Though I am primarily a cataract and refractive surgeon, I treat a lot of patients with glaucoma. Taking an interventional approach to glaucoma therapy fits perfectly with the goal in my practice to identify technologies that allow out-patients to lower IOP and reduce medications—without a major procedure that requires a lot of perioperative and postoperative management. We are well positioned to treat glaucoma before it reaches the severity level for major surgery.
Cataract surgery alone brings down the pressure, so we cataract and refractive surgeons are accustomed to moving the needle for our patients with glaucoma, but the shift to actively treating glaucoma is a major change.
I’ve always known that about 15% of my cataract patients were on some type of glaucoma medication, and cataract surgery might help reduce the burden somewhat. Now we have the technology to bring down pressure significantly during cataract surgery, or even as a standalone procedure.
The most exciting part of this, from an interventional glaucoma perspective, is that this is an entirely different threshold for glaucoma surgery than we saw in the past. Well short of the need for trabeculectomy or tube shunt, patients can have minimally invasive, lowrisk therapies that lower pressure and reduce the burden of medication. It’s a major blow against compliance problems and disease progression. And several procedures can take place during cataract surgery, with no additional risk.
Many cataract surgeons will expand into the MIGS space because the patient base is already in our exam rooms.
Whether surgeons adopt cataract surgery-paired MIGS implants or a broader range of interventional therapies, our practices will change because we are so well positioned to meet patients’ urgent need for glaucoma therapy beyond eye drops.
Farrell “Toby” Tyson, MD, is medical director, Tyson Eye, Cape Coral, FL. He was an investigator for the Glaukos iStent inject.