During my fellowship, I learned that glaucoma is a disease of change. Progressive retinal ganglion cell loss is indeed the primary pathophysiology of the disease. We detect glaucoma progression, or sometimes even its existence, by noting change in the eye’s structure or function. I suppose then it should not come as such a surprise to me that the very field of glaucoma is also in a constant state of change.
Some of these changes are phenomenal, and I will get to those, but other changes that have come to the field of glaucoma can be frustrating. For me, it has been frustrating to see how a lack of reimbursement for a variety of glaucoma treatments can create problems for physicians and patients. I don’t think you can put a price on the amazing value that MIGS procedures provide for patients, but when your glaucoma surgery is being reimbursed at the same price as a modest haircut, things are out of alignment. When a patient with glaucoma undergoes a procedure that allows him or her to maintain vision and keep living a productive life at work and with family, the value is priceless. To cure glaucoma, we are going to need more procedures that will undoubtedly involve a lot of technology. We cannot allow a backwards system of reimbursement to inhibit the growth of new glaucoma technologies.
Moving to the positive side of glaucoma’s constant change, in this issue of Glaucoma Physician we again highlight the many advances and refinements in glaucoma care, from neuroprotection to surgery. I would like to take a minute to highlight the role of laser in glaucoma therapy. The eye’s optically clear media gives us a serendipitous opportunity to treat eye disease, including glaucoma, with laser. In this issue we highlight the evolving role of endoscopic cyclophotocoagulation (ECP) as well as the therapy of excimer laser trabeculostomy (ELT). I hope you enjoy reading about these treatments, and I hope you share my confidence that laser therapy will be a critical part of the future of glaucoma care.
Glaucoma is here to change. The barriers that glaucoma physicians face in our difficult reimbursement environment will undoubtedly continue to exist, but on a positive note, I think we will be blessed with increasingly better therapies to employ toward improving patients’ lives. Please join me in hoping that the patient continues to be ultimate focus in glaucoma care. GP
On the cover: Postoperative appearance from an excimer laser trabeculostomy. From “Current Status of Excimer Laser Trabeculostomy,” page 12.
