Iqbal Ike K. Ahmed, MD, FRCSC; Arsham Sheybani, MD; and Joseph F. Panarelli, MD
Arsham Sheybani, MD, and Iqbal Ike K. Ahmed, MD, take MIGS Unplugged on location to Panama. The duo invites Joseph F. Panarelli, MD, to discuss his experience performing ab interno canaloplasty with the iTrack microcatheter (Nova Eye Medical) and a heads-up 3D display. Dr. Panarelli highlights the importance of early intervention and treatment for patients with mild-to-moderate glaucoma and shares advice for surgeons who want to take a step forward in adopting new technology.
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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.
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