Eyeworld

FEBRUARY 2025 | EYEWORLD BONUS ISSUE | 11 G the single digits to low teens to have the oppor- tunity for intervention, hopefully further down the road, to decrease failure rates." Dr. Yadgarov said that current options for interventional glaucoma include SLT, procedure pharmaceuticals (such as bimatoprost intraca- meral implant, Durysta, AbbVie, and travoprost intracameral implant, iDose, Glaukos), and MIGS. The current standalone MIGS are goniot- omy blades, catheter-based canaloplasty with or without trabeculotomy, and the iStent infinite. He stressed that MIGS should be offered to all patients who have either intolerability to medication, suboptimal compliance to medica- tion, or signs of progressive disease. MIGS can work in all stages of glaucoma, but surgeons need to be mindful that in mod- erate to advanced stages, patients need to be monitored closer, he said. "I would not try to re- duce medication burden, but instead use MIGS as an adjunct to medication to prevent further progression." Meanwhile, for mild to moderate glaucoma, Dr. Yadgarov said MIGS can be a great way to control IOP and reduce medication burden. At this time, Dr. Ristvedt said standalone options include viscodilation with trabeculot- omy (like OMNI or iTrack, Nova Eye Medical), goniotomy (like the KDB, New World Medical, TrabEx, MST, and SION, Sight Sciences), three stents (iStent infinite), cyclophotocoagulation (like ECP or MicroPulse, Iridex), and minimally invasive bleb surgery (XEN, AbbVie). options, Dr. Yadgarov said, adding that inter- ventional glaucoma prior to MIGS consisted of tube shunts and bleb surgeries, which are high risk and highly invasive. "Due to the introduc- tion of various MIGS into the market and the backing of peer-reviewed evidence supporting their efficacy and safety, interventional glauco- ma has taken off and has empowered doctors to provide these options to patients," he said. "The overarching reason we need MIGS is that medications have too many inherent flaws, such as intolerances, forgetfulness, cost, and lack of long-term adherence, which is a big contributor to glaucoma progression. Therefore, we need MIGS as an option to circumvent the inherent drawbacks that eye drops are associated with. Interventional glaucoma allows the doctor to treat the glaucoma instead of relying on daily patient adherence." Dr. Ristvedt said she continues to cele- brate the many options and how the treatment paradigms have expanded over time. "We now have procedural pharmaceuticals that can be used across ocular hypertension and all stages of POAG, giving us options to bridge our sur- gical procedures. SLT has become accepted as first-line therapy, avoiding a long-term commit- ment to daily drops. We now have the option of doing a standalone procedure like the OMNI Surgical System [Sight Sciences], which dilates and opens up the meshwork, or iStent infinite, which uses three stents to bypass the trabecular meshwork," she said. "MIGS has allowed us to look at the long-term game and judge what we can do now and what we will be able to do down the road to lessen medication burden, provide more stable reduction in IOP over a 24- hour period, and hopefully reduce the amount of blindness from glaucoma." She said that is why interventional glauco- ma is so important—to treat the whole person and being in it together. "I continue to believe that we still need more invasive procedures available, like trabeculectomy and tube shunts. However, with this shift in mindset and more options available, it is my hope that we see less progression in visual field loss by optimizing treatments that are more safe and still effective. This will allow those who really need an IOP in continued on page 12 OMNI Surgical System Source: Inder Paul Singh, MD

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