Myopia, or extreme nearsightedness, creates visual challenges on its own, but it also increases a person’s risk of developing glaucoma. In an interview at the 2023 Asia-Pacific Association of Cataract and Refractive Surgeons conference, Dr. David Lubeck discussed the future of individualized treatment and care for patients with myopia and glaucoma.* 

Options for customizing care

The spectrum of treatment for glaucoma used to be sparse, Lubeck said, with “[medicated eye]  drops on one end, and trabeculectomy and drainage devices on the other end, and virtually nothing in between.”

Fortunately, there are now many more options available with which to custom-tailor treatments for glaucoma patients. Approximately 30-40 individual procedures, and about 40 different possible combinations of treatments, including various types of micro-invasive glaucoma surgeries (MIGS), can now be considered to “achieve specific targets.”

While Lubeck cited canaloplasty as his “favorite because of its versatility,” he said that his approach to treatment boils down to three specific “algorithms”:

• The severity of the individual person’s glaucoma,
• Whether or not their intraocular (internal eye) pressure is controlled, and
• Whether the surgical treatment being considered is to be a standalone treatment or combined with cataract surgery.

It’s preferable to apply interventions before treatment becomes necessary, however, Lubeck adds, and myopia is a good intervention point.

Myopia as an intervention point

“We all understand that the more myopic an eye, or the greater the axial length, the more prone it’s going to be to many things,” said Lubeck. In addition to being a major risk factor for open-angle, normal-tension, and high-tension glaucoma, myopia can lead to vision complications such as:

• Cataracts,  
• Retinal detachment, 
• Long-term vascular issues, and 
• Myopic macular degeneration. 

The need for collaboration between ophthalmologists and optometrists

Ophthalmologists are specialists in eye diseases, and are usually only called in once an eye disease requires treatment. Since myopia is most likely to be noticed and documented by optometrists–usually your neighborhood eye doctor–Lubeck calls for more cooperation and collaboration between ophthalmologists and optometrists in addressing eye disorders before they escalate and do irreparable damage.

“I suspect that our optometric colleagues have been discussing myopia and myopia prevention for a long time,” he said, “and the fact that we as specialists haven’t had a cross-dialogue is regrettable.”

*Media MICE. (2023, July 17). Dr. David Lubeck on Future of Glaucoma & Myopia: Bridging Ophthalmology & Optometry @APACRS 2023 [Video File]. YouTube. https://www.youtube.com/watch?v=DBZGQGZH5Jk 

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