YoungMD Connect hosted a recent workshop called “The Interventional Glaucoma Revolution,” which brought together four esteemed glaucoma experts to answer some important questions about the proactive approach to treating glaucoma. These questions, among others, included, “What is interventional glaucoma?”, “Why is an interventional approach needed?” and “What are potential barriers to adopting an interventional approach?” John Berdahl, MD; Rachel Simpson, MD; Brian Shafer, MD; and Sarah Van Tassel, MD, guided attendees through these queries.

John Berdahl, MD

WHAT IS INTERVENTIONAL GLAUCOMA?

“It is our attitude. It’s saying, ‘What would I want if it was me–if I was the patient?’”

Interventional glaucoma is a proactive, rather than reactive, approach to managing glaucoma. It entails early and predictive diagnostics, active disease monitoring, and intervention with procedures earlier in the treatment paradigm.

The advantages of taking such an approach include:

• Minimizing issues surrounding patient compliance, commonly associated with patient-administered topical medication;
• Intervening earlier in the disease course, before significant progression, with modern diagnostic tools, regular follow-up visits, and interventions like laser therapy or MIGS;  and
• Gaining the opportunity to better preserve patients’ vision and thereby improve their quality of life.

Sarah Van Tassel, MD

WHY IS INTERVENTIONAL GLAUCOMA NEEDED?

“To understand the why, we have to look at the historical context.”

The conventional glaucoma patient journey starts with a series of topical medications to lower IOP. As the disease progresses, more invasive interventions are often necessary. Some physicians may be set in this “medication first and always” mindset.

• Patients, however, are looking to their doctors for guidance to achieve sustainable IOP reduction.
• Adherence to drop therapy is an issue for myriad reasons, including side effects and cost.
• The interventional mindset means recommending a MIGS procedure to patients earlier in their disease process to help preserve their vision.

Rachel Simpson, MD

WHAT ARE THE BARRIERS TO INTERVENTIONAL GLAUCOMA ADOPTION?

“Interventional glaucoma is a long-term management mindset.”

Physicians treating glaucoma would truly prefer to avoid the risk of complications associated with glaucoma surgery. However, stacking topical medications and knowing that the patient is not adhering to their prescribed protocol does more harm than good. The interventional glaucoma mentality is a long-term mindset, but physicians are stuck in a short-term situation.

• Barriers to accepting this new mindset include perceived procedure complication risks, physician or patient reluctance, reimbursement issues, and cost.
• A physician with an interventional glaucoma mindset who believes in early surgical intervention as the best way to proactively treat this disease needs to make sure they have sufficient OR time available.
• Adopting this mindset requires building confidence in discussing  MIGS options and outcomes with patients. It sometimes requires more time than currently allocated to educate surgeons, optometrists, and patients to gain confidence in the procedures and their efficacy and safety profiles.   

Brian Shafer, MD

PRACTICAL APPLICATIONS OF INTERVENTIONAL GLAUCOMA

“When I see a new glaucoma patient, I sit down and show them a model of the eye. I say, ‘You have glaucoma, a disease of high pressure in the eye that causes damage to the optic nerve. Our goal is to get your pressure to a level by which you don't go on to suffer any more damage to your optic nerve. Additionally, we want to make sure you're comfortable during that treatment.’”

• A patient can be shown the range of treatment options for glaucoma and be informed that, over the lifetime of their disease, the physician may utilize several interventions.
• The key to adopting the interventional mindset is to present the intervention first. The patient will understand that this is the course that the doctor believes is best.
• Physicians need to fundamentally change their perspective regarding how long the effects of various treatment options last. Although they may not last forever, that doesn’t mean that the intervention is not worth using.