EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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DECEMBER 2020 | EYEWORLD | 115 G by Liz Hillman Editorial Co-Director Dr. An said more than half of her patient population at a university center in the Mid- west has advanced glaucoma and a lot of other comorbidities. "Drops still have quite an important place in my patient population," she said. Dr. Herndon said different treatment op- tions are recommended for patients based on their current and target pressures. Paradigm shift to first-line SLT Where interventional glaucoma has its prime time, Dr. An said, is early in the disease process. All of the physicians said they offer SLT as a first-line therapy to newly diagnosed patients. Each mentioned the LiGHT trial as shifting the paradigm toward laser being considered a first- line therapy. 1 W here do drops fit in the era of interventional glaucoma—a time when there are new technolo- gies, new drug delivery systems, and several MIGS options? It's a time where patients' treatments can be fine-tuned based on their need and availability of these newer agents, said Leon Herndon Jr., MD, but he, Jella An, MD, Jacob Brubaker, MD, and Lori Provencher, MD, all said there is still a significant place in their practice for drops. "From my standpoint, I think that medica- tions serve a couple of roles," Dr. Brubaker said. "One of them is if patients need adjuncts; in the more moderate to severe glaucoma, they, in a lot of cases, need more than one medication to be controlled. In those patients where they're on 2–3 medications, it's less likely that [selective la- ser trabeculoplasty (SLT)] or a sustained-release is going to be sufficient." Where do eye drops fit in the era of interventional glaucoma? About the physicians Jella An, MD Medical Director Mason Eye Institute East University of Missouri Columbia, Missouri Jacob Brubaker, MD Sacramento Eye Consultants Sacramento, California Leon Herndon Jr., MD Chief of Glaucoma Duke Eye Center Duke University Durham, North Carolina Lori Provencher, MD Cincinnati Eye Institute Cincinnati, Ohio Open conjunctiva ab externo placement of a XEN Gel Stent. This technique can achieve a low target IOP, reducing or eliminating drops, while still providing a rapid visual recovery and favorable safety profile. Source: Lori Provencher, MD continued on page 116