Eyeworld

64 | EYEWORLD | SUMMER 2025 G UCOMA by Manjool Shah, MD Glaucoma Editor cut out for us. Fortunately, there are more sus- tainable practices we can adopt. These include making sustainable choices about surgical and diagnostic equipment as well as leveraging tele- health and home monitoring devices. The Ara- vind Eye Care System is cited as an example of how extensive reuse can be implemented while maintaining low complication and infection rates; we can and should strive to mirror best practices from our colleagues around the world. Finally, the concept of virtual visual fields, initially embraced out of necessity, has rapidly demonstrated its potential as a versatile tool. Virtual reality (VR) headsets offer ergonom- ic benefits for patients, including those with mobility or neck issues, and are generally well-liked and easy to use. For practices, they provide efficiency, completing tests in just 2–3 minutes, reduce bottlenecks caused by tradi- tional machines, and are portable and easier to maintain. Some physicians envision this technology becoming the standard of care in 10–20 years. While some are still studying their accuracy for monitoring progression and not yet using them for clinical decisions, the potential benefits are clear: easier testing, more efficient clinic resource use, lower cost, portability, and the possibility of home testing. Hand-in-hand with advancements in diagnostics is the potential of artificial intelli- gence (AI) in glaucoma. Our colleagues foresee a future where AI significantly aids clinicians, where AI could synthesize the immense amount of data we use to make decisions, help clinicians risk stratify patients, and support efficient deci- sion making. AI could also monitor for progres- sion and, importantly, potentially screen and accurately triage patients, a necessity as we face a demographic wave with our aging population and stretched medical system. As we celebrate victories and look toward future hurdles, this issue reminds us that prog- ress in glaucoma is multifaceted. It involves em- powering patients through lifestyle discussions, critically re-examining our practices to ensure they are sustainable for both our healthcare sys- tem and the planet, and adopting cutting-edge technology like virtual reality and AI. The jour- ney continues, driven by our collective commit- ment to improving the lives of our patients. H ere we are on the cusp of another quarter, reflecting on the journey we've taken and the exciting path ahead in glau- coma care. Looking back at previous issues, it's clear our field is in constant evolution, building on the foundations of the past while eagerly embracing innovation. We've seen revolutions in surgery and pharmaceuticals, the rise of "interventional glaucoma," and a shift toward more patient-ori- ented and precise approaches. Yet, old challeng- es persist and new dilemmas emerge, driving a continuous cycle of learning and innovation. This issue of EyeWorld delves into areas that perfectly capture this dynamic blend of established practice, emerging technology, and holistic patient care. We explore the often-asked question about the impact of lifestyle modifi- cations, the increasingly critical imperative of sustainability in our practice, and the rapidly advancing world of virtual visual fields and artificial intelligence. Moving beyond traditional medical and sur- gical interventions, patients frequently ask what else they can do to help manage their glaucoma. While IOP reduction remains the only proven way to prevent glaucoma progression, discus- sions around nutrition, exercise, and other factors offer valuable supplemental strategies. While evidence on slowing existing disease is pending, level 1 evidence suggests certain dietary modifications can reduce the risk of developing glaucoma. There is biological plausi- bility to the role of similar strategies in reduc- ing progression, such as through mitigation of oxidative damage and enhancing mitochondrial function. Aerobic exercise can modestly lower IOP, but caution is advised against exercises that increase eye pressure. As the global burden of glaucoma continues to rise, requiring increasing resources, the con- versation turns to sustainability in ophthalmol- ogy. Our colleagues identify significant concerns from the clinic to the OR. From the immense quantities of surgical waste to carbon emissions from patient transport to and from multiple appointments, it is clear that we have our work A continuous cycle of learning and innovation

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