Diverse developments shape future of glaucoma care

San Francisco-The future of glaucoma management is happening now and is being shaped by developments in health reform, financing reform, information technology, ongoing research in drug delivery systems, and the emerging potential for personalized targeted therapy, said George A. Cioffi, MD.

“The therapeutic triad for glaucoma composed of topical drops, laser procedures, and filtering surgery has been an incredibly effective mainstay in the majority of patients,” said Dr. Cioffi, who has been chairman, Devers Eye Institute, Portland, OR, and now chairman, Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York. “However, it is not enough because these options have too many significant drawbacks to be considered optimal for management of a chronic disease.

“What we need in the future is to have effective, safer, and affordable options that will be applicable to the growing number of patients who will need glaucoma care,” he said. “These interventions must be suitable for use in managing a chronic disease, and importantly, they must be acceptable to patients who are increasingly going to the Internet for information but continue to turn to their physicians for answers.”

Dr. Cioffi noted that developments in health reform, financing, and information technology are in full stride and already influencing the future of glaucoma care. There has been a huge adoption of information technology that will enable outcomes research, but will also be used to analyze utilization, which is important in glaucoma care since chronic diseases of the aging population are costly and therefore targets for health-care reform.

He said novel therapeutics, including advanced delivery systems, will play an important role in the near term in addressing the major problem of medication nonadherence among patients with glaucoma. Dr. Cioffi noted there are already a huge number of innovations in this field, and he predicted one solution would be with an intraocular injectable platform.

Looking further ahead, but still what he believes will be the not-too-distant future, Dr. Cioffi said that a personalized targeted approach will reshape glaucoma therapy.

“The availability of genetic testing on beta-blocker responders is exploding now, and we will know such things as how a person’s lamina, vasculature, or IOP reacts to medications,” Dr. Cioffi said. “With this knowledge, treatment will move from being by a trial-and-error approach to individualized therapeutic selection.”

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