Taken together, the data from the HORIZON trial, in which the Hydrus® Microstent (Alcon) + cataract surgery (CS) was compared to CS alone, offer an example of the impact we can have on patients’ daily lives. Because of the safety profile of this microstent, we can feel confident in surgically intervening earlier in the disease continuum.1 As a result, we can accomplish long-term control of IOP, the only known modifiable risk-factor for glaucomatous progression, and we are doing so in a way that addresses the significant medication compliance issues our patients face.1
Regardless of how impressive the data may seem, however, it is fair to ask, “to what extent should these clinical trial data guide clinical practice when treating mild-to-moderate primary open-angle glaucoma?” We can question, for example, whether the outcomes from HORIZON are because of the study’s demographics, or whether they are representative of what is observed in real-world practice. As clinicians, we also want to be assured that the outcomes are, indeed, clinically meaningful.
To answer these questions, I recently met with two of my colleagues, Brian Flowers, MD, and Pradeep Ramulu, MD, PhD, to discuss the findings from the HORIZON trial and how we use these data in our own clinical practices. A summary of our discussion is presented in the following pages.
In short, we concluded that, rather than a single data point, it was the total evidence from HORIZON that suggests that Hydrus® + CS is a rational option for addressing primary open-angle glaucoma, regardless of the stage of the disease. Furthermore, the rigor of the trial gives us confidence as we counsel patients in our clinics about their options to manage their glaucoma.
— I. Paul Singh, MD
1. Ahmed IIK, De Francesco T, Rhee D, et al; HORIZON Investigators. Long-term outcomes from the HORIZON Randomized Trial for a schlemm’s canal microstent in combination cataract and glaucoma surgery. Ophthalmology. 2022;129(7):742-751.
