Eyeworld

76 | EYEWORLD | WINTER 2026 G UCOMA makes decisions based upon each patient and the best care for that patient. "Our main goal at this facility is everyone is equal," he said. "Ev- eryone needs to be taken care of no matter what their background is." There can be issues where something is planned and he's later told that it's not covered, but for the most part, these issues can be worked through. With continued development in the field, Dr. Giovingo said there are some new options he's looking forward to being able to implement for patients in need of glaucoma care. He's looking forward to working with the AlloFlo Uveo device (Iantrek). "I really would like to do an ab interno procedure that allows for lowering pressure significantly," he said. He said he is a "really big proponent of tra- beculectomy," noting that he still uses this pro- cedure frequently. "In the state of a successful trabeculectomy, there is no surgery in my mind that can do as well. It's a hard surgery to go through, and there's a little bit of 'lumpy bumpy' for about 4 to 6 weeks afterward," he said. But when the patient is committed to coming to their appointments and understanding the possibility of needing some extra procedures, this can be a good option. He added that while tubes are great, they're never as good at getting people off drops. Dr. Giovingo also noted the AquaLumen (PLU Ophthalmic), which is advertised as an implant-free, precision-engineered surgical device for minimally invasive filtration surgeries that uses an ab externo approach to create stan- dard drainage pathways. He's been happy with results with this, adding that minimally invasive bleb surgery (MIBS) is a good option as well. "All of these options are great, but it would be nice to not have to do a 30- to 45-minute procedure on someone with the complications of sutures and other things. There are many things coming down the pipeline," he said. One of these is the minimally invasive micro sclerostomy (MIMS) procedure, developed by Sanoculis, which has not yet come to market. "You go inside the eye with a probe, put it up against a trabecular meshwork, and it has a trephine that drills from inside of the eye to the outside of the eye, takes a punch, and comes back out. Then you take it out, and you have a filtering procedure," Dr. Giovingo said, describ- ing it as similar to the AquaLumen approach, except that's external when you take a punch out of the sclera from the outside. Any of those procedures could be great if there was repeatable data and efficacy, he said. The impact of care Dr. Giovingo said everyone on the team—pro- viders, technicians, nurses, residents, etc.—is happy to be able to help these patients in need of care. "It's like being able to go on a mission trip, but it's your everyday work; you're helping people," he said. Dr. Giovingo added that his institution also participates in providing care to those in need in other countries through mission trips, partic- ularly in Guatemala, but this is mostly cataract surgery. "We currently are only doing cataracts, but they want to add more," he said. "Every year it grows and grows, and we're trying to improve it. Even though I haven't gone, we've been working to get some support from compa- nies to … donate a laser that we can leave there [for] doing SLT." Oluwatosin Smith, MD A challenge with glaucoma, Dr. Smith said, is it may not have symptoms. While visual screen- ings can help with trying to catch patients earlier in the disease, often by the time patients with glaucoma actually have symptoms, they're further along, and options for management are different for more advanced disease. This issue occurs even in the U.S., she said, adding that in other countries, there may be even more chal- lenges with access to basic eyecare. "In many countries, the U.S. included, they're working on increasing disease awareness," she said. Another challenge that can pose a prob- lem around the world is the discrepancy in the number of ophthalmologists in different areas compared with the population density, and more ophthalmologists tend to be in more urban areas. To address glaucoma, there are some basic things to help with diagnosis, including pressure checks. There are also other, more specialized tests, like visual field tests or scanning of the optic nerve, or photography of the optic nerve itself. As an eyecare provider, being able to have a view and knowing what normal looks like is important, she said. Every eyecare provider has a visual field machine, but not everyone continued from page 75 continued on page 78

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