Take-home message: Thomas W. Samuelson, MD, shares his perspective on how microinvasive glaucoma surgery has been integrated into his daily practice.
Minneapolis—With overwhelming evidence supporting the belief that cataract surgery lowers IOP in most patients with ocular hypertension and early-to-moderate glaucoma, more and more glaucoma specialists are integrating microinvasive glaucoma surgery (MIGS) into their practices.
“Glaucoma is a very heterogeneous condition,” said Thomas W. Samuelson, MD, founding partner at Minnesota Eye Consultants, Minneapolis.
“The risk of functional impairment from glaucoma varies widely among those with the disease,” he said. “Filtration surgery and aqueous drainage devices are highly efficacious and well suited for patients at significant risk for functional visional impairment from glaucoma, and indeed, is the gold standard for such patients.”
In Dr. Samuelson’s opinion, cataract surgery should be considered an incremental step in the management of early-to-moderate glaucoma.
The introduction and rapid acceptance among surgeons for MIGS, however, mean that “we now have the luxury of matching the risk of our interventions versus the risk of functional impairment,” Dr. Samuelson said.
Glaucoma specialists now have a more complex management strategy than previously, “where we basically ‘marinated’ the eye with medicines until we did filtration surgery.” He said. “Those days are thankfully long gone.”
While trabeculectomies (“trabs”) and tubes are generally efficacious, glaucoma surgeons have not had a procedure that errs on the side of safety in lieu of efficacy.
“MIGS provides us that option,” he said. “We can triage each patient . . . to the appropriate procedure based on what's the risk of a disease and what's the risk of our recommended treatment.”
He recommends surgeons analyze their own procedures and results to ensure “you don't have to reallocate a little bit based on your outcomes. That is, make sure that your surgical choice doesn’t put your patient at greater risk the disease itself. It's really important to have an option that errs on the side of safety,” he said, but not to misconstrue his statement to mean surgeons should abandon other surgical options.
“When we are faced with cases of advanced glaucoma, trabs and tubes are still a good and viable option,” he said.