One of our favorite ways to teach and learn in medicine is through patient cases. These cases often illustrate a specific problem or dilemma and help us learn how to resolve it. Examples include choosing the initial therapy, such as laser or medication; picking the right next step for a patient who is uncontrolled on 1 eye drop; or treating a patient who is using 1 eyedrop and has a controlled pressure but is starting to develop dry eye or ocular surface disease. How about a patient on 2 medications who seems to be progressing despite seemingly controlled pressures? For patients who admit that they aren’t taking their medication as prescribed, what is next: laser, sustained delivery implant, or standalone MIGS? Some patients have undergone a variety of laser therapies and medical approaches but are still uncontrolled. Is their cataract severe enough for a MIGS procedure, or did this patient have cataract surgery 10 years ago and now needs standalone MIGS or an incisional surgical intervention?
These are the treatment dilemmas that we explore in Glaucoma Physician. Also, although they could describe many different patients, the scenarios I present above could very well be progressive steps in a single patient’s journey over a decade. Glaucoma progresses, compliance worsens, ocular surface disease develops, and, often, many alternative approaches are needed as the patient ages. However, the minor details of each patient presentation will determine the pathway that a patient takes through their glaucoma journey. For some patients, compliance, tolerability, or dry eye problems will be so pronounced from the beginning that physicians will lean toward interventional glaucoma (Ike Ahmed, MD, gets credit for coining this term). For patients with good compliance and a sturdy ocular surface, these problems may not show up until later. At the risk of sounding cynical, most patients will struggle with these issues eventually, and I want to be sure I have the tools to help them when the time comes. I also want to be sure I have the mindset to recognize when a patient has changed from a medically treated patient to a patient who would benefit from an interventional approach.
We cannot see that the patient has made this transition unless we have the knowledge and skillset to offer alternative therapies. In many ways, this is what Glaucoma Physician aims to bring you, our reader. If you understand the indications and ins and outs of laser, sustained delivery, MIGS, and other incisional therapies, then you will be able to help your patients when the time is right. Of course, we also cover a potpourri of glaucoma topics that will help you in detecting progression and managing complications or other important care issues. Thank you for coming on this journey with us; we hope it helps you and your patients. GP
On the cover: Postoperative bleb. Image courtesy of Oluwatosin “Tosin” Smith, MD, attending physician and surgeon at Glaucoma Associates of Texas in Dallas, Texas.
