Surgeons enjoy learning from each other, particularly as surgeons on one continent earn experience with a new device or technique and their peers on the other side of the Atlantic want to know more about it
Freedom and flexibility
In addition to access to new procedures, EU and US surgeons can differ in terms of the amount of freedom and flexibility they have to use those procedures and to explore new avenues. European surgeons have the flexibility to use multiple MIGS implants such as Hydrus and iStent, for instance, as well as to use those devices outside of cataract surgery. These approaches would not be reimbursed for surgeons in the US, but their European peers are more likely to be approved based on the balance of outcomes and costs.
The flexibility to use many MIGS devices as standalone procedures not only leads to different indications, but also reflects the trend in Europe for glaucoma surgeons to perform most glaucoma procedures, rather than turn them over to cataract surgeons. That trend, which generally results in more solo procedures than cataract-MIGS combinations, allows European surgeons to intervene in cases of advanced or aggressive glaucoma without waiting until the patient’s cataracts warrant surgery. US surgeons tend to be more flexible than their European peers in performing manipulations related to glaucoma procedures such as bleb work and needling at the slit lamp, rather than in the OR. This difference may be related to the costs of OR time in the US, compared to some European countries.
In addition to following the literature, many surgeons take advantage of online videos of our peers’ talks and surgeries. Videos are welcome opportunities to get specific information in a very convenient format.
It is especially helpful to listen to peers with access to many surgical techniques and devices for glaucoma, so we can understand not only how they are used, but also how they are selected and/or combined. Because we do not have side-by-side comparisons of most glaucoma treatment modalities, and study designs vary for MIGS and other procedures, experienced surgeons’ perspectives on how they weigh treatment choices for their patients are particularly valuable.
Perhaps the richest source of learning is a face-to-face meeting at international conferences. For surgery in particular, small groups and workshop offer the important opportunity to ask questions about specific cases. Skype lectures are productive as well, but small workshops are most enjoyable for us as both attendees and lecturers for sharing experiences with peers, from close to home and far away.
Davinder S. Grover, MD, MPH, specializes in glaucoma and cataract surgery at Glaucoma Associates of Texas in Dallas.
Ingeborg Stalmans, MD, PhD, is head of the glaucoma unit at the University Hospitals Leuven (UZLeuven), Belgium