Ophthalmologists, and even their patients, are all too familiar with the challenges and limitations of topical medications. Trouble is found with compliance and adherence, incidents of ocular surface disease, increased risk of future surgical failure, local and systemic side effects, the burden of a daily eye-drop routine, decreased quality of life—the list goes on.
And yet, topical medications continue to dominate much of the glaucoma treatment landscape.1,2
The paradigm shift toward proactive glaucoma management
Over the last decade, the glaucoma treatment paradigm has been evolving—from the traditional topical medications as the first approach to one involving proactive glaucoma management.
Termed interventional glaucoma (IG), proactive glaucoma management is a patient-centric approach that features earlier intervention with lasers, minimally invasive procedures, and procedural pharmaceuticals to help slow disease progression, preserve vision, and reduce the burden of daily medication, without compromising quality of life for patients.1,2
In other words, rather than “watching and waiting” until glaucoma progresses before considering other treatment options, a proactive approach means acting sooner in the patient journey—leveraging evidence-based procedures and technologies to minimize irreversible optic nerve damage and optimize long-term outcomes.
It also prioritizes patient education, regular monitoring, and a collaborative partnership between ophthalmologists and patients to anticipate and prevent vision loss.1-3
Benefits of a proactive approach to glaucoma management
In theory, a proactive approach sounds like the logical step forward for glaucoma management. After all, at its core is managing conditions as early as possible—which is critical for a disease like glaucoma that often has no noticeable symptoms and, if undiagnosed and untreated, can advance and eventually lead to blindness. But a proactive approach is even further substantiated by its impressive outcomes when put into practice.
Research has shown that proactive intervention with minimally invasive procedures may provide many benefits, including, but not limited to:1,2
- More continuous 24-hour intraocular pressure (IOP) control
- Improved compliance
- Delayed visual field progression
- Decreased medication burden
- Revitalization of the natural outflow pathway
- Less reliance on topical medications
- Reduced need for more invasive procedures
Focus on proactive treatment options for glaucoma patients
When taking a proactive approach to glaucoma management, ophthalmologists may choose from a variety of minimally invasive treatment options, such as:1
- Laser procedures: Includes selective laser trabeculoplasty (SLT), micropulse laser trabeculoplasty (MLT), and direct SLT (DSLT); typically implemented early in the disease course due to their safety, repeatability, and ability to delay or reduce reliance on topical medications.
- Minimally invasive glaucoma surgery (MIGS): Comprises tissue-sparing MIGS (trabecular micro-bypass, canaloplasty) and non-tissue-sparing MIGS (goniotomy, trabeculotomy).
- Procedural pharmaceuticals: Sustained-release intracameral implants such as iDose TR (travoprost intracameral implant 75mcg), and DURYSTA (bimatoprost intracameral implant 10mcg); used as standalone or adjunctive options to provide consistent IOP control without daily adherence challenges.
These treatment options can be tailored to the patient based on their disease severity and clinical characteristics; some can either be used independently or in combination.
For more detailed information on when to implement these options into your treatment plan, refer to the “Interventional Glaucoma Consensus Treatment Protocol,” published in Expert Review of Ophthalmology.
Tips for adopting interventional glaucoma in your practice
Here’s some guidance for how to take a more proactive approach to glaucoma management:
- Act earlier in diagnosing, monitoring for progression, and intervening1
- Base decisions upon both new and existing evidence1
- Move beyond rigid, “one-size-fits-all” treatment algorithms and adopt a more individualized approach—one that accounts for the patient's specific disease characteristics, lifestyle, and personal preferences1,3
- Acknowledge the limitations of topical drop therapy—including side effects, adherence challenges, and medication burden—and proactively explore alternative treatments when appropriate to optimize both outcomes and quality of life3
- Maintain a comprehensive understanding of all available therapeutic options and engage in transparent, patient-centered discussions to determine the most appropriate course of treatment for each patient3
Get your patients involved
Ophthalmologists, however, aren’t the only ones who can participate in proactive glaucoma management. There are steps patients can take as well to be more proactive in managing their eye health—one of the most important, of course, being to have regular eye exams.
Certain changes to their lifestyle have also been shown to help lower eye pressure, such as:4
- Performing light aerobic activity (walking, biking, swimming)
- Consuming a healthy diet
- Engaging in mental/emotional health practices that help reduce stress (gentle yoga, breathing exercises, meditation)
There’s also the importance of patient education in the shift toward a more proactive approach to glaucoma management.
Patient education on IG could include:
- Having an open discussion with patients about proactive treatment options
- Encouraging patients to monitor their eye health
- Providing lifestyle tips for how they can safely stay active with glaucoma
- Referring them to educational materials and resources for additional background information on the disease and treatment options
These are just a few ways in which ophthalmologists can involve patients in proactive glaucoma management.
The future of proactive glaucoma management
If current trends continue, within the next 10 years, the standard of care for glaucoma management should have advanced beyond topical medications as the first (and often only) treatment option offered to patients with glaucoma.
As more ophthalmologists adopt a proactive approach with earlier procedural interventions, more providers and patients will have the opportunity to experience safe and effective control of IOP without as much reliance on topical medications—and without the challenges and inconveniences that often accompany them.1
