Thoughts on glaucoma
Dr Hollo: In the field of glaucoma clinical research and practice, considerable development has been seen in several areas in 2017. In terms of diagnostics and research, optical coherence tomography (OCT) angiography is one such area, and there has also been progression in the understanding of the role of the Bruch membrane opening in optic nerve head OCT imaging.
With regards to surgical treatment, substantial new information has become available on an ab interno implantable microstent for glaucoma filtration surgery, while the popularity of using completely preservative-free topical glaucoma medication, including fixed combinations, has surged. We also see some new molecules in the Rho kinase inhibitor family moving closer to clinical application.
However, when it comes to patient referrals, European research has revealed that using an intraocular pressure (IOP) reading of between 21 and 25 mmHg as a sole criterion for referral to a glaucoma specialist may increase the number of false positive referrals and does not increase the detection of true glaucoma cases.
Although this situation has no direct influence on clinical practice in the upcoming year, I hope that a better or more established referral system will be rolled out in the future, as this will make glaucoma clinics more efficient, allow ophthalmologists to spend more time with those patients who really need it and prevent incorrect glaucoma diagnoses and the negative effect this has on patients.
Dr Augustin: Traditional glaucoma surgery has a significant lowering effect on IOP. However, this approach is not necessary in all patients and leaves patients at risk from several complications that are difficult to manage.
A less traumatic option is micro-invasive glaucoma surgery (MIGS), which is gaining in popularity. This technique uses different devices, allowing the complications seen with traditional techniques to be avoided and giving surgeons the opportunity to reduce IOP more easily and safely.
However, both techniques have advantages and disadvantages, and the major challenge in 2018 will be the decision-making process involved in choosing either MIGS or conventional surgery as the best treatment for the specific patient.