Spotlight on MIGS: Micro- invasive Glaucoma surgery Impact on my pracfce

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1 Spotlight on MIGS: Micro- invasive Glaucoma surgery Impact on my pracfce Managing Partner: Carolina Eyecare Physicians Medical Director: Carolina Eyecare Research InsFtute Adjunct Professor: Medical University of South Carolina Charleston, South Carolina

2 Financial disclosures Alcon Labs AbboN Labs Allergan Aquesys Bausch and Lomb Glaukos Haig Streit MaF TherapeuFcs Nidek PRN NutriceuFcals Versant Ventures Wavetec Zeiss

3 My pracfce Lasik refracfve pracfce RefracFve cataract pracfce

4 Patient Centered Refractive Cataract Practice PaFent SaFsfacFon PaFent Customer Service Surgical Outcomes

5 PaFent Centered RefracFve Cataract PracFce PRK Femtosecond assisted laser cataract surgery RefracFve Surgical OpFons Femtosecond bladeless LASIK Lifestyle choices Advanced technology IOLs

6 Quality of Life Issues Improved quality of vision Less dependence on glasses / contact lenses

7 MIGS approach is similar for my pracfce Less dependence on their topical medicafons Reducing or perhaps eliminafng the need for drops Compliance issues Cost issues May permit bener IOP control on/off drops Minimal risk/morbidity No effect on ocular structures for future surgical alternafves

8 PaFent Centered RefracFve Cataract PracFce Improving Quality of Life PRK/LASIK Femtosecond assisted cataract surgery Advanced Technology IOLs Dry Eye Center NutriceuFcals Lipoflow MIGS istent Reduce need for glasses/contacts Reduce need for glasses/contacts Reduce discomfort Improve QOV?Be$er control of a disease process..? Reduce # of topical meds

9 PaFent Centered RefracFve Cataract PracFce Quality of Life FS Cataract PRK/ LASIK Cataract Surgery AT IOLs MIGS istent Dry Eye Center

10 In my refracfve cataract pracfce 5% of my current surgery Using only 1 istent (data support use of 2) Document presence of POAG with OCT/VF Benefit in pafents with OHT and pseudophakic POAG/(s) Use can/should expand to 15-20% of my pracfce

11 My istent Preliminary 1 Month Results 41 pafents on 1 medicafon Preop 8 pafents on no medicafons preop 88% of pafents on 1 drop preoperafvely were able to disconfnue their drops postop 33% of pafents who were on meds preop had a > 20% decrease in IOP from preop IOP 100% of pafents who were not on meds preop had a 20% decrease in preop IOP (8 pafents) No adverse events Well received by pafents (95%+ eligible choose MIGs/iStent) Well received by staff Well received by referring doctors

12 Results Coverage from Medicare in South Carolina Coverage from Federal BCBS Denied from State BCBS that is being appealed

13 Healthcare OpportuniFes $3 trillion per annum (USA) or 20% of GDP Ophthalmology = 3% ($70 Billion today) $100 Billion 2020 Aging populafon, over age 65 growing 2x rate of under 65 Technology advances - Advanced technology IOLs Toric IOLs Presbyopia correcfng IOL s - Dry Eye advances - MIGS - A broad, diverse, well capitalized pipeline of new products Consumerism - baby boomers want quality of life - expect life improvements from therapies EscalaFng costs a catalyst for pafent shared responsibility ( Defined ContribuFon Plan ) Significant unmet needs Source: Leerink, SV Life Sciences 13

14 Concomitant Cataracts (US) 1 in 5 co- morbid cataract eyes Significant Treatment Opportunity Comorbid OAG / OHT 20.5% 3.5M US Cataract Procedures 717K Cataract Only 79.5% Centers for Medicare and Medicaid Services Medicare Standard AnalyFcal File. BalFmore, MD

15 Comprehensive Ophthalmology PracFce 2013 and beyond FS Cataract PRK/ LASIK Cataract Surgery AT IOLs MIGS istent Dry Eye Center

16 Cataract surgery is a plaporm: QOL Elevate our results beyond roufne cataract surgery MIGs presents an opportunity for cataract surgeons to leverage their skills and advance the treatment for their pafents with mild- moderate glaucoma

17 Summary MIGs opens up opportunifes for the comprehensive cataract surgeon Paradigm shiq OHT, Mild- moderate glaucoma will be treated by comprehensive ophthalmologist PaFent perspecfve BeNer confnuity of care with their own doctor BeNer control / more cost efficient / improved compliance Physician perspecfve Another tool in the surgical armamentarium for the comprehensive ophthalologist to assist in the control of glaucoma for their pafents High benefit, low risk Not jeopardize future surgical opfons

18 Thank You

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