J. Morgan Micheletti, MD, of Berkeley Eye Center in Houston, Texas, talks about the current state of interventional glaucoma.
J. Morgan Micheletti, MD:
It’s a really exciting time for interventional glaucoma. It’s a huge change in the way that we’ve previously done things over the last 20 years. We’re really looking at being proactive as opposed to reactive when it comes to management of glaucoma. We’re no longer waiting for patients to progress and saying, “You’ve lost vision. Let’s now start a treatment.” We’re saying, “You have glaucoma. This is where you are. Let’s prevent you from losing vision down the road.” We have these amazing technologies now, like DSLT, Durysta, standalone iStent infinite, all of the MIGS devices that are coupled with cataract surgery or those that are standalone. We have all of these in our armamentarium that we can use to manage glaucoma, and it’s a really exciting time to get ahead of the game and to actually start being proactive instead of reactive.
I talk to my patients about that, too. It’s really important to have buy-in from them. We’re shifting more and more away from, “Let’s use drops as primary therapy” to “Let’s use drops as a bridge to more definitive therapy that maybe takes it out of the hands of patients,” because we know that patients, over time, don’t always do a good job using their drops, and that’s not their fault. Personally, I would be terrible at using drops. Having that honest conversation with patients really opens their eyes to saying, “Yeah, you know what? I do think that’s an interesting thing to do.” But we have great data behind it, too. The LiGHT trial was now in 2019, it’s 2024. Five years ago, and yet still, in the majority of practices, SLT is not first line. I think it’s really time for us, as a whole group, to jump on and say, “Hey, it’s time. Let’s move forward with interventional glaucoma because it’s here to stay and it’s not going anywhere, and it’s the best thing for our patients.”
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