Christine Funke, MD, of Barnet Dulaney Perkins Eye Center, spoke with Ophthalmology 360 at the American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting about the latest highlights in interventional glaucoma care.
Question:
Can you talk about the interventional glaucoma consensus treatment protocol paper you are an author on that was recently published? What are the key takeaways?
Christine Funke, MD:
I was very privileged to be part of a consensus protocol that was created and recently published, this protocol or what I can consider more of a guideline of treatment for glaucoma. I think it’s something we’ve really needed and been yearning for, especially as we’re starting to shift the dogma of how we treat glaucoma to more procedural first.
What this paper was was basically a consensus between several glaucoma specialists as well as high-volume cataract surgeons. We all got placed together in a room and then started to discuss how we wanted to treat patients based on looking at different disease states, so primary open-angle glaucoma, mild, moderate, and severe stage. Then not just that, but then talking about the ideal patient, right? The majority of patients. Trying to get rid of the outliers.
What we realized was that as we started to talk, we found a very general consensus that everyone agreed upon about how we like to do a staged approach to procedural glaucoma therapy, starting with lasers, then looking at procedural pharmaceuticals, non-destructive MIGS, and then more destructive MIGS, meaning something where you’re removing tissue, and then finally looking at actual subconjunctival surgery.
This is going to be helpful, I hope, as a roadmap for people to understand and feel comfortable with procedure-first glaucoma care, and that they’re not outliers, they’re not alone in how they’re treating this disease, but actually, this is a consensus. This is a majority that we are moving forward in this manner. That was the basics of this paper. Again, I’m just hoping that it’s a good conversation-starter, a good guideline, and a way to help us move forward in the future with this more procedure-forward look at how we treat glaucoma.
Question:
You were part of a panel discussion at ASCRS 2025 that covered interventional glaucoma trends and innovation. What were some highlights from that session?
Christine Funke, MD:
The session was great. We were focused a lot on looking as holistically as we can at ourselves and how we’re doing as a group of what we would consider to be interventional-forward glaucoma specialists. An inward look is always sometimes enlightening and also challenging, and one thing I was involved in was something called the PIONEER study. Great way of looking personally inwards at my own practice to see how interventional I was, and also to help with some of the preconceived notions that I have around glaucoma and glaucoma care.
The big one, I think I learned from it, and I think the biggest takeaway from the symposium, was that when we start to look at our patient population, we’ve always had this assumption that if I do a procedure, any procedure, we’re worried that those patients are never going to follow up again because they feel cured. We actually found the exact opposite, not only in my dataset, but in multiple physician practice datasets, that the people and patients who are getting procedures first, or procedures generally, tend to have a very high rate of return to clinic, which is very important, obviously, for glaucoma, because this is an ongoing progressive disease that we never can cure. Those who we said, “Here’s a drop,” they actually had a very low rate of return to clinic.
It’s a really nice extra reason, on top of the many reasons that we’ve been compiling over the last decade-plus, as to why procedural treatment for glaucoma should really be our primary methodology of looking at how we want to take care of patients.
Other things that we discussed while we were there also was talking about new procedural pharmaceuticals, specifically iDose TR, and this is another lovely way of trying to get pharmaceutical available in the eye, because we know pharmaceuticals work beautifully, but the compliance is the issue. Now, by using something that can stay in the eye permanently, we are jumping over that huge barrier that we’ve been dealing with for the entire time that we’ve been trying to treat glaucoma pharmaceutically.
Now we have something that is able to be bioavailability 24 hours a day inside the eye, and we are seeing data, two and a half to three and a half years, that sustainable release is present and available in the eye. It’s another great step forward in just being able to treat this disease more effectively without as much worry about patient compliant issues.
Then the final discussion, I think, that was a nice other takeaway was talking about intervention as a standalone option. Standalone options still haven’t been the most popular, and a lot of questions around why, and I think there’s a lot of answers to that, but bottom line is I think, too, we have to remember what is available, remind ourselves what’s available when we’re talking to patients in the clinic, and discuss that option, because patients aren’t going to know, and if we don’t discuss those options with them, then of course they’re not going to choose those options. Talking about the availability of, again, iDose TR is one option and they can be done as standalone, but then also iStent infinite is another one that can be done as a standalone option, or combined together, which is one of the things I like to do.
I think glaucoma is exciting. I think we are just continuing to broaden what we’re able to do here and the tools that we have. We just need to start just becoming more excited and talking to all of these different options with our patients so that we can start using it more, and I hope and think, become much more effective at treating and controlling this long-term and challenging disease.
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