Eyeworld

80 | EYEWORLD | DECEMBER 2021 most experienced glaucoma surgeons can have challenges managing these problems, so we asked experts to update us on the best practices for addressing these complications. We also take a look at a serious occupational hazard to being an ophthalmologist, the issue of ergonomics. How we use our bodies during the challenging job of eye examinations and treatments is of critical importance for all of us. Again, managing glaucoma is not an easy job. I hope you will find that this issue provides you with information and insights that make your day just a little bit easier. by Nathan Radcliffe, MD Glaucoma Editor As a specialist who wants all ophthalmologists and optometrists to engage deeply in the care of glaucoma, I am sometimes guilty of trying to make the disease sound easy. This is because I know we have too many glaucoma patients in this world to be cared for just by the specialists, and because I know the early detection and treatment of the disease will ultimately improve outcomes. M anaging glaucoma is not easy. The disease has not been cured and is often difficult to diagnose. All glaucoma therapies have side effects, and less than half the time, a single intervention or therapy will be success- ful. In any long-term study of the disease, the overwhelming majority of patients worsen. All of these problems pale in comparison to the difficulties a surgeon might experience in and around the operating theater when treating glaucoma. As a specialist who wants all ophthalmol- ogists and optometrists to engage deeply in the care of glaucoma, I am sometimes guilty of trying to make the disease sound easy. This is because I know we have too many glaucoma patients in this world to be cared for just by the specialists, and because I know the early detec- tion and treatment of the disease will ultimately improve outcomes. A big part of this mission for me and my community over the past 10 years has been encouraging cataract surgeons to perform MIGS procedures. In many ways we have been successful, and the procedures have grown, but unfortunately, Medicare has reduced reimbursements to the point where physicians are essentially being asked to pay money out of their own practices in order to take care of their patients with MIGS devices. MIGS is overall a safe and efficient treatment, but there are problems and headaches with even the safest therapies that require complex decision making, extensive surgical time and attention, and at times, exhaustive postoperative care. In this issue of EyeWorld, we look at some of the most difficult topics involving complica- tions from glaucoma surgery: tube exposure, bleb leaks, and malignant glaucoma. Even the G UCOMA Not an easy job

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