

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you want to be comfortable.

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Your posture, you want to be comfortable

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with what you're looking at.

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And I will say this, even though it was my first experience

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with a decent-sized crowd in the room,

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I felt pretty comfortable, which I totally did not expect.

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And I'd say it's amazing how it started,

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and 10 minutes later when we started doing

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additional surgery, I really, I felt even more comfortable.

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So, I think it's true that we want to work

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outside of our comfort zone at times

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while making sure we have good backup.

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I think that's always one of the things,

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it's my teaching point to all my trainees,

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go ahead, push yourself, but make sure that you have

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the proper support, because we always want to do

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what's best for the patient and-

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What was your backup?

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I had you there, man.

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I had you, I had like the top 10 surgeons in the world.

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I felt like I could do anything.

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Was he scrubbed in then?

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I don't, he might have been scrubbed in.

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All I know is there was some taunting going on as well,

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which made it a little bit tricky.

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Now, but this does play into many surgeons out there

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who are watching MIGS and they're not sure whether

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to jump in or not.

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And maybe they don't have a mentor

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or have someone with them in there.

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So, how do people make that step forward?

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Whether it's innovation or whether it's just adopting

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new ideas, new technologies?

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I think it's, educate yourself.

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Read the literature, read the right literature.

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I think unfortunately there's a lot of literature out there

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and you have published some reports on this about

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how we really want the best and the highest forms

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of data to support the use of a lot of these devices.

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And it's out there.

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And more is being poured into the community.

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But I think understanding what you should expect to get

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from these procedures, choosing the right patients,

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and then accepting that you're going to have some failure

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early on, and that's okay.

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We're all, none of us are going to be,

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I think the thinking is, when we do these surgeries,

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we never experience any failure.

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Patients end up perfect.

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And I think we all do our best to improve our success rates,

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but man, we all go through our ups and downs.

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And so I think that's a big point that I try to stress

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to anybody who's adopting it for the first time.

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You're going to have some bumps in the road,

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but keep at it, keep at it.

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If there were other devices that I used that I gave

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up early on, it would've been, I'd feel ashamed,

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because at this point I try to utilize all these tools.

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Well, speaking of, before we start to wrap up,

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you're a big ab externo canaloplasty guy.

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Yeah, yeah.

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How was your experience doing that?

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Yeah, it was very nice.

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As a pediatric glaucoma specialist, I definitely work

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a little more from an external approach

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because a lot of times the children don't,

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there's not great visualization, but I will tell you,

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the comfort with that hand piece and the ability,

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even with the system you're using today,

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to have such good visualization, I would definitely think

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about maybe making the switch

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and maybe doing some more ab interno surgery.

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And I think sometimes you do, you just need that kick.

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I got that kick today.

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But it's great.

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It's really a pleasure getting to work with everybody here.

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And it's an honor.

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Well, it was amazing to work with new innovation

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and MIGS new visualization from surgeons

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that haven't used it before.

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Who just, by the way, he kicked butt.

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He was fantastic.

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It was fantastic, it was.

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And the cataract, too.

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And the cataract, yeah, I wasn't expecting that.

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That was a little treat, a little added bonus.

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So something that-

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Something, got to push yourself a little bit.

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I think it's great to see innovations we see now

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in canaloplasty making this more accessible

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and advancing the technology.

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So thank you, Arsham, thank you, Joe for being part of this.

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This is another edition of MIGS Unplugged.

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Stay tuned for our next version.