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BLOG: Get under your shelter, the glaucoma storm is upon us
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If you haven’t remained current with what is going on in the field of glaucoma, then you might have woken up in the eye of the hurricane. It actually started several years ago with a few clouds as selective laser trabeculoplasty was introduced. Among other things, SLT attempted to safely bridge the gap in the treatment paradigm between drops that had compliance issues and gold-standard trabeculectomy and tube shunt surgery that had significant risk. This led to a new breeze in the air with the adoption of Trabectome from NeoMedix. Then came some unexpected thunder bolts with iStent from Glaukos that startled some, causing them to put on their coats.
Before everyone had a chance to get bundled up, it started to rain with canaloplasty and ab interno trabeculotomy. This rain, however, was not normal as it came from all different sides, ranging from ABiC (Ellex) to GATT, Trab360 (Sight Sciences) and Kahook Dual Blade (New World Medical). There was even some hail seen from ECP and MicroPulse (Iridex). We then all realized that this storm was not the usual spring shower. With the blink of an eye, there were flash floods with old once-impenetrable barriers going down as CyPass (Alcon) and Xen (Allergan) appeared. What was once a quiet landscape where grass grew slowly for years became a procedural hurricane in our specialty.
Now, for a short moment, the weather has settled down. However, we all understand that this is just the eye of the hurricane. There is still the second half to come. What will this look like? At least from this view we will have even more weather that would include Hydrus (Ivantis), iStent inject and Supra, and InnFocus (Santen). Will things ever be the same again, where we go from eye drops to trabs and tubes? Probably not. We may still be in the same location, but the environment is no longer the same.
But unlike the actual destruction we see from a real-life hurricane, the aftermath of this glaucoma hurricane will leave behind a productive field able to have fruitful growth. The landscape just changed right before us — glaucoma is becoming more of a procedure-oriented subspecialty with management using lasers and MIGS. This relationship from laser to surgery also is not a one-way street. With the growth and acceptance of MIGS by physicians and patients, the use of laser gains momentum in order to decrease or eliminate drops. What could be left behind after this procedural storm is an environment of “SLT and MIGS” besides the usual “MIGS and meds.” The exciting part is the bright future ahead of us and our patients.
Disclosure: Teymoorian reports he is a consultant for Alcon, Allergan, Glaukos and Ellex.