Eyeworld Daily News

6 | EYEWORLD DAILY NEWS | MAY 6, 2023 ASCRS ANNUAL MEETING DAILY NEWS PUBLISHER Steve Speares MANAGING DIRECTOR Stacy Jablonski EDITORIAL CO-DIRECTORS Ellen Stodola Liz Hillman GRAPHIC DESIGNERS Susan Steury Katherine Beutner PRODUCTION MANAGER Cathy Stern SALES, SPONSORSHIPS, AND CORPORATE PROGRAMS Jessica Donohoe Joe Dooley Cathy Stern knowing when it's time to intervene. For predictive diagnostics, he said there could be risk-factor analysis, ocular biomechanics, genetic testing, digital health, and the use of AI. Advanced monitoring could include structural and functional progression analytics, home monitoring, IOP sensors, and detecting apoptosing retinal cells. "The concept is to try to do things earlier. … The impact on the patient's lifetime is greater when we apply them earlier in the disease process," he said, but Dr. Ahmed noted that the issues associated with surgery—lack of predictability and increased complication risk—need to be avoided. This is where he thinks invasiveness matters. "Less invasive options have advantages and disad- vantages, but it's about our ability to address disadvantages." I ke Ahmed, MD, in delivering the Stephen A. Obstbaum, MD, Honored Lecture at Glaucoma Day, spoke on the technology paradigm shift that is interventional glaucoma. Dr. Ahmed said that the 2000s are when MIGS were met with ridi- cule, questions, and controversy. He acknowledged, MIGS are not per- fect for everything, but the concept of MIGS is now clear. Here in the 2020s, he said the subspecialty is faced with another major change: the concept of interventional glaucoma. "We are at a point in time where we're seeing significant shifts in how we treat glaucoma and in our treat- ment paradigm," he said. Dr. Ahmed said we need to change the way we model things, because our models don't work. He explained that he would argue the field is ready for a new approach to initial and step-wise interventional glaucoma therapy. The current paradigm is very medication heavy, with a period of watching and waiting for pro- gression. SLT, he noted, is mostly considered after maximum medical therapy and surgery is reserved for refractory glaucoma. The problems with this current paradigm are issues with patient compliance/adherence, suboptimal 24/7 IOP control, and histopathological changes that could be linked to medication and progres- sion that are leading to irreversible damage that further impacts therapy efficacy. Dr. Ahmed said it's time to take treatment out of the patient's hands and provide 24/7, sustained therapy to control IOP, prevent pro- gression, and improve quality of life. Dr. Ahmed sees this being done with a new paradigm that puts SLT as a first-line therapy, improved drug delivery options, non-incisional MIGS, standalone MIGS, a continued use of combined MIGS and phaco, and microinvasive bleb surgery. He acknowledged that the right patient for the right procedure at the right time is still important. "For me interventional glaucoma is addressing that earlier patient who doesn't need aggressive therapy but isn't best served by medical therapy. Glaucoma is only young once … as it gets older, it's harder to treat," Dr. Ahmed said. He went on to describe inter- ventional glaucoma (or IG) as an attitude. It's one that is proactive vs. reactive. It relies on early predictive diagnostics, active and advanced monitoring, and early intervention that might be more aggressive, and it addresses adherence and risk. What he means by a proactive approach is not waiting for disease progression, avoiding medication stacking, and Obstbaum Lecture focuses on interventional glaucoma Dr. Ahmed thinks it's time to enter the era of interventional glaucoma.

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