In the inaugural issue of Glaucoma Physician, I wrote my first article, titled “The Dream of the Drop-Free Practice.” In this article, I spoke of laser trabeculoplasty, MIGS, and potential drug delivery (none were FDA approved yet). I asked, “could we treat glaucoma without drops?” Subsequently, my friend and colleague Ike Ahmed coined the term for this approach, interventional glaucoma (IG), and relegated eyedrop use to the category of “bridge therapy,” to be used between interventions.
With a multitude of new laser approaches, novel MIGS options (including new supraciliary approaches), and 2 sustained drug delivery options approved today, I believe we now have the technology to offer most patients a drop-free treatment pathway. That said, I believe IG surgeons need to develop some new skills that were not as valuable 10 years ago.
Here are the skills I believe are necessary for interventional glaucoma success:
Ability to self-initiate surgical training. With many new treatment options arriving after formal medical training has finished, the successful IG surgeon will need to acquire new treatment skillsets by working with industry and colleagues outside of the traditional educational pathway.
Ability to persuasively offer interventions against the headwinds of the “drops first” mentality. IG surgeons must be able to listen carefully to patients to translate their complaints (eg, “my eyes are dry and red”) into treatment plans (eg, drug delivery). Additionally, the IG surgeon must be able to explain to patients the risks of staying the course vs the benefits of early intervention.
A keen knowledge of ophthalmic coding, including T-codes, J-codes, and the difference between professional and facility payments at the ambulatory surgery center (ASC) or hospital. Newer FDA-approved options such as sustained drug delivery and standalone stents require a nuanced knowledge of insurance coverage, appropriate coding, and how to ensure payments for the physician, the practice, and the ASC.
The ability to engage in advocacy for glaucoma patients. With the Medicare budget being a target for payment cuts, our new and innovative treatments will face resistance. IG surgeons must advocate for their patients by working with specialty societies at the state and federal level to support payments for these appropriate treatments.
We are now in the era of interventional glaucoma, and new skills will help us be successful. In this issue of Glaucoma Physician, we have articles on new surgical MIGS, new laser options, and coding/advocacy that can help the IG surgeon thrive. GP
