Supported through an educational grant from New World Medical.

Learning Objectives

At the completion of this educational activity, the participating ophthalmologist will be better able to:

•Identify and understand the advantages and disadvantages of trabecular, supraciliary, and subconjunctival microinvasive glaucoma surgery (MIGS) procedures.

•Describe the efficacy and safety of trabecular meshwork (TM) and Schlemm canal MIGS procedures.

•Identify the patient characteristics that favor the use of TM and Schlemm canal MIGS procedures.

•Adopt optimal surgical techniques when performing TM and Schlemm canal MIGS procedures.

Accreditation and Designation Statement

Accreditation Statement
Evolve Medical Education LLC (Evolve) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement
Evolve designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Disclosures

Jason Bacharach, MD

Founding Partner & Director of Research
North Bay Eye Associates Inc.
Sonoma County, California

Co-Director of Glaucoma Division
California Pacific Medical Center
San Francisco, California

Jella An, MD

Medical Director, University Eye Institute East
Director, Glaucoma Service and Fellowship Program
Department of Ophthalmology
University of Missouri
Columbia, Missouri

Jason Bacharach, MD, hand or spouse has had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Advisory Board/ Speaker’s Bureau: Aerie, Allergan, Bausch & Lomb, Eyepoint, Glaukos, Gore, New World Medical, Nicox, Novartis, Ocular Therapeutix, and Santen.

Jella An, MD, and or spouse has had a financial agreement or affiliation during the past year with the following commercial in the form of Consultant/Advisory Board/Speaker’s Bureau: Allergan, Iridex, New World Medical.

EDITORIAL SUPPORT
•Erin K. Fletcher, MIT, director of compliance and education, Evolve, has no financial relationships with commercial interests.

•Susan Gallagher-Pecha, director of client services and project management, Evolve, has no financial relationships with commercial interests.

•Cassandra Richards, director of education development, Evolve, has no financial relationships with commercial interests.

•Nisha Mukherjee, MD, peer reviewer, has no financial relationships with commercial interests.

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Pretest

1. Please rate your confidence in your understanding of microinvasive glaucoma surgery (MIGS) procedures (based on a scale of 1 to 5, with 1 being not at all confident and 5 being extremely confident).*
1. Not at all confident 2. Not very confident 3. Neutral 4. Confident 5. Very confident
2. Please rate how often you currently use MIGS in your practice (based on a scale of 1 to 5, with 1 being never and 5 being always).*
1. Never 2. 3. Neutral 4. 5. Always
3. Which of the following procedures does NOT involve the Schlemm canal?*
- A. iStent
- B. Hydrus Microstent
- C. OMNI
- D. XEN Gel Stent
4. Which MIGS device is only approved to be performed with cataract surgery?*
- A. iStent
- B. MicroShunt
- C. Trabectome
- D. XEN Gel Stent
5. Which statement is NOT consistent with the original definition of what constitutes a MIGS procedure?*
- A. Ab-interno microincision
- B. Minimal Trauma
- C. Excellent efficacy
- D. Rapid Recovery
6. What is a differentiating factor between traditional and excisional goniotomy*
- A. Can be used to treat pediatric glaucoma
- B. Used to open an obstructed trabecular meshwork
- C. Performed under direct gonioscopy to visualize area
- D. Elevates and excises TM to access multiple collector channels
7. Following a MIGS procedure, patients should be advised they may have blurred vision (on average) for how long?*
- A. 1 to 2 hours
- B. 1 to 2 days
- C. 1 to 2 weeks
- D. 1 to 2 months
8. Which of the following describes a patient best suited for a trabecular-based MIGs procedure?*
- A. Mild to moderate disease
- B. Able to tolerate some medications
- C. IOP target of 15 to 18 mm Hg
- D. All of the above
9. Which type of procedure requires a steeper learning curve than others?*
- A. Supraciliary MIGS
- B. Subconjunctival MIGS
- C. TM/Schlemm Canal MIGS
- D. All of the above
10. Which of the following is NOT a relative contraindication for trabecular-based angle surgery?*
- A. Goal IOP >10 mm Hg
- B. Patient on maximum medical therapy
- C. Active uveitic glaucoma
- D. Chronic angle closure with significant chronic PAS

Video Resources

Targeting the Trabecular Meshwork: Goniotomy Past, Present, and Future

By: Jason Bacharach, MD; Jella An, MD

Instructions

Step 1 of 2

50%

1. After completing this activity, please rate your confidence in your understanding of microinvasive glaucoma surgery (MIGS) procedures (based on a scale of 1 to 5, with 1 being not at all confident and 5 being extremely confident).*
1. Not at all confident 2. Not very confident 3. Neutral 4. Confident 5. Very confident
2. After completing this activity, please rate how often you currently use MIGS in your practice (based on a scale of 1 to 5, with 1 being never and 5 being always).*
1. Never 2. 3. Neutral 4. 5. Always
3. Which of the following procedures does NOT involve the Schlemm canal?*
- A. iStent
- B. Hydrus Microstent
- C. OMNI
- D. XEN Gel Stent
4. Which MIGS device is only approved to be performed with cataract surgery?*
- A. iStent
- B. MicroShunt
- C. Trabectome
- D. XEN Gel Stent
5. Which statement is not consistent with the original definition of what constitutes a MIGS procedure?*
- A. Ab-interno microincision
- B. Minimal Trauma
- C. Excellent efficacy
- D. Rapid Recovery
6. What is a differentiating factor between traditional and excisional goniotomy?*
- A. Can be used to treat pediatric glaucoma
- B. Used to open an obstructed trabecular meshwork
- C. Performed under direct gonioscopy to visualize area
- D. Elevates and excises TM to access multiple collector channels
7. Following a MIGS procedure, patients should be advised they may have blurred vision (on average) for how long?*
- A. 1 to 2 hours
- B. 1 to 2 days
- C. 1 to 2 weeks
- D. 1 to 2 months
8. Which of the following describes a patient best suited for a trabecular-based MIGs procedure?*
- A. Mild to moderate disease
- B. Able to tolerate some medications
- C. IOP target of 15 to 18 mm Hg
- D. All of the above
9. Which type of procedure requires a steeper learning curve than others?*
- A. Supraciliary MIGS
- B. Subconjunctival MIGS
- C. TM/Schlemm Canal MIGS
- D. All of the above
9. Which of the following is NOT a relative contraindication for trabecular-based angle surgery?*
- A. Goal IOP >10 mm Hg
- B. Patient on maximum medical therapy
- C. Active uveitic glaucoma
- D. Chronic angle closure with significant chronic PAS
Profession:*
- MD/DO
- NP
- Nurse/APN
- PA
- OD
- Other
Years in Practice:*
- >20
- 11-20
- 6-10
- 1-5
- <1
Patients Seen Per Week ( with the disease targeted in this activity):*
- 0
- 1-20
- 21-40
- 41-55
- 56-75
- 75+
Region:*
- Northeast
- Northwest
- Midwest
- Southeast
- Southwest
Setting:*
- Solo Practice
- Community Hospital
- Government or VA
- Group Practice
- Other
- I do not actively practice
Models of Care:*
- Fee for Service
- ACO
- Patient-Centered Medical Home
- Capitation
- Bundled Payments
- Other

Did the program meet the following educational objectives?*

	Agree	Neutral	Disagree
Identify and understand the advantages and disadvantages of trabecular, supraciliary, and subconjunctival microinvasive glaucoma surgery (MIGS) procedures.
Describe the efficacy and safety of trabecular and Schlemm canal MIGS procedures.
Identify the patient characteristics that favor the use of trabecular and Schlemm canal MIGS procedures.
Adopt optimal surgical techniques when performing trabeular and Schlemm canal MIGS procedures.

	Yes	No
The design of the program was effective for the content conveyed
The content supported the identified learning objectives
The content was free of commercial bias
The content was relative to your practice
The faculty was effective
You were satisfied overall with the activity
Would you recommend this program to your colleagues

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Targeting the Trabecular Meshwork: Goniotomy Past, Present, and Future

Webinar Credits: 1.25

Expiration Date: Saturday, October 31, 2020

Release Date: October 2019

Learning Objectives

Accreditation and Designation Statement

Faculty and Disclosures

Pretest

Video Resources

Targeting the Trabecular Meshwork: Goniotomy Past, Present, and Future

Test

Instructions

Step 1 of 2

Targeting the Trabecular Meshwork: Goniotomy Past, Present, and Future

Webinar Credits: 1.25

Expiration Date: Saturday, October 31, 2020

Release Date: October 2019

Learning Objectives

Accreditation and Designation Statement

Faculty and Disclosures

Please log in to view this course

Pretest

Video Resources

Targeting the Trabecular Meshwork: Goniotomy Past, Present, and Future

Test

Instructions

Step 1 of 2