EyeWorld India September 2020 Issue

EWAP SEPTEMBER 2020 51 GLAUCOMA including preservative-free medications, new drops with daily dosing, new combination drops, and laser therapy, Dr. Huang said. Newer approaches to treatment such as intracameral sustained delivery of medications and sustained- release drug delivery systems may reduce the need for topical administration, Dr. Swaminathan said. “All of these advances have improved the armamentarium of glaucoma specialists in providing options to patients prior to surgery,” he said. Of course, more surgical options are available as well. Using laser and MIGS alternatives The pendulum seems to have swung in favor of laser and surgical treatments in modern glaucoma treatment, Dr. Brown said. For instance, laser trabeculoplasty is now more popular and is as safe and as good as adding a medication. However, one barrier that he has seen is patient acceptance. “Somehow we’ve created a feeling among patients that laser use is a very dramatic treatment, and they have the sense that it indicates that their glaucoma is very bad,” Dr. Brown said. For this reason, glaucoma specialists and their staff should spend some chair time to properly explain what laser treatment can offer and how it is a positive alternative to more medications, he advised. The acceptance of laser use over medications needs to permeate among ophthalmologists and staff for patients to accept that message, Dr. Brown added. Surgical interventions that fall under the category of traditional conjunctival glaucoma surgery (such as trabeculectomy and aqueous shunt implantation) are also available. However, Dr. Swaminathan prefers to consider MIGS options such as viscocanalostomy or goniotomy in patients who have controlled IOP but have significant adverse effects with medications or younger patients who would prefer to avoid conjunctival surgery. Schlemm’s canal stenting procedures can be considered during concurrent cataract surgery, he added. “Newer MIGS procedures can also lower pressures and decrease medications but with less risks than traditional glaucoma procedures,” Dr. Huang said. “Given the improved safety profile, MIGS procedures can be offered sooner along the treatment algorithm.” This is something that Dr. Brown has seen as well, especially for patients whose burden of medical therapy is too great financially or in terms of adherence. The use of MIGS in cataract surgery patients is another exciting possibility, Dr. Brown said. “The opportunity in patients who’ve had cataract surgery is the biggest untapped opportunity without the burden of medical therapy,” he said. EWAP Editors’ note: Dr. Brown practices at Atlanta Ophthalmology Associates Atlanta, Georgia, and has relevant interests with Glaukos and Sight Sciences. Dr. Huang practices at the Glaucoma Institute of Northern New Jersey, Rochelle Park, New Jersey, and has relevant interests with Glaukos and Sight Sciences. Dr. Swaminathan is assistant professor of clinical ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, and declared no relevant conflicts of interest. Webinar2.indd 3 01/09/2020 11:12 AM