YoungMD Connect hosted a recent workshop called The Interventional Glaucoma Revolution, which convened four experts to answer important questions about the proactive approach to treating glaucoma. The discussion centered on the definition of interventional glaucoma, why an interventional mindset is needed, and the potential barriers to adopting this approach.

WHAT IS INTERVENTIONAL GLAUCOMA?

Sahar Bedrood, MD, PhD

Interventional glaucoma is a proactive, rather than reactive, approach to managing glaucoma with the primary goal of preventing blindness. It entails early and predictive diagnostics, active disease monitoring, and procedural interventions early in the treatment paradigm. This approach involves intervening before significant disease progression manifests, avoiding medication stacking, and not presuming patient compliance with drop therapy. Early and predictive diagnostics encompass analyzing risk factors for glaucoma development and assessing ocular biomechanics. Providers should schedule regular follow-up visits and conduct comprehensive structural and functional progression analyses. Procedural intervention with innovative techniques like procedural pharmaceuticals and MIGS may be used at an earlier disease stage.

WHY IS INTERVENTIONAL GLAUCOMA NEEDED?

Manjool Shah, MD

The conventional approach to glaucoma management typically involves escalating treatment with multiple drops and resorting to more invasive procedures as the disease progresses. The effectiveness of this approach can be questioned, especially in more advanced cases of glaucoma. Many patients face significant challenges with topical therapy, including side effects, cost, inconvenience, and even forgetfulness. Therefore, it is important to explore more proactive strategies to improve patient adherence and outcomes.

WHAT ARE THE BARRIERS TO INTERVENTIONAL GLAUCOMA ADOPTION?

Shivani Kamat, MD

According to a recent MarketScope survey, glaucoma specialists use only 10% of MIGS devices in standalone procedures.¹ The other 90% of usage occurs via combined cataract procedures. Respondents cited several barriers to adopting standalone MIGS, including significant education for physicians and patients, concerns over safety and efficacy, disruption to workflow, reimbursement challenges, and associated costs.¹ However, these barriers can be addressed by increasing access to devices, providing targeted education to boost physician confidence, and developing efficient workflow strategies that integrate MIGS into clinical practice. Overcoming these hurdles will support the adoption of MIGS as an early intervention, helping to stabilize glaucoma earlier in the disease course while improving patients' quality of life.

PRACTICAL APPLICATIONS OF INTERVENTIONAL GLAUCOMA

I. Paul Singh, MD

In the past, glaucoma specialists had to prioritize either patient compliance or safety; with the interventional glaucoma approach, these goals can be achieved simultaneously. The variety of available treatment options helps tailor care to the individual based on factors such as disease severity and subtype. This departure from the traditional approach of starting with drops and progressing to more invasive interventions marks a significant shift in glaucoma management. Providers must possess confidence in the procedures and technologies they offer, enabling surgeons to effectively educate patients on the potential need for multiple procedures or technologies throughout their life span. To embrace the interventional mindset, physicians should prioritize presenting interventions as the initial course of action, recognizing the ongoing value of treatment despite potential impermanence. A surgeon should focus on maintaining the highest quality of life for patients while protecting the nerve from damage by lowering pressure. This may involve multiple treatments over time, with varying effectiveness for each patient, but the good news is that we have options.

1. Market Scope Q1 2023. Interventional Glaucoma Survey. Licensed to Glaukos Corporation.