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CIME 2024: Innovative approaches in glaucoma management center on the trabecular meshwork


Deborah Ristvedt, DO, in her Controversies in Modern Eye Care presentation, discussed the evolution from traditional glaucoma treatments to novel therapies that target the trabecular meshwork and that aim to optimize IOP management without the need for multiple medications.

Glaucoma treatment development has taken on new mechanism of action medications that are designed to treat natural outflow pathway. Deborah Ristvedt, DO, spoke on the topic alongside Inder Paul Singh, MD, Arsham Sheybani, MD, and Melissa Tawa, OD, FAAO, in a session titled "Innovations and Interdisciplinary Approaches in Glaucoma Management—Expanding the Treatment Arsenal" at the 18th Annual Controversies in Modern Eye Care meeting on May 4, 2024, in Los Angeles, California.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Deborah Ristvedt, DO:

Hi, I'm Deb Ristvedt from Alexandria, Minnesota, part of Vance Thompson Vision. I am an anterior segment and glaucoma surgeon. Today at the Controversies in [Modern] Eye Care symposium, I'm talking about the unmet needs in glaucoma treatment and therapy.

We've had our tried-and-true medications and a lot of you may not know that we've only had our first-line therapy prostaglandin analogues since 1997 and then there was kind of a lull when it came to how we treat glaucoma. We know that in the past we've had drops, we've had laser, and then we've had more invasive surgery in the form of trabeculectomies or tube shunts.

But now we're looking at the histology of the trabecular meshwork and what's happening in glaucoma and now we have new mechanism of action medications designed to treat just that, our natural outflow pathway.

This morning we talked about latanoprostene bunod, which releases nitric oxide to relax the trabecular meshwork. We talked about rho kinase inhibitors in the form of netarsudil, which works at the cellular level of the trabecular meshwork, as well as decreases episcleral venous pressure.

So when we're talking about medication therapy, 1 of our main goals nowadays in intervention of glaucoma is to eliminate the need of stacking medications and to use some of these medications to get the biggest bang for our buck when it comes to lowering IOP.

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