Nobody wants to have glaucoma, simply put. It also stands to reason that nobody wants any of the treatments available for glaucoma. We all want a “normal” life. Although there ahve been many significant advances in glaucoma therapy, it is hard to argue that our therapies are particularly desirable. That said, it is also the case that some of our therapies are more palatable than others.

Evidence from the Ocular Hypertension Treatment Study and other studies shows that early and aggressive therapy for glaucoma can decrease progression.^1,2 Herein lies a paradox for glaucoma patients: early, aggressive therapy given at a time when the disease is largely asymptomatic is required to keep the disease asymptomatic. In other words, in a best-case scenario, glaucoma patients will mostly suffer the side effects and burdens of prescribed therapies.

If this is the case, it seems that the goal should be to treat glaucoma early and aggressively in the manner that is least likely to cause symptoms, side effects, or other quality-of-life burdens. In my mind, laser therapy, sustained-delivery systems, and standalone MIGS can nicely lower IOP without causing chronic side effects like hyperemia or eye irritation or creating compliance burdens.

In this issue of Glaucoma Physician, we take a careful look at topics that speak to early, aggressive, and patient-friendly care. Dr. Paul Singh discusses the Idose (Glaukos) program and how this sustained delivery implant can help reduce the burden of topical treatment. Addressing glaucoma that arrives early in life, Drs. Neustein and Moster tackle pediatric glaucoma surgical techniques. We present viewpoints from experts in artificial intelligence for ophthalmology on the applications of artificial intelligence to glaucoma care. Along those lines, we also discuss Icare, currently the most available home IOP monitoring system. Finally, we consider the paradox of normal-pressure glaucoma. As you read this issue of Glaucoma Physician, we invite you to think of how you can serve your patients with highly effective therapies that can be delivered early, but that also allow your patients to live a normal life — in other words, give them more, so they deal with less. 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.

References

1. Kass MA, Gordon MO. Clinical application of the 20-year results from the Ocular Hypertension Treatment study (OHTS)-reply. JAMA Ophthalmol. 2021;139(10):1146-1147.
2. Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E; Early Manifest Glaucoma Trial Group. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol. 2003;121(1):48-56.

On the cover: Idose implant (Glaukos). From “Data on the Idose Intracameral Travoprost Sustained-release Implant,” page 10.