Eyeworld

74 | EYEWORLD | FALL 2024 G UCOMA by Manjool Shah, MD Glaucoma Editor H umility is the mark of the experienced surgeon, and every patient encounter is an occasion to learn and be humbled. Nowhere is that truer than in the glauco- ma operating room. The same surgery, performed the same way, in the same patient type, treating the same disease can yield dramatically different outcomes. Understanding why our procedures work and why they don't enables us to do better the next time, and the desire to achieve greater standardization and predictability has given birth to a wealth of innovation and invention in our space. Our patients look to us to provide them with the best possible advice and expect us to continue to improve as the breadth of knowl- edge and wisdom expands. By doing so, not only do we live up to the ideals and principles we signed up for when we started this journey in medicine, but we ensure that our clinical lives remain rich and fun. There is very little more rewarding than overcoming an obstacle. In this issue, we delve into some of the chal- lenges of common glaucoma surgeries, as well as discuss exciting new technology that may provide us an opportunity to overcome barriers and provide high-quality care in a safer and more predictable fashion. Inder Paul Singh, MD, and Richard Lewis, MD, shared their thoughts on some of the exciting new laser-based surgical technolo- gies that will further broaden our interventional glaucoma toolkit. These new lasers will hopeful- ly streamline our operating room procedures, as is the case with excimer laser trabeculostomy, as well as expand the ease of SLT with the direct SLT technology. The femtosecond laser trabecu- lostomy technique could bridge the gap between office and operating room-based therapies, and the ramifications therein could be quite exciting. Jithin Yohannan, MD, and Ang Li, MD, provided their insights on optimizing outcomes with one of my favorite procedures, the XEN Gel Stent (AbbVie). Truly a versatile device, the XEN often hits a sweet spot in terms of risk-ben- efit ratio, and Drs. Li and Yohannan shared learnings that are likely to be useful for the other devices in the emerging MIBS (micro-in- vasive bleb surgery) space. Finally, Jacob Kanter, MD, Poonam Misra, MD, and Ying Han, MD, PhD, shared their pearls and tricks for placing tube shunts. I have often considered a well-placed shunt to be the Swiss army knife of glaucoma surgery, and reading our contributors' suggestions has given me a few new ideas to try next week. As Alan Crandall, MD, used to say, "The only way to not have complications is to not op- erate." The necessity of handling the challenges that we all have and will continue to face has been the mother to a tremendous set of ever-ex- panding innovations, and the glaucoma toolkit continues to broaden and deepen. I hope we all continue to find joy in our work by relishing in our victories today and identifying the challeng- es we hope to knock down tomorrow. Opportunities to overcome barriers and provide high-quality care The necessity of handling the challenges that we all have and will continue to face has been the mother to a tremendous set of ever- expanding innovations, and the glaucoma toolkit continues to broaden and deepen.

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