Interventional Glaucoma

Increased patients and patient access, new payment models, and the rise of comparative effectiveness research top the list of challenges that ophthalmologists will face in the future, according to William L. Rich, III, MD, FACS.

The search for glaucoma biomarkers is in high gear. Funded by Catalyst for a Cure, the research program has already produced new biomarker candidates and novel techniques that promise to advance research in glaucoma. Research is focusing on ways to diagnose glaucoma early and detect the specific, minute changes that could allow researchers to reduce vision loss.

The availability of technologies for ambulatory IOP measurement will usher in a new era in glaucoma patient management. L. Jay Katz, MD, said the technologies will provide better understanding of IOP and patient adherence to topical medications and to make more timely adjustments in therapy while reducing the number of office visits.

New generation of surgical procedures for glaucoma are being performed with good facility and encouraging safety and efficacy results. Only time will tell whether these techniques will maintain their initial promise and how they impact the treatment for glaucoma.

Intraocular pressure (IOP) is only the starting point for glaucoma treatment. Successful treatment begins with establishing an IOP goal, but there are multiple considerations that affect treatment choices. Robert Stamper, MD, explored the considerations that go into drug selection. None of the factors that should influence drug selection are new, he said, but it is easy to forget that the patient with glaucoma likely has other medical problems and is taking other medications.

Future healthcare reform is not a luxury. Rather, it is a necessity, especially when the performance and costs of healthcare in the United States are considered.

For many years, researchers have suspected and tried to prove a link between glaucoma and dementia, said Yvonne Ou, MD. Definitive answers, however, have been hard to come by. Glaucoma and dementia have several factors in common: both are neurodegenerative, chronic, and progressive diseases that are age-related and cause irreversible neuronal cell loss. They are both becoming a major public health concern as the U.S. population ages.

Value-based medicine analyses have indicated that glaucoma therapy has great patient benefits because it preserves their vision-which positively impacts their quality-of-life (QOL)-and it is cost effective with a high return on investment, according to Gary Brown, MD.

Glaucoma specialists can be advocates for their patients on a number of levels. On a daily basis, ophthalmologists help overcome barriers to treatment and offer solutions to patients for instilling medications, involving family members in their care, organizing services for patients, and providing educational materials, said Cynthia Mattox, MD, New England Eye Center, Tufts University School of Medicine, Boston.

Glaucoma is now in a post-Renaissance period with far superior medications, better lasers, and the potential for individualized treatments for patients, according to Thomas W. Samuelson, MD.

Although generic medications approved by the FDA are identical to the innovator in their active and inactive ingredients, prescribers must be cognizant about sources of problems associated with the use of ophthalmic generic drugs.

The prevalence of open-angle glaucoma varies by ethnicity. There are also ethnic-related variations in structural characteristics of normal eyes.

Bausch + Lomb has initiated its phase III clinical program of latanoprostene bunod (licensed by Nicox S.A.) for the reduction of IOP in glaucoma or ocular hypertension.