For as long as I can remember, glaucoma has always had just 3 modes of treatment: drops, laser, and surgery. For better or worse, our therapies are typically employed in that order. The LiGHT study recently challenged the notion of topical therapy being our primary treatment, likely because eye drop compliance is suboptimal.

Despite appearing to lower pressure as much as latanoprost, the laser group was shown to have less progression over a 3-year period. Minimally invasive glaucoma surgery has also exploded in recent years, providing a plethora of new tools and techniques to safely lower pressure, particularly by manipulating the trabecular meshwork. So, while there has been considerable development over the past decade, the treatment of glaucoma has rested comfortably for many years on those 3 pillars of eye drops, laser, and surgery.

This spring, a new category of treatment came to glaucoma management, and glaucoma care gained a new pillar. The FDA approved sustained-release bimatoprost (Durysta; Allergan/AbbVie), giving our field its first sustained intracameral treatment. Sustained-delivery bimatoprost has been in development by Allergan for 15 years, and yet we are still at the beginning of a new era in glaucoma therapy. An infinite number of questions is upon us. Who to treat? When to treat? Will we be able to give repeat injections in the near future?

For years, glaucoma patients have been treating their own glaucoma with eye drops, but often only when they are able to get their hands on their drops, when the drops don’t cause side effects, when their drops don’t cause dry eye, when they get the drops in their eyes, when they remember to take their drops, or when their drops don’t run out too soon. Armed with a new set of tools, ophthalmologists are finally able to wrestle control of glaucoma treatment out of the patient’s hands and into a more certain future. Here at Glaucoma Physician, rest assured that we will follow the development of interventional glaucoma with great interest. Until we can tell that story, let’s take a moment to appreciate this magnificent milestone. GP

Dr. Radcliffe is a clinical associate professor of ophthalmology at the New York Eye and Ear Infirmary of Mount Sinai and a surgeon at the New York Eye Surgery Center.