Since I finished training and entered clinical practice in 2008, glaucoma therapeutic procedures have evolved dramatically. Now might be a good time to appreciate the late George Baerveldt, MD, not just for the tube shunt bearing his name, but for his part in the development of the Trabectome, in many ways the beginning of ab-interno angle surgery. The iStent by Glaukos then brought the field exponential growth because the procedure’s coupling with cataract surgery introduced glaucoma procedural intervention to cataract surgeons. A multitude of glaucoma surgical innovations followed. For these procedures, undoubtedly the secret to success and the main driver of their growth was their combination with cataract surgery. Surgeons and patients were willing to try something new as long as the well-known benefits of cataract surgery were part of the package.

Cataract surgery provided the opportunity for surgeons new to angle surgery to get to know the space while offering their patients excellent vision improvement. It is unlikely that MIGS could have grown as it did as a standalone procedure while so many surgeons needed to tackle ab interno learning curves.

What will bring the next exponential growth phase in glaucoma procedures? I believe this is right around the corner. Over the next 10 years, we will probably see standalone indications for trabecular stents and continued growth of angle procedures, such as canaloplasty and goniotomy, performed as solo procedures. We will see new angle surgeries come to market, and glaucoma laser techniques are likely to see novel developments as well.

The benefits of MIGS are now well known. With the data we have amassed from our current MIGS literature — perhaps close to 1,000 published articles — we have the information we need to know that these approaches are safe and efficacious.

Additionally, cataract surgeons have acquired and mastered the skills necessary to perform MIGS, and the time is upon us to replace traditional multidrop therapy with glaucoma procedures. The literature is clear about effects to the ocular surface and compliance problems with multibottle therapy for glaucoma. Because so many patients with glaucoma are already pseudophakic or do not have cataracts and would benefit from standalone procedures, the glaucoma market will grow tremendously, perhaps even more so than in the first years of MIGS. Most importantly, patients will receive safe and efficacious therapies that do not wreak havoc on the ocular surface and do not depend on unrealistic levels of compliance. Indeed, the future for glaucoma is bright and full of growth.

This issue of Glaucoma Physician presents a range of resources for ophthalmologists interested in cutting-edge glaucoma therapy, including a discussion of the uses of artificial intelligence in glaucoma, approaches to cases on the angle-closure spectrum, technology that detects apoptosing retinal cells, ab-interno canaloplasty, and an update on subconjunctival devices. We encourage you to explore the issue and hope it proves useful to your practice. 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.