Lecturer: Glaucoma treatment paradigm needs to shift to more proactive approach
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Key takeaways:
- The interventional glaucoma treatment paradigm should shift from reactive to proactive treatment.
- An overreliance on medication in glaucoma treatment should be addressed.
SAN DIEGO — It may be time for a new approach to initial and stepwise interventional therapy in glaucoma, according to a speaker here.
“I think our current model ... is very much a passive model,” Iqbal Ike K. Ahmed, MD FRCSC, said during the Stephen A. Obstbaum, MD, Honored Lecture at Glaucoma Day at the American Society of Cataract and Refractive Surgery meeting.
According to Ahmed, the current glaucoma treatment paradigm begins with watching and waiting for progression, rudimentary risk analysis and a heavy reliance on medications, which may not be the best way to treat patients anymore.
“I think it goes without saying that we don’t really assess compliance well, but this is a mainstay of why we think medications have limitations,” Ahmed said. “Adherence is a problem, and when adherence is not well performed by patients, patients get worse and they progress.”
Ahmed proposed that elevated IOP is an interventional problem and that oftentimes the best way to treat the earlier patient with mild to moderate glaucoma who does not need aggressive surgery is through medical therapy.
“You may say, ‘Why, what’s the rush?’ Well, glaucoma is only young once,” he said. “Eventually, glaucoma gets old, and glaucoma gets hard to treat. So, the advantages of treating earlier to me are somewhat apparent. This is what the new paradigm is, I believe, for mild to moderate glaucoma.”
A more proactive treatment plan may include considering selective laser trabeculoplasty as a first-line treatment, performing stand-alone MIGS sooner rather than later and using medications as a supplemental bridge therapy rather than continuing with a heavy reliance on them.
“Maybe we’re going to come to the day where we think about doing things a little bit different — where medications are supplemental, where they’re bridges, where we go from one intervention to the next because we’re confident with the safety and the patient benefit and the comfort in our hands and our clinical settings as well,” Ahmed said.
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Ahmed IIK. Interventional glaucoma: A technological paradigm change. Presented at: American Society of Cataract and Refractive Surgery meeting; May 5-8, 2023; San Diego.
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