PUBLICATION EXCLUSIVE: Advances in glaucoma management blur the barriers between subspecialties

Glaucoma management has undergone significant advancements in recent years. New minimally invasive surgical options have become available, filling in the gap between medical management and major surgeries such as trabeculectomy and tubes. On the diagnostic side, OCT technology has allowed a better understanding of the pathophysiology of glaucoma and more accurate monitoring of the effects of treatment, and has broadened the view to new imaging markers for progression. Glaucoma has opened up as a subspecialty to share areas of interest with other subspecialties and even other branches of medicine.

“The life of a glaucoma specialist has become a lot busier with so many options. We wear many hats now, and it is great to be able to wear a white hat with MIGS for our patients rather than the black hat we used to wear previously in many cases, when we could only offer invasive surgery with a high risk of complications,” E. Randy Craven, MD, said.

MIGS has brought radical changes in the way cataract and glaucoma treatments are combined. Cataract surgery was used previously as a stand-alone procedure to lower IOP, but now the two procedures work synergistically in a safe manner.

E. Randy Craven, MD, says he personally welcomes the widespread use of MIGS devices by cataract surgeons.

“MIGS has also shifted a significant portion of glaucoma treatment in the hands of the cataract surgeon. It is tempting, and it makes sense to implant a MIGS stent in a patient who has glaucoma and needs a cataract operation,” Craven said.

While some glaucoma specialists are still reluctant to jump into the MIGS space due to efficacy concerns, cataract specialists have greatly increased the number of glaucoma patients who are managed now with MIGS.

“This is a positive aspect of the crossover between specialties. In addition, cataract surgeons have high operating skills as they perform a much higher amount of procedures and perform them in a patient population that has earlier disease and a higher likelihood of responding to surgery. So, I personally welcome the widespread use of MIGS devices by cataract surgeons,” Craven said.

Managing blebs

“Certainly a number of these devices are suitable to be used by cataract surgeons, typically the blebless MIGS that involve no bleb management postoperatively. They are safe procedures which take just a couple of extra minutes, so it is very convenient to implant these devices at the time of cataract surgery,” Ingeborg Stalmans, MD, PhD, said.

Click here to read the full publication exclusive, Cover Story, published in Ocular Surgery News U.S. Edition, August 25, 2017.