The fundamental goal of glaucoma management is to preserve patients’ quality of life over the course of their lifetime. As such, ophthalmologists’ focus must extend beyond IOP to encompass all aspects of glaucoma care, from the effects of the disease to the effects of its treatment.
An evolution is occurring in our efforts to achieve this goal. Glaucoma care is shifting away from an observational model, in which medications are added and procedures are reserved for advanced disease. New interventions have brought new considerations.
To continue this progress, we must consider the limitations of the current treatment paradigm. Patient adherence to topical glaucoma therapy is poor, and medication stacking is ineffective.1-3 Sustained IOP control is beneficial for disease stability but suboptimal with current therapies.
Waiting to intervene may contribute to permanent glaucomatous damage. Outflow disease causes inflammatory changes via the accumulation of extracellular matrix in the trabecular meshwork (TM). Over time, this progresses to a more irreversible fibrotic and sclerotic process. Secondary outflow obstruction may also occur with advancing disease.
Glaucoma is only young once. As we evaluate the safety and efficacy of novel technologies, we must consider where they will be most effective along the patient’s journey and how they will best serve our objective to preserve quality of life.
1. Wolfram C, Stahlberg E, Pfeiffer N. Patient-reported nonadherence with glaucoma therapy. J Ocul Pharmacol Ther. 2019;35(4):223–228.
2. Neelakantan A, Vaishnav HD, Iyer SA, Sherwood MB. Is addition of a third or fourth antiglaucoma medication effective? J Glaucoma. 2004;13(2):130-136.
3. Johnson TV, Jampel HD. Intraocular pressure following prerandomization glaucoma medication washout in the HORIZON and COMPASS trials. Am J Ophthalmol. 2020;216:110-120.
