This article was originally published in a sponsored newsletter.
The new interventional glaucoma approach is to consider procedures over drops as first-line therapy because more doctors are starting to reconsider whether drops are truly the best first-line or even long-term therapy. This approach begins with selective laser trabeculoplasty (SLT), followed by bridge therapy with topical drops, microinvasive glaucoma surgery (MIGS), and finally procedural pharmaceuticals. From what I have experienced in my own practice, SLT is a noninvasive procedure that is an excellent option for most patients.
Given that MIGS procedures have become commonplace and their safety profile is proven, there is also a shift toward earlier intervention with angle-based surgery. This new way of thinking may be less conventional, like MIGS was a decade ago, but innovative and proactive surgeons are starting to lean toward this approach. Again, much of this shift harkens back to recognizing that drops are not without risks.
I agree that it’s important to look at ways to minimize patients’ medication burden. In addition to the side effects of drops, patient compliance with drop regimens is a serious issue. We don’t know yet how patient retention with drops vs. procedures will be impacted because it’s a multifactorial issue. However, I suspect that patients who have procedures might be better about returning for their follow-up visits because they often start to take their glaucoma more seriously once they have a procedure for it. It makes the disease real in a way that perhaps drops do not—at least for some.
While it will likely take doctors time to accept this new approach, I expect that it will become common practice so that the interventional glaucoma approach can also support better patient retention.
