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Do physicians have an obligation to provide all the newest glaucoma surgical procedures and devices to patients in their practices?
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 George L. Spaeth |
Physicians do not have an obligation
Surgeons do not have a responsibility to offer every or even any new procedure to their patients. By definition, most new surgical procedures are still experimental — that is, their long-term risks and benefits have not been established. It usually takes years before the true value of a procedure can be established. I usually counsel my patients to be aware of the uncertainties of every “newest procedure” and not to have one unless they like the idea of trying something unproven. Osler’s advice about not being the first to try a new treatment nor the last to discard an old one is wise.
George L. Spaeth, MD, is an OSN Glaucoma Board Member.
 Richard A. Lewis |
New procedures offer new options
Glaucoma surgery no longer comes in one size. The new procedures, such as canaloplasty (iScience), Trabectome (NeoMedix) and others soon to be approved, are safer short- and long-term as compared with trabeculectomy. In addition, the modified procedures of old, such as the Ex-PRESS shunt (Optonol), have helped to standardize the sclerostomy and should enhance efficacy. These plus the drainage devices, endoscopic cyclophotocoagulation and others are all valuable tools that will likely change the approach of glaucoma from a medically to a surgically treated disease.
Understanding when, where and how to do these surgeries is important and necessary to manage glaucoma for years to come.
Richard A. Lewis, MD, is an OSN Glaucoma Board Member.