Becoming Interventional: Analyzing Practice Data and Shifting Internal Workflows
This content was developed in partnership with and is sponsored by Glaukos.
Glaucoma management has been undergoing meaningful change since the emergence of minimally invasive and standalone interventional options, which has led to a broader rethinking of how glaucoma care is best delivered. Practices committed to bringing an interventional care approach to their patients have an opportunity to impact adherence, long-term disease control, and patient education.
The Interventional Glaucoma Project series, hosted by Matt Jensen, of MJM / Marjen, and powered by Ophthalmology 360, offers real-world insights from US practices that have taken a deep dive into their practice patterns in order to lead with an interventional mindset.
In the latest discussions in the series, teams from the Thomas Eye Group and Omni Eye Group discuss their transition toward proactive glaucoma care by redesigning practice workflows, retraining staff, engaging referring providers, and building data systems to track and sustain change.
From Drops to Procedures: A Paradigm Shift Emerges
A central theme described by both teams is that glaucoma can and should be managed procedurally earlier on. Philip Garza, MD, of Thomas Eye Group, explained the transition his group has undergone over the past 2 years to become more procedural-based, saying, “It has been an absolute revolution in how we think about [and execute] glaucoma care.” This evolution has been driven by advances in minimally invasive glaucoma surgery and procedural pharmaceuticals that allow for safe and effective intraocular pressure (IOP) control, while reducing the reliance on topical medications.
Arkadiy Yadgarov, MD, of Omni Eye Group, emphasized that the goal is not just IOP reduction, but an improved patient experience: “Drops sometimes have pressure control (if taken as per the prescription and without gaps and instillation issues), but patients are miserable on [them]. Now you have an opportunity to improve pressure control while making patients happier.”
Both clinicians point to a growing recognition that the traditional reliance on topical medication is misaligned with patient needs and real-world behavior. “Asking for perfect adherence to glaucoma drops is not realistic for most patients,” said Dr. Garza.
Dr. Yadgarov agreed: “We have tons of studies and literature that confirms that there is about a 50% non-compliance rate, on average, [with drops], which we should not accept.”
Clinical and Operational Implications
The conversations highlight 2 major “elephants in the room” when it comes to topical therapy: adherence and tolerability. Patients may fail to fill prescriptions, use their topical treatment inconsistently, and disengage from follow-up care.
“The reality is an every-day-of-the-week drop regimen is not an easy administrative ask for a patient,” said Ben Seals, CEO of Thomas Eye Group. This leads to what he describes as delayed care and the potential for patients to get lost in the healthcare system.
Mr. Seals, a known “data buff,” used the organization’s data to understand patterns of care. He noted that some patients would come in for upwards of 6 appointments before they would undergo a procedure or interventional approach.
“Without that data, our glaucoma specialists really otherwise might not have had the impetus to change or at least the baseline awareness of how often and how frequently their patients were having to come back and forth to clinic, between their appointments, testing, prescription refills, [and] medication updates,” he said.
Kathy Disner, practice administrator of Omni Eye Group, acknowledged the burden that other practice staff can feel from a delay in interventional care, citing time-consuming prior authorizations, refill coordination, and repeated patient counseling.
Each team conducted a practice review and subsequently implemented changes that take a more interventional care approach. Dr. Garza highlighted the “Christmas morning experience” for patients who see a reduction in topical therapy after interventional care. “It has been a significant change in mindset and a significant change in execution, with more and more patients passing through a procedural pathway and fewer patients than ever on habitual drops,” he said.
Mr. Seals noted that the shift to procedure-first care has resulted in “happier patients with better outcomes [and] better managed vision and pressures,” which leads to “less necessary follow-up and inconvenience to the patient to create the same clinical outcome.”
Dr. Yadgarov echoed this sentiment by sharing that post-procedural intervention, the patient visit is streamlined, and the patient can wait up to 6 months to return for an assessment.
This altered practice pathway also allows Drs. Garza and Yadgarov to focus on their surgical skillset and practice “to the top of [their] license,” noted Mr. Jensen, meaning they are able to spend more time in being surgeons providing procedures to patients in need and less time attending to the burdens of the clinic, which can be fueled by many patients receiving topical therapy.
Executing the Transformation
A major focus of both discussions was how practices operationalize this paradigm shift. Moving from a topical-based to procedure-first model required intentional redesign of workflows, staffing, and patient pathways.
At Thomas Eye Group, this included adopting a goal of minimizing pre-procedural visits. This required building a collaborative care model with optometrists, whom Dr. Garza described as “our medical glaucoma specialists…[who] allow us to get down to that 1 visit before a procedural recommendation.”
The concept of parallel clinic structures also emerged, enabling same-day evaluation and potential intervention. This improves access, addressing what Mr. Seals identified as a bottleneck: limited availability of proceduralists and long wait times.
“We need to be lowering the barrier to safe care for our patients by making ourselves more available, focusing on the things that only we as proceduralists can do, which opens up more availability in our clinics,” said Dr. Garza.
Data-Driven Decision-Making Made Possible With Dashboards
Both organizations emphasized the importance of data infrastructure to guide implementation. Mr. Seals described developing a dashboard modeled after cataract and refractive surgery metrics, tracking consults, conversions, and procedural yield.
Similarly, Ms. Disner highlighted the role of dashboards in monitoring bottlenecks in the office, timing of patient exams, conversion rates, and surgery scheduling, enabling the continuous refinement of workflows and resource allocation. She noted that their interventional glaucoma capacity calculator helps anticipate procedural volume and align staffing and scheduling accordingly.
Education and Alignment Are Key
A recurring theme from both conversations was the need for comprehensive education across all stakeholders. Mr. Seals detailed the need for pre-appointment patient education, where individuals receive information about interventional glaucoma options prior to their visit, which outlines treatment options other than topical therapies.
Internally, practices are standardizing communication through staff training and scripting. Ms. Disner emphasized the importance of consistent communication from optometrists to technicians: “We want to speak the same language. We want the same message every time somebody else is talking to that patient throughout their exam journey.”
She continued, “That puts confidence in the techs because they know how to communicate with the patient, and it puts the patient at ease because they’re hearing the same message. Then hopefully, it’s going to save time for the [ophthalmologist] counseling the patient because the patient has heard the same message, starting with the referring optometrist, through our entire staff, through their exam journey, and now into the physician’s office.”
Dr. Yadgarov noted that changing longstanding habits requires education and clear algorithms: “When there’s no good organization, doctors are always going to default to habits. What have been the habits? It’s drops. In order to break that habit, you have to create an algorithm in order to help operationalize how we’re going to go along this new paradigm.”
He was part of developing a consensus protocol to establish interventional glaucoma approaches as the standard of care. The treatment algorithm is based on patient disease severity, and the practice uses this information as a step-by-step guide to educate staff and patients.
Measuring Progress and Sustaining Momentum
While both organizations reported significant growth in procedural-forward care, they noted that the transition is ongoing. “If we say that we’ve arrived where we want to be, I think most of us would be kidding ourselves,” said Dr. Garza. “This whole process really starts with taking a good, hard look at your own practice and asking yourself, ‘Who are you? What do you intend to be for your patients? What services do you really intend to provide, and are you really doing it?’”
Continuous evaluation, iteration, and team alignment are essential to sustain the transformation in mindset, systems, and philosophy.
These discussions illustrate how interventional glaucoma is a broader redefining of how clinicians approach a chronic, progressive disease. The movement from topical therapy dependence toward earlier procedural intervention reflects pharmaceutical progress and a patient-centered focus.
Uptake of this care model depends as much on operational excellence as it does on clinical skill. Practices that have seen success have aligned their teams, invested in education, built data-driven systems, and created patient pathways that focus on important outcomes.
“You could just manage glaucoma how we’ve been doing it for 30 years, but you’re really not doing what’s best for the patient because now we have tools that are just substantially better at helping patients than we’ve had before,” said Dr. Yadgarov.
INDICATIONS AND USAGE
iDose TR (travoprost intracameral implant) is indicated for the reduction of intraocular pressure (IOP) in patients with open angle glaucoma (OAG) or ocular hypertension (OHT).
IMPORTANT SAFETY INFORMATION for iDose® TR (travoprost intracameral implant) 75 mcg
Dosage and Administration
For ophthalmic intracameral administration. The intracameral administration should be carried out under standard aseptic conditions.
Contraindications
iDose TR is contraindicated in patients with active or suspected ocular or periocular infections, patients with corneal endothelial cell dystrophy (e.g., Fuch’s Dystrophy, corneal guttatae), patients with prior corneal transplantation, or endothelial cell transplants (e.g., Descemet’s Stripping Automated Endothelial Keratoplasty [DSAEK]), patients with hypersensitivity to travoprost or to any other components of the product.
Warnings and Precautions
iDose TR should be used with caution in patients with narrow angles or other angle abnormalities. Monitor patients routinely to confirm the location of the iDose TR at the site of administration. Increased pigmentation of the iris can occur. Iris pigmentation is likely to be permanent.
Adverse Reactions
In controlled studies, the most common ocular adverse reactions reported in 2% to 6% of patients were increases in intraocular pressure, iritis, dry eye, visual field defects, eye pain, ocular hyperaemia, and reduced visual acuity.
Please see full Prescribing Information.
You are encouraged to report all side effects to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. You may also call Glaukos at 1-888-404-1644.
IMPORTANT SAFETY INFORMATION for iStent infinite®
INDICATION FOR USE. The iStent infinite® Trabecular Micro-Bypass System Model iS3 is an implantable device intended to reduce the intraocular pressure (IOP) of the eye. It is indicated for use in adult patients with primary open-angle glaucoma in whom previous medical and surgical treatment has failed. CONTRAINDICATIONS. The iStent infinite is contraindicated in eyes with angle-closure glaucoma where the angle has not been surgically opened, acute traumatic, malignant, active uveitic, or active neovascular glaucoma, discernible congenital anomalies of the anterior chamber (AC) angle, retrobulbar tumor, thyroid eye disease, or Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure. WARNINGS. Gonioscopy should be performed prior to surgery to exclude congenital anomalies of the angle, PAS, rubeosis, or conditions that would prohibit adequate visualization that could lead to improper placement of the stent and pose a hazard. MRI INFORMATION. The iStent infinite is MR-Conditional, i.e., the device is safe for use in a specified MR environment under specified conditions; please see Directions for Use (DFU) label for details. PRECAUTIONS. The surgeon should monitor the patient postoperatively for proper maintenance of IOP. Three out of 61 participants (4.9%) in the pivotal clinical trial were phakic. Therefore, there is insufficient evidence to determine whether the clinical performance of the device may be different in those who are phakic versus in those who are pseudophakic. ADVERSE EVENTS. The most common postoperative adverse events reported in the iStent infinite pivotal trial included IOP increase ≥ 10 mmHg vs. baseline IOP (8.2%), loss of BSCVA ≥ 2 lines (11.5%), ocular surface disease (11.5%), perioperative inflammation (6.6%) and visual field loss ≥ 2.5 dB (6.6%). CAUTION: Federal law restricts this device to sale by, or on the order of, a physician. Please see DFU for a complete list of contraindications, warnings, precautions, and adverse events.
PM-US-3013
Matt Jensen, Dr. Philip Garza, Ben Seals, Dr. Arkadiy Yadgarov, and Kathy Disner were compensated by Glaukos for their time.
Related Content
