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5 Supported by Aerie Pharmaceuticals, Alcon Laboratories, Allergan, and Bausch + Lomb by Ike Ahmed, MD MIGS and glaucoma treatment Conversely, trabeculectomy is performed for advanced pro- gressive normotensive glaucoma (open or closed angle). It has a low IOP target (less than 12 mm high safety profile and rapid recovery. It is performed for mild to moderate open-angle hyperten- sive glaucoma. It has a modest IOP target (approximately 15 to 16 mm Hg). Patients can tolerate some medications if needed. reduce morbidity, but safety must be established. Early intervention With MIGS, we take an ab-inter- no approach and it is minimally traumatic, providing at least modest efficacy. 3 It has a very Early intervention helps reduce disease progression A lthough topical medi- cations have been the mainstay of treating increased intraocular pressure (IOP), less than 50% of patients use their drops after 1 year. 1 This lack of adherence is associated with vision loss. 2 Looking to the future, we should consider ourselves inter- ventionalists in treating glauco- ma. With microinvasive glaucoma surgery (MIGS) and other proce- dures, we can intervene earlier to Figure 1. Image shows laminar striated episcleral vein receiving aqueous from the aqueous vein. continued on page 6 Ike Ahmed, MD " We have many options to reduce IOP in patients with glaucoma, and many others are expected. " –Nathan Radcliffe, MD intraocular pressure lowering in patients with open-angle glaucoma or ocular hypertension: APOLLO and LUNAR studies. 2016 Association for Research in Vision and Ophthalmology annual meeting. 10. Liu JHK, et al. Effect of latanoprostene bunod compared with timolol maleate on ocular perfusion pressure in subjects with open angle glaucoma or ocular hyperten- sion (CONSTELLATION). 2015 American Glaucoma Society annual meeting. 11. www.financialexpress.com/article/ pharma/latest-updates/sparc-licenses- xelpros-to-sun-pharma/82566/ 12. Myers JS, et al. A dose-escalation study to evaluate the safety, tolerability, pharmacokinetics, and efficacy of 2 and 4 weeks of twice-daily ocular trabode- noson in adults with ocular hypertension or primary open-angle glaucoma. J Ocul Pharmacol Ther. 2016 Mar 22. [Epub ahead of print] 13. www.businesswire.com/news/ home/20160217006453/en/Aerie-Phar- maceuticals-Reports-Positive-Rhopres- saTM-QD-netarsudil 14. www.allergan.com/news/news/ thomson-reuters/positive-phase-i-ii- interim-data-of-bimatoprost-su 15. Brandt JD, et al. Six-month intraocular pressure reduction with a topical bimato- prost ocular insert: results of a phase II randomized controlled study. Ophthalmolo- gy. 2016 May 5. [Epub ahead of print] Dr. Radcliffe is clinical assistant pro- fessor of ophthalmology, New York University Langone Medical Center, New York. He can be contacted at drradcliffe@gmail.com. continued from page 4

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