EyeWorld Asia-Pacific December 2017 Issue

September 2017 3 EWAP EDITORIAL Dec EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Hiroko BISSEN-MIYAJIMA, Japan Hungwon TCHAH, Korea ASIA-PACIFIC CHINA EDITION Regional Managing Editor YAO Ke Deputy Regional Editors HE Shouzhi ZHAO Jialiang Assistant Editors SHENTU Xing-chao ZHOU Qi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN Deputy Regional Editor Abhay VASAVADA ASIA-PACIFIC KOREA EDITION Regional Managing Editor Hungwon TCHAH Deputy Regional Editor Chul Young CHOI John CHANG, Hong Kong Johan HUTAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Ronald YEOH, Singapore S. NATARAJAN, India Sri GANESH, India YAO Ke, China Y.C. LEE, Malaysia Cataract+ Graham Barrett Chief Medical Editorial EyeWorld Asia-Paci c T he treatment of glaucoma poses a major challenge for patients and ophthalmologists alike. Although the underlying pathogenesis is a neuropathy and there are several factors contributing to ongoing field loss, manipulating the intraocular pressure (IOP) remains the mainstay of treatment of the disease process. New pharmacological agents, particularly prostaglandin agonists, have transformed the medical treatment of glaucoma and the majority of patients can be controlled with a daily dose of a single agent or combination treatment. Successful management of the disease, however, requires ongoing treatment over several decades with continued observation to ensure the medical regime is adequate. Laser trabeculoplasty has a modest effect, which may not be long-lasting, and surgical options, particularly trabeculectomy or tubes, have been the most effective surgical procedures to control IOP when medical treatment is inadequate. The dawn of a new age of microinvasive glaucoma surgery (MIGS) in the last decade has opened a new avenue for safer surgical treatments. MIGS devices such as the iStent have been used in a complementary fashion combined with cataract surgery to improve control and possibly reduce the number of medications required after cataract surgery. Newer MIGS devices, however, appear to be more effective. In addition to the trabecular micro- stents, alternative routes of drainage such as the suprachoroidal space with the CyPass device are becoming available. In addition, the XEN device is a new alternative to true subconjunctival drainage, with reduced risks compared to conventional trabeculectomy. As we gain more experience, the clinical situations which are best suited to individual devices will become apparent as discussed in this issue of EyeWorld Asia-Pacific . Historically, glaucoma surgery was practiced quite widely by anterior segment surgeons and early on in my career I often performed either trabeculectomy or combined phaco/trabeculectomy. As the efficacy of medical treatment improved, the frequency of glaucoma surgery declined and these procedures largely became the preserve of glaucoma specialists. It is interesting to speculate that with the advent of new MIGS devices the paradigm will change again and I suspect that glaucoma surgery will once again become widely practiced by cataract and anterior segment surgeons and not limited to the glaucoma subspecialty. EWAP “ Historically, glaucoma surgery was practiced widely by anterior segment surgeons...It is interesting to speculate that with the advent of new MIGS devices the paradigm will again change and I suspect that glaucoma surgery will once again become widely practiced by cataract and anterior segment surgeons and not limited to the glaucoma subspecialty. ” –Graham Barrett, MD