What Role Do ODs Play in Glaucoma Surgery?

Mar 11, 2022
8 min read
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As the second leading cause of blindness worldwide and with its numbers steadily rising, glaucoma must be considered among the top public health crises in eyecare. Glaucoma statistics show that roughly 4 million Americans will suffer with glaucoma by the year 2030. By 2050, that number is expected to rise to an alarming 6 million. Though there is currently no cure, the most effective way to preserve sight is through appropriate and early intervention.

Sight Sciences and their Chief Commercial Officer Shawn O’Neil are fervent about educating ophthalmologists, optometrists, and their patients on the available options, particularly in the area of minimally invasive glaucoma surgery (MIGS).

According to O’Neil, “The ultimate goal really is education: educating eyecare providers so that they can then transfer that knowledge to their patients—ultimately, to make the best decision for that patient and ensure we're doing everything we can to intervene appropriately early in their treatment regimen to preserve the visual field.”

Justin Schweitzer, OD, FAAO, has worked alongside glaucoma specialists at Vance Thompson Vision since 2012, when MIGS entered the clinical landscape. He shares this passion for education and advocates for the role of ODs in glaucoma surgery. Dr. Schweitzer stated, “It's something that I'm very passionate about and have been for a long time. I like to educate and drive the conversation around the best practices of managing glaucoma patients. And I think we'd be wrong not to include minimally invasive glaucoma procedures in those conversations with optometrists.”

To this end, Sight Sciences recently launched its "Don't Wait For Too Late" educational campaign to combat the world’s leading cause of irreversible blindness.

What is the “Don’t Wait For Too Late” campaign?

The campaign’s mission is to raise awareness and educate optometrists—and the optometric community at large—about the safety, efficacy, and benefits of MIGS as an earlier surgical intervention for glaucoma.

“The ‘Don't Wait For Too Late’ educational campaign was really created to raise awareness throughout the eyecare community in both optometry and ophthalmology, but really focusing on optometry from the standpoint that they are typically the eyecare providers who are managing the patient's glaucoma journey once they are diagnosed,” O’Neil stated.

Dr. Schweitzer added, “The campaign really resonates with me. We have surgical options that can really benefit patients much earlier in the disease process, I think we have an opportunity to really change the narrative of how we treat patients.”

For patients with mild to moderate glaucoma, prescription eye drops and selective laser trabeculoplasty (SLT) have long been the first line of treatment. Surgery was reserved for advanced disease.

MIGS presents the opportunity for patients to receive a standalone procedure in the early stages of the disease, which can reduce their dependence on eye drops, decrease the medication burden, and lead to improved management of intraocular pressure. MIGS can also be combined with cataract surgery in eligible patients.

There are three primary benefits of early intervention with MIGS:

  • Decrease the medication burden for patients, which, in turn, decreases noncompliance.
  • Lowers IOP with less risk and post-operative care than later, more invasive surgeries.
  • Avoid ocular surface disease caused by certain glaucoma medications.

Which glaucoma patients can benefit from MIGS?

It is estimated approximately 85% of adult patients with primary open-angle glaucoma (POAG) could benefit from a standalone MIGS procedure.1

Dr. Schweitzer outlined five types of patients who would be excellent candidates for MIGS.

  1. Patients with medication compliance issues.
  2. Cataract patients who also have glaucoma being treated by medication.
  3. Patients with glaucoma who have undergone cataract surgery and are on medication but whose glaucoma is progressing.
  4. Patients suffering from ocular surface disease exacerbated by glaucoma medications.
  5. Patients with more advanced glaucoma who could benefit from a MIGS combination procedure.

The role of the OMNI® Surgical System

With recent FDA clearance, the OMNI® Surgical System* has emerged as a standalone procedure to lower IOP in adult patients with primary open-angle glaucoma (POAG), the most prevalent form of the disease.

O’Neil explained, “Surgical glaucoma management has typically been reserved for more of the late stage portion of the disease and involved quite invasive procedures. What we've done with the OMNI® Surgical System is create a minimally invasive glaucoma surgical procedure that can be used in combination with cataract surgery or as a standalone procedure.”

The OMNI® Surgical System uses canaloplasty and trabeculotomy to target all three points of resistance in the conventional outflow pathway. By expanding the Schlemm's Canal (canaloplasty), flushing out the collector channels (canaloplasty), and unroofing diseased trabecular meshwork (trabeculotomy), the main impediments to flow are eliminated.

Co-management of glaucoma is key

With glaucoma’s continued acceleration, the sheer number of patients who will present to optometry and ophthalmology practices will demand that the entirety of the eyecare community work in tandem to co-manage the disease.

“It's so imperative that optometrist and ophthalmologists work together to provide care for these patients, because the fact is if we don't work together it's going to ultimately hurt patient care. Ideally, ophthalmologists should spend the majority of their time in the operating room using their talents doing glaucoma procedures, and optometrists should be in the clinic preparing these patients preoperatively and managing them post-operatively,” Dr. Schweitzer stated.

This will require optometrists to have a comprehensive understanding of the variety of different MIGS procedures and be familiar with which surgeons in their area perform the full scope. This not only allows for pre-operative patient education, but for more in-depth discussions with the surgeon who will be operating.

In the post-operative period, an optometrist’s focus should be on adjusting/stopping glaucoma medications; managing intraocular pressure spikes, managing hyphema, and more rarely, hypotony and then supervising, going forward, for the rest of the patient’s life.

How can optometrists become educated on MIGS?

Dr. Schweitzer has been co-managing glaucoma and incorporating MIGS referrals into his treatment plan for the last decade: “I really have essentially grown up with MIGS in my practice, and I really couldn't imagine managing glaucoma patients any other way, meaning if I didn't have MIGS, it would be a challenge for me to manage glaucoma patients.”

He urges other optometrist to become as educated as possible on the various procedures and offers the following suggestions:

  • Take advantage of trade journals and read articles by experts in the field.
  • Listen to optometry and ophthalmology podcasts on MIGS procedures and glaucoma management, in general. .
  • Spend time with the surgeons performing the procedure to learn the nuances of how they use MIGS in their practices.
  • Visit considermigsearly.com for tailored information on MIGS and early intervention.
  • And last, but certainly not least, attend live or virtual events, like Eyes On Glaucoma, to get a wealth of information on MIGS and other glaucoma-related topics from dedicated experts in the field.

Patient education on minimally invasive glaucoma surgery

In addition to providing optometrists with the facts to share with their patients, Sight Sciences can also provide additional patient education resources in the form of pamphlets and animations, so ODs can demonstrate to their patients the merits of MIGS.

According to O’Neil, “In this day and age, patients love to be educated, and there's so many different avenues for them to gain education. But we believe it is so important for them to be educated on the frontline of their diagnosis and treatment options. By arriving at the surgeon well educated, hopefully, a lot of the anxiety has decreased, and they can make the best decision in conjunction with the eyecare provider.”

Obviously, the optometrist is the primary source of this initial information and early education. Dr. Schweitzer suggests making patients aware of the options from the beginning by outlining the treatment timeline and introducing MIGS (and the OMNI® Surgical System) as a viable intervention as the disease progresses, which it inevitably will.

Looking toward the future

As for the future, Dr. Schweitzer feels optometrists must be armed with a thorough understanding of all the different tools to combat this sight-stealing disease, with MIGS being one of the most promising. He said, “I want to continue to drive the discussions, the narrative around MIGS, and I want to continue to educate my colleagues on what I believe is best for patients and really MIGS fits into that treatment category.”

With the “Don’t Wait For Too Late” campaign, Shawn O’Neil and his team are advancing the Sight Sciences mission to “always keep the patient at the center of the conversation and build a collaborative environment between optometry and ophthalmology with consistent and continual education during that patient's glaucoma journey.”

For a range of educational resources, visit: considermigsearly.com.

References

  1. Unpublished internal analysis of Market Scope 2021 Glaucoma Surgical Device Market Report.
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About Eyes On Eyecare Editorial Team

Led by Managing Editor Eleanor Gold, PhD, Eyes On Eyecare is a digital publication that provides clinical and career education to the young generation of optometrists and ophthalmologists. We work with eyecare professionals to create compelling, educational content available …

About Shawn O’Neil

Shawn O’Neil serves as the Chief Commercial Officer for Sight Sciences. As as ophthalmic industry veteran, he leads Sight Sciences’ commercial activities and product launches.

Previously, Shawn spent more than 20 years at Alcon, a global leader in eye care, …

About Justin Schweitzer OD, FAAO

Dr. Justin Schweitzer is a fellowship-trained optometrist specializing in the treatment of glaucoma, corneal-related vision conditions, and cataracts at Vance Thompson Vision in Sioux Falls, SD.

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