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Individualized glaucoma surgery offers effective results
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WAIKOLOA, Hawaii — Glaucoma surgery should be individualized to each patient’s specific needs and form of glaucoma, a speaker said here.
According to Thomas W. Samuelson, MD, OSN Glaucoma Section Editor, reducing glaucoma surgical complications is now easier for physicians due to the availability of the correct surgical tools.
Thomas W. Samuelson
“In the past, there’s been a huge safety gap,” he said at Hawaiian Eye 2013. “It’s been tough to decide when to operate for glaucoma. Medications and laser as initial treatments, but the big gap is between trabeculectomy and tube shunts. We’ve built that gap with timely cataract surgery.”
Samuelson said the most important factor to determine when dealing with a cataract patient is the status of the lens.
He said he rarely performs cataract surgery on a patient with a clear lens or who is asymptomatic, usually waiting for cataract symptoms.
“If a patient has definite cataract and needs lower intraocular pressure but is asymptomatic, I will nudge them a bit toward earlier cataract surgery if it means sparing them a glaucoma operation,” Samuelson said.
Transscleral surgery should only be performed on patients who are at high risk of developing functional impairment from glaucoma or who have failed minimally invasive glaucoma surgery, he said.
Samuelson also said that trabeculectomy should be performed on patients who are at high risk of severe vision loss and that the surgery is not ideal for those who are at low risk of significant functional vision impairment.
Disclosure: Samuelson is a consultant for, receives research support from, and is on the advisory board for Alcon Surgical, Glaukos and Ivantis.