Photoshop 2018 vs. Wacom Pen ctrl+opt modifier

I'm using Photoshop 19.0.1 on Mac High Sierra and a Wacom Intuos Pro.

I'd like to use a ctrl+opt modifier on the lower pen button to change brush size and hardness, but I couldn't get this working when using a custom profile for Photoshop in Wacom system settings.

This has been working fine before in Photoshop 2017, I'm just not sure if it appeared with Photoshop 2018, High Sierra, or both combined.

It does work fine if I set this for "all other apps" (though it causes awkward behavior when using the pen otherwise), and it also does work fine when creating a custom profile for other image editor apps, like Affinity Photo (same ctrl+opt modifier shortcut there to change brush size/hardness).

So I think it's Photoshop 2018 related. Either Photoshop ignores the wacom setting, or wacom doesn't realize it's painting in a Photoshop window.

Is anyone else having the same issue, and is there maybe a solution to this?