Eyeworld

WINTER 2026 | EYEWORLD | 75 G TO THE MOON AND BACK by Ellen Stodola Editorial Co-Director About the physicians Michael Giovingo, MD Director of the Glaucoma Service and Ophthalmology Research Cook County Health and Hospital Systems Northwest Eye Specialists Chicago, Illinois Oluwatosin Smith, MD Glaucoma Associates of Texas Dallas, Texas G laucoma can be a challenging condition to treat, with patients often needing extended care and continued treatments. Two physi- cians discussed how they tackle the challenge of glaucoma in low-resource settings for patients who might not have the means to get the care they need because of issues with financials, diagnosis, access, and more. Michael Giovingo, MD, and Oluwatosin Smith, MD, shared their experiences with patients both in their own communities in the U.S. and abroad. Michael Giovingo, MD At Cook County Health and Hospital Systems, "we deal with a significant amount of patients who have no insurance, are underinsured, Med- icaid patients, and those who can't get access elsewhere," Dr. Giovingo said. Being a glaucoma specialist, Dr. Giovingo sees a lot of patients who don't seek care for most of their lives. Patients may come in not having seen a physician since childhood, saying that they can't see. "We end up diagnosing all kinds of blinding diseases, and even things like diabetes, rheumatoid arthritis, etc.," he said. "We have a lot of challenges with patients who did not seek care for most of their lives due to lack of insurance, lack of access, or sometimes fear of the medical system." He tries to bridge those gaps and make patients feel as comfort- able as possible. At the hospital, Dr. Giovingo said they have good resources, but it's more the access that's the problem. Other issues for patients include not having transportation or a support system, or they can't afford to pay for medications. Patients may need more in terms of conversa- tions to explain the severity of their issues. For example, he said, you might start a patient on a glaucoma drop and tell them to refill it. When they come back, they haven't been on the med- ication for 3 months, and when asked why they stopped, the patient says they finished it, not understanding that they were supposed to go back to the pharmacy and get more. To ensure the patient understands the full scope of glau- coma treatments, Dr. Giovingo said you might need to sit down for a longer period of time and explain the disease, expectations, and outcomes. He noted that young males especially can be difficult to get to see a doctor, and that's one of the larger populations seen with glaucoma. This is a disease that if caught early, the patient can live a totally normal life. Dr. Giovingo noted that his hospital does community outreach to specifically try to reach these patients. Treatment options Dr. Giovingo said choosing a treatment for a glaucoma patient, including those in a low-re- source or at-risk setting, is a multi-tiered approach because there are so many options including laser, minor surgeries, and major sur- gery. There's a risk of infection, especially in a patient who may not be able to make it back to appointments or who has complications when they're outside of the country. Dr. Giovingo has begun to rely more on SLT and said he is a big proponent of using it as first-line therapy. "I bang the drum with my residents about SLT in patients as first line be- cause of compliance issues. The complications are not zero, but they are very low. The patients tolerate it extremely well." In the population he works with, mainly minority patients, SLT is particularly effective as a first-line therapy. Dr. Giovingo also uses MIGS frequently but mostly holds off on that until someone needs cataract surgery. He also has access to the MicroPulse Transscleral Laser (Iridex), which he uses for patients who either have good visual potential but compliance issues or when want- ing to avoid surgery. He has used some sustained release op- tions, like Durysta (bimatoprost intracameral implant, AbbVie), in patients with compliance issues. He mentioned the ease of use with this approach because he can do it at the slit lamp or in the minor room. The problem is repeat- ability, and it only works for a certain amount of time. Dr. Giovingo said his center has also had discussions about using the iDose TR (travo- prost intracameral implant, Glaukos), though that may come with some cost concerns. While many of these approaches come with a price consideration, Dr. Giovingo noted that he tries to remove himself as much as possible from cost as a factor in treatment choice. He Glaucoma in a low-resource setting: helping patients in need domestically and abroad continued on page 76

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