Eyeworld

104 | EYEWORLD | SPRING 2025 G UCOMA Relevant disclosures Kahook: Alcon, FCI, New World Medical, SpyGlass Pharma Contact Chen: rebeccaichen@gmail.com Kahook: malik.kahook@gmail.com Noecker: noeckerrj@gmail.com When treating these patients, Dr. Chen said the best approach varies depending on the indi- vidual situation. "I usually work with the patient and the provider who prescribed the steroids to determine if there are any alternatives to steroid therapy. It is ideal if the steroid can be discon- tinued or switched to steroid-sparing therapy. We also assess whether reduced drug dose, frequency, or potency is an option," she said. "For many patients, steroids are a medically necessary treatment. In those cases, we focus on controlling IOP while the patient is on steroid therapy." Dr. Chen said that a typical first-line approach is to start ocular hypotensive medica- tions (usually eye drops) to lower the eye pres- sure. If that is insufficient, surgical procedures may be considered. Reversibility In most cases, IOP returns to normal with- in a few weeks after cessation of the steroid, Dr. Chen said. "However, in some cases, IOP remains elevated even after the medication is discontinued. Steroid exposure induces changes to the tissue that makes up the eye's internal drainage system. As a result, there is a 'bottle- neck' effect in the drainage outflow that leads to increased intraocular pressure." Steroid-induced IOP elevation is often re- versible if detected early and treated promptly, Dr. Kahook said. Upon discontinuation or re- duction of the steroid, IOP generally normalizes over several weeks, and further glaucomatous damage can be prevented. "However, if optic nerve damage or significant visual field loss has already occurred, those effects are irreversible. This underscores the importance of early detec- tion and intervention." Additional thoughts Dr. Noecker again stressed the importance of checking the eye pressure. "We get lazy when everything looks good after routine procedures, but there is value in checking the eye pressure," he said. Dr. Kahook also stressed that close monitor- ing of IOP is critical for any patient on steroids, particularly those in high-risk groups. "Baseline IOP measurement, followed by periodic moni- toring, is essential for detecting early changes." He added that educating patients about the potential risks of steroid use and the importance of adherence to follow-up appointments can significantly mitigate the risk of steroid-induced glaucoma. continued from page 103

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