The concept of “interventional glaucoma” has not yet been widely adopted among glaucoma specialists. This insightful interview with Sahar Bedrood, MD, delves into the idea of shifting toward early therapeutic interventions with minimally invasive procedures to improve quality of life for glaucoma patients. She shares tips for implementation of interventional glaucoma in practice and discusses the crucial doctor-patient partnership required to make interventional glaucoma a reality.
Q: What does “interventional glaucoma” mean to you?
A: Interventional glaucoma is a therapeutic paradigm for treating glaucoma earlier in the disease process with minimally invasive surgeries or interventional procedures aimed at reducing IOP. It is a shift from the way glaucoma was treated years ago, which was aimed more towards topical treatment until vision loss was observed and then a more invasive and often riskier surgery was performed toward the middle or end of the disease process. Interventional glaucoma intervenes earlier in the process, with the aim to prolong the vision for as long as possible and improve the patient’s quality of life through the reduction of topical therapy.
Q: How do you operationalize the concept of interventional glaucoma in your practice?
A: I aim to customize the care for each patient. Every patient has different tolerance and sensitivity to topical medications; therefore, I address that with each patient and try to minimize the topical medications. Sometimes I do a washout of medications to see the least number of medications they need for target IOP. Sometimes I discuss other options by presenting the data and talking to patients about the change in the treatment landscape in glaucoma. I discuss SLT, sustained release therapy, angle surgery, and minimally invasive subconjunctival procedures that help reduce the pressure as well. In general, everyone on the practice management team is on the lookout for an opportunity to intervene to best suit the needs of our patients.
Q: How do you, and how should other ophthalmologists, describe the concept to patients?
A: The main takeaway is that we should not sit back and wait for progression but instead take steps to intervene earlier. I always try to make sure my patients understand the health impact of taking a proactive approach as well as the benefits and potential risks. It is essential to emphasize that by opting for certain procedures, they may mitigate the risks of traditional major surgeries as well as reduce their reliance on eye drops, which we know patients struggle to comply with due to the complexity, frequency, difficulties with administration, and side effects, which are often significant. I make sure patients understand that our goal is always to preserve their vision and quality of life while minimizing the impact of the disease as early in their treatment journey as possible.
That said, no matter what, I tend to approach the conversation with empathy and understanding of my patients’ preferences. Some of my patients are hesitant or resistant to any type of surgery at all — even for a minimally invasive procedure. Depending on their unique situation, I will tailor my recommendations so that my patients feel heard, respected, and comfortable while enabling them to fully understand the unique benefits of minimally invasive glaucoma surgeries (MIGS) to effectively preserve their vision.
Q: What are the current challenges to interventional glaucoma and what are some solutions to overcoming them?
A: One of the biggest challenges to interventional glaucoma is that it is not yet widely adopted by ophthalmologists in practice. In our training we were taught that a “meds first” approach is the first-line standard of care to treat glaucoma. There is a significant need for increased awareness among ophthalmologists and referring health care providers about the benefits of interventional glaucoma.
To overcome this challenge, continued education for health care providers, payors, and patients is essential. By working together, the eyecare community can overcome these obstacles and make interventional glaucoma a more accessible and widely adopted reality, ultimately improving patient outcomes and quality of life.
Q: In what ways can ophthalmologists and patients partner to make interventional glaucoma a reality?
A: Patients rely on the expertise and knowledge of their physicians. My experience is that patients’ trust in me propels me to constantly improve my techniques and be on the cutting edge of technology. Ophthalmologists will propel the field forward by using new technology and obtaining data that help us understand how we can best treat our patients.
With knowledge and data, we then must have discussions with patients about various possibilities for treatment. For the patient, the glaucoma journey is long, so the doctor-patient relationship is important. Trust and discussions are the foundation of glaucoma treatment in the long term. GP