Eyeworld

30 | EYEWORLD BONUS ISSUE | FEBRUARY 2025 G UCOMA Contact McCabe: cmccabe13@hotmail.com Simpson: Rachel.Simpson@hsc.utah.edu residency and wanted a place that was desig- nated for that. I think people are recognizing the need out there to help people develop these skills," she said, adding that both ASCRS and AAO offer wet labs in this area. Dr. McCabe said there are MIGS symposia at all major meetings. "Stay informed because this is a very fast-paced and evolving space right now; it's exciting to see what's coming, and there's good data coming out," she said. "Some- times it's not a new device you'll learn about, but maybe you'll get long-term data that's important in comparing efficacy and different choices, and that's great to see, too." If you can go to a skills transfer lab, she said that is a great opportunity. The models for the space, for the angle, are improving, and some of the dry lab models allow you to acquire the exact skills you need for a new technique. we're trying to avoid that have complications, like trabeculectomies and tubes. An exciting development, Dr. McCabe said, is the area of sustained drug delivery. She noted Durysta (bimatoprost intracameral implant, AbbVie) and iDose TR (travoprost intracamer- al implant, Glaukos). There are others in the pipeline that might be easier to access for the general ophthalmologist who doesn't want to acquire skills to look in the angle, she said, add- ing these will allow for more treatments that are longer term before surgical intervention needs to happen. She mentioned the SpyGlass Pharma Drug Delivery Platform, which has so far shown significant, long-term, stable IOP reduction. It's "clipped on at the optic-haptic junction to the IOL," Dr. McCabe said. "The reason I'm excited is because [it has] nice long-term results so far in terms of pressure lowering. But second, there's no additional skill needed. It's an IOL that goes into the eye like any other IOL." Dr. Simpson noted that when it comes to diagnostics and testing, what she relies on if she's trying to decide if a patient needs a MIGS procedure or other glaucoma surgery is OCT to determine if their glaucoma is stable or pro- gressing and preoperative gonioscopy. New technology is exciting, she said, but "when you're talking about glaucoma decision making that's tried and true, and if I'm trying to decide what type of surgery I'm going to do … it's what their goal pressure is and how many medications, and I don't need anything fancy to make those decisions." The toolkit starts with a broad understand- ing of each option that is available, Dr. Simpson said, as well as when to use what. She noted that there are many resources to obtain the necessary skills. Her university had a glaucoma MIGS masterclass designed for surgeons in prac- tice who wanted to develop their angle-based surgical skills. "It was geared for comprehensive doctors who felt like they didn't get enough in continued from page 29 Nathan Radcliffe, MD, EyeWorld Glaucoma Editorial Board member, shared his thoughts on interventional glaucoma: "The traditional glaucoma treatment paradigm of 'drops then laser then surgery' has been uprooted with new data and approaches for SLT and the availability of standalone MIGS and drug delivery. While a new treatment pathway has not yet been solidified, it is clear that laser, drug delivery, and MIGS options should be used much earlier in treatment than they are being used today." INTERVENTIONAL GL AUCOMA

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