In this installment of Interventional Mindset, Preeya K. Gupta, MD, sits down with Mitch Ibach, OD, FAAO, to discuss the importance and benefits of collaborative and effective relationships between optometry and ophthalmology, particularly as it relates to management of glaucoma patients.
Dr. Ibach is a residency-trained optometrist at Vance Thompson Vision in Sioux Falls, South Dakota. He specializes in anterior segment surgical care including cataracts, corneal diseases, glaucoma, and refractive surgeries. Dr. Ibach maintains a large collaborative glaucoma clinic that focuses on long-term disease care. He is a member of the American Optometric Association and a fellow of the American Academy of Optometry. Dr. Ibach is also affiliated with the South Dakota Optometric Association, the Optometric Cornea, Cataract, and Refractive Society (OCCRS), and the Optometric Glaucoma Society (OGS).
Watch the full interview with Dr. Ibach to learn about:
- Trends in the development of new topical therapies for glaucoma;
- The latest information regarding selective laser trabeculoplasty (SLT) as a first-line therapy;
- Recent advances in drug delivery systems for glaucoma;
- Surgical approaches to glaucoma, particularly micro-invasive glaucoma surgeries (MIGS).
A contemporary approach to the glaucoma patient
Dr. Ibach began by talking about the latest developments in glaucoma management over the last ten years, when – as he put it – “glaucoma became exciting again”. With regard to topical therapies, the focus seems to have shifted; recently introduced medications are beginning to target the diseased tissue in the trabecular meshwork, improving conventional aqueous outflow and, in the process, perhaps preventing tissue contraction and helping to sustain it’s integrity for the long term. He went on to state that we’ve seen a concerted effort to lessen the amount of drops being used by patients , particularly those that contain preservatives, in order to: 1) decrease the overall burden of drops for the patient; and 2) help preserve the integrity of the ocular surface.
Dr. Ibach explained that he thinks of glaucoma management in terms of four distinct categories: drops, laser procedures, drug delivery, and glaucoma surgeries. He suggested that SLT has become his recommended treatment of first choice for newly-diagnosed glaucoma patients. Well-designed studies, such as the LiGHT Trial, have revealed some very positive data with regard to SLT as a first-line therapy.1 He explained that the safety aspect of SLT, combined with the diminished financial burden associated with drop therapy, can be really impactful in both quality of life and clinical outcomes.
In terms of drug delivery, while we now have some excellent molecules that can help alleviate the pathological impact of glaucoma, their respective efficacy still comes down to patient compliance, which is often not very good with topical agents. In order to take that burden out of patients’ hands, the advent of procedural pharmaceuticals, which has been very beneficial for certain individuals. Dr. Ibach said that, going forward, he fully expects to see similar advances in drug delivery. Along similar lines, Dr. Ibach said that he’s also seeing greater utilization of glaucoma procedures today, especially MIGS, far earlier in the course of disease treatment.
Dr. Gupta asked Dr. Ibach what he would recommend to colleagues in terms of referring glaucoma patients for either office-based procedures or MIGS. Dr. Ibach responded by saying that it really comes down to the physician’s personal confidence level; any time a doctor begins to feel uncomfortable with their management strategy or outcomes, then it’s time to refer to a specialist with greater experience and/or capabilities, at least to obtain a second opinion.
For a deeper discussion of the ins & outs of glaucoma treatment and co-management between optometry and ophthalmology, be sure to watch the full interview with Drs. Gupta and Ibach!
MIGS on the move
Dr. Gupta asked Dr. Ibach to briefly discuss where MIGS fit into his current treatment algorithm. He said that one of the most obvious places where MIGS can be of benefit is in any glaucoma patient scheduled to undergo cataract surgery, since that provides a perfect opportunity to not only improve vision but also alleviate the disease burden on the patient. For phakic or pseudophakic patients without cataracts, MIGS can be not only an efficacious option, but also quite safe according to Dr. Ibach, so we shouldn’t hesitate to consider their use whenever we feel that other treatments are no longer adequate.2,3 He suggested that we all need to become a little more aggressive in this regard, recognizing that, over the patient’s lifetime, we’re likely going to need multiple treatment modalities to control intraocular pressure effectively, including medications, laser, and surgical options. Each of these interventions has an anticipated “life span” with regard to efficacy. Dr. Ibach and Dr. Gupta agreed that we must always regard glaucoma management as a years-long journey, which carries with it the consistent need to reassess and reconsider our treatment approach in light of current and emerging therapeutic options.
PM-US-2393
Dr. Ibach was compensated by Glaukos for his time on this initiative.
