Eyeworld

I MAY 2020 | EYEWORLD | 61 Contact Brown: reaymary@comcast.net Huang: lindayhuangmd@gmail.com Swaminathan: sswaminathan@med.miami.edu 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 concur- rent 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 pa- tients is another exciting possibility, Dr. Brown said. "The opportunity in patients who've had cataract surgery is the biggest untapped oppor- tunity without the burden of medical therapy," he 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 avail- able as well. Using laser and MIGS alternatives The pendulum seems to have swung in favor of laser and surgical treatments in modern glau- coma 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 treat- ment, 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 About the doctors Reay Brown, MD Atlanta Ophthalmology Associates Atlanta, Georgia Linda Huang, MD Glaucoma Institute of Northern New Jersey Rochelle Park, New Jersey Swarup Swaminathan, MD Assistant professor of clinical ophthalmology Bascom Palmer Eye Institute Miami, Florida Relevant disclosures Brown: Glaukos, Sight Sciences Huang: Glaukos, Sight Sciences Swaminathan: None A patient regularly uses multiple glaucoma medications in the left eye (pictured right), which exhibits significantly more redness than the right eye, in which no medications are used (pictured left). Source: Reay Brown, MD

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