For decades, glaucoma management has largely been reactive. Specifically, after diagnosing the disease, we typically prescribe an anti-glaucoma topical medication, switch medications (if needed), add another medication as IOPs rise, and then consider surgical interventions after further glaucoma progression. Examples of these interventions: selective laser trabeculoplasty (SLT) or minimally invasive glaucoma surgery (MIGS).   

The Challenge

The challenge with this approach is that it places significant reliance on patient compliance to anti-glaucoma medications early on to prevent disease progression and, thus, vision loss.

It’s no secret that patient adherence to topical anti-glaucoma medications is an ongoing challenge. Reasons for non-adherence vary from forgetfulness and difficulty instilling drops, to aversions to side effects, and systemic concerns, to name a few. (See the article “Achieving patient adherence to IOP-lowering drugs,” written by Dr. Justin Holt.)

In this month’s column, I discuss an alternative approach to reactive glaucoma management; namely, interventional glaucoma (IG) management.

Interventional Glaucoma Defined

IG management is comprised of early diagnostic device use, advanced monitoring, and proactive interventions that incorporate lasers and surgical options (i.e., SLT, sustained-release drug delivery platforms, MIGS) earlier in the disease course.

Anti-glaucoma medications serve as bridge therapies to these proactive interventions, which provide IOP control without reliance on daily patient adherence.

For example, SLT targets the trabecular meshwork, improving aqueous outflow and, thus, reduces the need for anti-glaucoma medication.¹

Sustained-release drug delivery platforms deliver medication over months or years.

MIGS during cataract surgery (or as a stand-alone procedure if indicated) significantly enhance the likelihood of long-term visual stability.

The Way Forward

Adopting the IG management approach allows us to thwart the issues associated with daily patient compliance to anti-glaucoma medications and align with a broader trend in health care — earlier, more aggressive interventions that prioritize long-term outcomes and quality of life.

So, to me, the question isn’t whether optometry should embrace IG management, but how soon.

In just a few years, glaucoma management will likely revolve around this model. By integrating these strategies into practice now, we not only position ourselves at the forefront of care but we can also make a profound beneficial impact on our glaucoma patients’ lives.

The IG management approach was a focal point at the most recent Optometric Glaucoma Society meeting in Indianapolis, signaling its growing relevance in our profession.

As primary eye care providers and glaucoma clinicians, we are poised to not just follow this trend, but to lead it. OM

Reference

1. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-Year Results of Primary Selective Laser Trabeculoplasty versus Eye Drops for the Treatment of Glaucoma and Ocular Hypertension. Ophthalmology. 2023;130(2):139-151. doi:10.1016/j.ophtha.2022.09.009

Mike Cymbor, OD, FAAO, is the medical director of the Glaucoma Institute of State College and the lead OD at Nittany Eye Associates in State College, Pa.