The management of glaucoma, a leading cause of irreversible blindness, is evolving towards a more proactive, patient-centered approach called interventional glaucoma. At a recent workshop, Drs. John Berdahl, Rachel Simpson, Brian Shafer, and Sarah Van Tassel delved into key questions surrounding this approach. The workshop emphasized an interventional, rather than traditional, method for treating glaucoma, focusing on early diagnostics and timely interventions. Learn more about interventional glaucoma and what it could mean for patients.*

A Patient-Centered Mindset

“Interventional glaucoma is our attitude,” explains Berdahl. “It’s saying, ‘What would I want if it was me—if I was the patient?’” This approach prioritizes early detection and intervention, positioning glaucoma treatment as more than just a series of reactive measures. 

Unlike traditional treatment, which often depends on patient-administered medications, interventional glaucoma employs:

• Diagnostics,  
• Routine monitoring, and 
• Procedures like laser therapy or minimally invasive glaucoma surgery (MIGS) early in the disease course.

This approach seeks to address common compliance issues associated with topical medications, which can lead to inconsistent results. 

As Berdahl notes, intervening early allows clinicians to preserve vision and enhance their patients’ quality of life. Interventional glaucoma, therefore, is more than a treatment—it’s a mindset that redefines how doctors manage chronic eye diseases.

Breaking Away from Tradition

“To understand the why [of interventional glaucoma],” says Van Tassel, “we have to look at the historical context.” Traditionally, glaucoma treatment begins with topical medications, often escalating to surgery only after the disease progresses. 

This medication-first mindset has limitations, however; adherence issues due to side effects or high costs are prevalent, reducing treatment efficacy. As Van Tassel observes, “Patients are looking to their doctors for guidance to achieve sustainable IOP reduction.”

The interventional approach challenges this convention by recommending MIGS or other surgical options early on, with the aim of ensuring long-term stability of intraocular pressure (IOP). 

Like all glaucoma treatments, proactive intervention is designed to:

• Manage symptoms,
• Slow disease progression, and 
• Preserve sight. 

By shifting away from over-reliance on topical medications, however, Van Tassel says, doctors can offer patients a more sustainable path to maintaining their vision.

Barriers to Changing Perspectives and Practices

According to Simpson, “Interventional glaucoma is a long-term management mindset.” Yet, the shift from traditional medication-focused care to proactive procedures faces resistance from both doctors and patients. Concerns tend to revolve around:

• Potential surgical complications, 
• Recovery and costs, and
• Reimbursement policies. 

Despite these hurdles, Simpson emphasizes that relying on multiple medications while patients struggle with compliance “does more harm than good.”

To overcome these barriers, she says, physicians need to spend more time explaining MIGS options to patients, which involves more patient education time. It also requires collaboration among optometrists, patients, and surgeons to understand the benefits of interventional glaucoma.

Practical Applications: Engaging Patients 

“When I see a new glaucoma patient,” Shafer says, “I sit down and show them a model of the eye. I say, ‘You have glaucoma…Our goal is to get your pressure to a level by which you don’t go on to suffer any more damage to your optic nerve.’” 

Engaging patients in this way, he says, fosters trust and helps them understand the variety of treatment options they may encounter over the course of their disease.

Overall, the panel members agree that presenting interventions as the first line of defense requires a shift in mindset, where physicians demonstrate the immediate and long-term value of early procedures, even if they may not last indefinitely. 

As Shafer observed, the key lies in explaining that these interventions are part of a strategic, proactive approach to maintain vision stability and patient comfort, thereby embracing a new era of glaucoma management.

If you’re interested in learning more about interventional glaucoma, register for this free webinar on November 13th, 2024 from The Glaucoma Foundation! 

*YoungMD Connect. (2023, November). The Interventional Glaucoma Revolution. Retrieved from https://youngmdconnect.com/articles/2023-nov-supplement/the-interventional-glaucoma-revolution 

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