EnVision Summit 2026: Patient access and glaucoma

Pathik Amin, OD, FAAO, faculty member at the Illinois Eye and Ear Infirmary at the University of Illinois at Chicago, reflecting on a series of lectures given to an optometry cohort about glaucoma care. The sessions focused on 4 main areas: optimizing non-surgical management, interventional treatments beyond traditional drops, access challenges in glaucoma care, and the value of collaborative care models, illustrated through clinical cases.

A key clinical theme is the management of primary open-angle glaucoma (POAG). While POAG generally has a good prognosis with timely diagnosis and appropriate treatment, Amin emphasized that 15–20% of patients are “fast progressors” who deteriorate more quickly than expected despite therapy. Identifying these patients requires more frequent visual field testing and OCT imaging. However, a 2025 Ophthalmology Glaucoma study by Stagg et al. showed that visual fields are obtained only about once every 1.6 years, well below preferred practice guidelines. This gap supports strategies such as cluster testing or front-loaded visual fields to gather more data in shorter intervals.

Amin then shifted to interventional advances “beyond medications.” He notes the excitement around iDose, which has received FDA approval for re-administration in patients with healthy corneas, and the role of SLT as a first-line therapy. These options can reduce the treatment burden on patients who struggle with multiple topical medications, potentially improving adherence and outcomes.

Access and capacity constraints are highlighted as major systemic issues: chair time is limited, field testing is time- and resource-intensive, and patients face a learning curve that may require several tests before reliable results are obtained. To address this, Amin proposes using faster visual field protocols (ie, SITA Fast / SITA Faster) with multiple tests in a single visit, and exploring virtual visual field clinics or separate technician-run testing environments.

A discussed case involves neovascular glaucoma with markedly elevated intraocular pressure (IOP). The case illustrates optometry’s role in temporizing IOP with topical and oral medications, while ensuring urgent referral to retina specialists for anti-VEGF therapy. Early treatment may preserve the angle and avoid the need for tube or shunt surgery, whereas delayed management can lead to angle closure and surgical necessity.

Finally, Amin underscored the growing epidemiologic burden of glaucoma, noting an estimated 4.2 million affected individuals in 2022, roughly double the 2010 figure, alongside a projected 30% mismatch between ophthalmology workforce supply and demand. In response, he advocates for collaborative care models between optometry and ophthalmology (MD–OD collaborations), such as those implemented at UIC and other academic centers, to leverage the strengths of both professions, expand access, and sustainably manage the rising glaucoma population.