New World Medical’s mission
is to preserve and enhance vision by delivering innovations to benefit humanity. The company is committed to leading the ophthalmic industry in the treatment of glaucoma and is determined to provide eyecare professionals with the most cutting-edge technologies to alleviate the suffering of glaucoma patients around the world.
New World Medical’s flagship products include:
- Ahmed® Glaucoma Valve —the world’s leading glaucoma drainage device, providing immediate IOP reduction for all types of refractory glaucoma.
- Ahmed ClearPath® —the newest valveless glaucoma drainage device, designed with convenience in mind with its Model 250 being a true single-quadrant device
- KDB GLIDE® —the gold standard for excisional goniotomy with its unique design and dimensions that enable precise excision of diseased trabecular meshwork (TM), allowing access to collector channels.
- STREAMLINE® Surgical System —the first-line, implant-free viscoelastic delivery solution designed to achieve the results eyecare providers want.
Mitch Ibach, OD, FAAO, works at Vance Thompson Vision, which is an OD-MD collaborative care practice where host Justin Schweitzer, OD, FAAO, is a colleague.
“We're a tertiary referral center for anterior segment disease and surgical care,” Dr. Ibach said. “Primarily, I work with cataracts, corneal disease, glaucoma, and refractive surgery.”
Noting that most of his glaucoma patients have been referred from other providers, Dr. Ibach said when he sees them in clinic, he builds a care plan and then executes it with one of his surgical partners.
“I also have a large continuing-care glaucoma practice,” he explained. “So, I tag team with their primary eye doctor and see them every six months or once a year.”
What is New World Medical like as an industry partner?
Dr. Ibach said a differentiating factor for New World Medical is that they focus solely on glaucoma.
“Right now, they’re really focused on surgical glaucoma,” he explained. “I think a unique characteristic of New World Medical is that they have surgical technologies that span the whole disease continuum for mild, moderate, and severe patients.”
Dr. Ibach said that in their practice, minimally invasive glaucoma surgeries (MIGS) are a “predominant force.”
Dr. Ibach explained that most of his patients have mild to moderate glaucoma. For those who have more advanced glaucoma, he said they occasionally use goniotomy in combination with a cilial ablative procedure to try to reduce aqueous production.
“For severe patients, New World Medical has both the Ahmed Glaucoma Valve and the Ahmed ClearPath,” he noted. “In these incisional glaucoma surgeries, we're bypassing the patient's natural drainage system and basically putting in a new drain. The surgeons in our practice use the full gamut of these technologies, and we're able to customize the procedure based on the patient's needs.”
Dr. Ibach also said that as an industry partner in glaucoma, New World Medical is dedicated to education.
“They really want to raise and elevate glaucoma education related to the disease itself, the journey for patients, and collaborative care,” he explained. “I've had the opportunity to do a couple of different OD-MD projects to elevate education in glaucoma so that more patients can hopefully get better care.”
What’s the glaucoma patient journey like within your practice?
“As I said, a majority of our patients are referred to us, and they tend to have more advanced glaucoma,” Dr. Ibach explained. “When they come into our practice, they're usually progressing or ready for surgical intervention — and many also have visually significant cataracts.”
As such, he said new patients get a full glaucoma evaluation, which includes:
- Visual acuity testing
- Intraocular pressure (IOP) measurement
- Corneal hysteresis
- Visual field testing
- Optical coherence tomography (OCT)
“We also perform a dilated exam and look at the nerve,” Dr. Ibach said. “From there, we can assess both the patient's current glaucoma status and risk of progression to create a treatment plan.”
How does OD-MD glaucoma co-management work in your practice?
Noting that every practice and referral relationship is different, Dr. Ibach said the partnerships they’re engaged in have been built upon years of experience and trust.
“In many cases, I build the surgical plan and then our surgical partner ophthalmologist executes it,” he explained. “We get to make that plan, and 95 percent of the time, that's what we follow going forward. But, we have very open and honest communication.”
Dr. Ibach underscored the importance of open dialogue and the ability to view a patient’s case from multiple angles, “because glaucoma is an art.”
“There's not a silver bullet that's going to work for every patient,” he said. “If the patient is being managed with topical glaucoma medications, that's mostly going to be my call. But when we enter the surgical space, the laser space, or drug delivery, that's when I collaborate with the ophthalmologist I work with.”
How does New World Medical fit into your surgical decision algorithm?
Dr. Ibach said that in glaucoma management, he tries to “break it up into three different buckets of patients.”
“First, you have a patient with a phakic clear lens,” he explained. “He or she is not ready for cataract surgery and may have more mild glaucoma. Typically, we manage this patient medically.”
Noting that they like to use laser therapy as a first-line treatment in their practice, Dr. Ibach said they do a lot of drug delivery, too — and that this type of glaucoma patient isn’t commonly a candidate for surgery.
“We will do some phakic, minimally invasive glaucoma surgeries,” he explained. “If a patient has an angle closure or some other type of glaucoma, then we may take a different route. For me, the surgical glaucoma space is typically for patients who have a visually significant cataract and the comorbidity of glaucoma.”
Saying that he thinks of cataract surgery in a glaucoma patient as “just a timestamp in their life” to help improve vision by removing the cystic lens and improving outflow, Dr. Ibach said he feels this step should be paired with MIGS — which can be achieved with New World Medical’s KDB GLIDE or its STREAMLINE Surgical System.
“We try to help the patient's natural drainage system work better or maybe restore it. For those patients, we really like to combine cataract surgery with some type of minimally invasive glaucoma surgery.”
Dr. Ibach said the “third bucket” of patients are those who are pseudophakic.
“They've already had cataract surgery, and maybe they’ve had previous laser surgery, or drops, or a minimally invasive glaucoma surgery,” he said. “In these pseudophakic patients, we can still come back and use MIGS. We can still use goniotomy. We can still use trabecular meshwork bypass stenting. We can still use canaloplasty. So, we have MIGS in both the at-the-time-of-cataract-surgery bucket and in the bucket for standalone patients.”
In his practice, he said the Ahmed Glaucoma Valve and the Ahmed ClearPath are typically reserved for use in patients with end-stage glaucoma.
“We kind of have a mantra that we're almost always going to try MIGS first in a POAG [primary open angle glaucoma] patient,” Dr. Ibach explained. “But for a patient who has uveitic glaucoma or neovascular glaucoma, we have end-stage glaucoma in which we’re trying to save both the peripheral visual field and the central vision, so we can keep this patient with some sight for the rest of their days.”
“This is where we're going to implement an Ahmed Glaucoma Valve or an incisional glaucoma surgery in which we're bypassing the patient's natural drainage system,” he added. “Inherently, these surgeries have more risks, and with some of these patients, we need to take more risks. Fortunately, we've had really good luck with both the Ahmed Glaucoma Valve and the Ahmed ClearPath for some of our most difficult glaucoma patients.”
What are some postoperative management considerations for patients who undergo MIGS?
“First and foremost, it’s important to remember that with MIGS, safety is paramount,” Dr. Ibach said. “We want these to be very safe procedures.”
He said in his practice, they typically follow the same post-operative follow-up schedule as they do for cataract surgery.
“We typically set it at one day, one week, one month, and three months,” Dr. Ibach explained. “Of course, we can change that based on visual acuity, IOP, and glaucoma severity.”
He added that with goniotomy, it’s important to remember that the surgeon is cutting into a vascularized space.
“So, you can get some reflux of blood,” Dr. Ibach said. “That's not an alert or an urgency. Usually, it will resolve on its own, but it is something to be aware of. That's probably the biggest specific issue with that type of surgery."
What is your advice for ODs who want to increase their care of glaucoma patients?
“I think it's really three things,” Dr. Ibach said. “Number one, learn as much as you can. The more you know, the easier it is to gain experience in the glaucoma space.”
He added that he feels surgical glaucoma is an arena that optometry “should elevate into.”
“We should feel comfortable doing the preoperative workup, performing gonioscopy, making a referral, and then ultimately collaborating in the glaucoma postoperative care and follow-up care of these patients,” Dr. Ibach explained.
The second step is to invest in technology.
“I think in 2023, to manage glaucoma at a high level, you must possess the ability to look at the optic nerve,” Dr. Ibach said. “You need to be able to check the intraocular pressure. You need to have an OCT, and you really need to have perimetry. I think these are the four core foundation blocks.”
And the third is to build key relationships.
“Build a relationship with a glaucoma surgeon or someone who can help when needed, because in a lot of our states, optometrists are not able to perform these surgical procedures,” Dr. Ibach said. “We’re definitely not performing surgeries with devices like an Ahmed Glaucoma Valve or an Ahmed ClearPath.”
“Build a relationship, build trust, and then just do it,” he added. “I think the best way to learn is by doing — by starting to see some of these patients and just getting your feet wet.”