VIDEO: New treatment paradigms mark evolution of glaucoma care

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Over the last number of years in the field of glaucoma, we've seen a lot of new and interesting treatment approaches grow. In my mind, there's sort of three tenets to this growth. One is been improved data for laser trabeculoplasty, procedure's been around, but our knowledge about when to use it and using it early has grown. Secondly, we've had a full new field, maybe two, come along. The first of those new fields was the field of MIGS.

It all started with adding trabecular bypass stents to cataract surgery. But we now have additional procedures that don't involve stents, goniotomy, canaloplasty, even now a new area of biocompatible implants placed at this point in the supraciliary space. But we realized that the MIGS options also can be standalone treatment options. So that really changes the paradigm, 'cause we're not waiting for cataract surgery anymore to intervene, and we know these procedures are efficacious and very safe.

The third really major new treatment paradigm that's evolved really in the past five years, although it's taken probably decades of development, has been drug delivery. And drug delivery allows us to address our patient's issues with compliance, tolerability of medication, difficulty administering medications, and allows us really to provide pharmacotherapy, but in a paradigm that isn't dependent on the ocular surface or the patient's compliance.

When you put all of these three major developments in the field of glaucoma together, you see an entirely disrupted traditional treatment pattern, where we used to always start with drops, move to laser too late, and then do serious glaucoma surgery. Now, we have all these different options, probably beginning with laser, and then you can quickly move to either drug delivery or any of these MIGS options to be sort of early aggressive, but in a safe manner, and one that's really focused on helping the patient with their quality of life, while controlling the glaucoma.

So it's an exciting time. The new options are here, and we have lots of places to use them, and most of those places really are earlier in the treatment paradigm.