EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1521228
62 | EYEWORLD | SUMMER 2024 G UCOMA by Manjool Shah, MD Glaucoma Editor Profound changes in the glaucoma field T he glaucoma genie has been quite good to us in the last decade, granting us the wish of having a family of safer interventions that we can apply to so many of our patients in order to help them achieve greater qualities of life. From the MIGS revolution to the rise of sustained drug delivery, the practice of glaucoma has changed in a profound way in the direction of the ulti- mate wish of every caring physician—becoming more patient-oriented and precise while still being generalizable and within reach to many more practitioners and patients. But as every journey with a genie seems to reach a point of conflict only after wishes are granted, we are beginning to see some of the downstream effects of the paradigm shift we are experiencing. While we continue to develop and hone great strategies to employ in the clinic and operating room, we still struggle to determine who the best patients are for a given treatment, how to create robust pathways to think and integrate new technologies into the developing toolkits of our trainees and colleagues, and how to evaluate our outcomes and choose from the wealth of strategies out there. In this issue of EyeWorld, we attempt to tackle some of these challenges, often raising questions and opportunities for innovation while highlighting what we have available today. We highlight some of the unique and out- of-the-box tips that stole the show at the ASCRS Annual Meeting's Glaucoma Essentials sym- posium this spring, helping us hopefully make some sense of the large and evolving world that is glaucoma. We discuss the evolving role of genetics in glaucoma, a complex relationship that I wish will one day enable us to better serve our patients on the macro level by targeting our screening and monitoring and on the micro level by helping us eventually tailor our inter- ventions to specific pathophysiology. In an effort to better train our residents, fellows, and future colleagues, we highlight the changing landscape of residency training in MIGS, demonstrating the promises and chal- lenges of the paradigm shift toward interven- tional glaucoma that we are continuing to bear witness to. While the words "I wish" are often colored by a tinge of regret and melancholy, my mind goes instead to the journey we've already taken and the one we have ahead. It has been and continues to be a journey of progress, inno- vation, collective action, mutual support, and growth, and fortunately, the glaucoma genie doesn't seem to have run out of wishes left to grant. Nathan Radcliffe, MD, Glaucoma Editorial Board member, shared what he wishes he had: I wish I had known throughout my whole career that SLT is the ideal first-line therapy. When I was trained in fellowship in 2007, it was presented to patients late in glaucoma, just before a trabeculectomy was to be rec- ommended. It didn't work that well in that scenario, and we hadn't been giving the laser its best opportunity to work. I know to- day, based on many studies published over my career and culminating in the prospec- tive, randomized, controlled, multicenter Laser in Glaucoma and Ocular Hyperten- sion (LiGHT) study, that SLT is the ideal first- line therapy, beating latanoprost in many important metrics such as need for incisional surgery and visual field progression. I WISH I HAD ...