Interventional Approaches to Lower IOP and Minimize Medication Use

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EP: 1.Interventional Approaches to Lower IOP and Minimize Medication Use

EP: 2.Procedural Pharmaceuticals in Glaucoma: Focus on Bimatoprost and Travoprost Implants

EP: 3.Surgical Considerations for Implanting Travoprost Intracameral Implant (iDose)

In this segment, the panelist reflects on a roundtable discussion that explored the evolving concept of interventional glaucoma and its impact on patient care. Unlike the traditional approach of waiting for disease progression, interventional glaucoma emphasizes early, proactive treatment using modern tools such as selective laser trabeculoplasty (SLT), drug delivery systems, and minimally invasive procedures. The discussion highlighted how newer technologies now allow physicians to reduce IOP safely while addressing issues of cost and patient adherence, improving the likelihood of long-term disease control.

The conversation also examined how the definition of controlled glaucoma has expanded beyond target pressures and stable visual fields. Evidence from studies such as the LIGHT trial shows that even when pressures are similar, patients treated with SLT in the first line have less progression, fewer surgeries, and lower overall costs than those started on drops. The panel emphasized that adherence and quality of life are now key elements of disease control. Patients who struggle with cost, adverse effects, or remembering to take drops may appear controlled by IOP but are actually at higher risk of progression due to inconsistent adherence.

Finally, the panelist described strategies to identify nonadherence and redefine success in glaucoma care. Clues such as patients forgetting the name or color of their medication, repeatedly asking for samples, lacking refill requests, or experiencing fluctuating vision can signal poor adherence. These situations can serve as triggers to move toward interventions like SLT, drug delivery implants, or minimally invasive glaucoma surgery to reduce drop burden. Importantly, success is no longer defined solely by lowering IOP, but also by reducing medication dependence and improving the patient experience, even if that means accepting slightly higher pressures as long as stability is maintained.