Early Adopters of Interventional Glaucoma Strategies Say Act Now to Protect Vision
This content was developed in partnership with and is sponsored by Glaukos.
Being interventional is about using every opportunity to manage glaucoma more effectively.
Interventional glaucoma (IG) offers a proactive strategy to preserve vision and protect patients’ quality of life, making early adoption a compelling priority for forward-looking ophthalmic practices. Harvard Eye Associates, in Orange County, California, was an early adopter of IG. “We’re always asking if there’s a better way to care for our patients,” glaucoma surgeon Savak “Sev” Teymoorian, MD, MBA, explained. That mindset paved the way for a shift toward IG.
How It Started
The limitations associated with relying solely on topical medications or traditional surgery, particularly in newly diagnosed glaucoma patients, prompted the Harvard Eye Associates team to explore alternative treatment options, including procedural pharmaceuticals, selective laser trabeculoplasty (SLT), and MIGS. Well-known challenges associated with traditional glaucoma therapy include poor adherence, inconsistent intraocular pressure (IOP) control, complex dosing schedules, physical difficulty administering topical medications, medication-related side effects such as ocular surface disease, and financial burden.1 Publication of the landmark LiGHT study, which demonstrated SLT was an effective first-line therapy for open-angle glaucoma, gave the practice the clinical justification to formalize its interventional strategy.2 “It gave us the confidence to move away from starting patients on drops by default,” said Dr. Teymoorian.
Around the same time, a selection of microinvasive glaucoma surgeries (MIGS) that could be performed independently or paired with cataract surgery emerged, and procedural pharmaceuticals such as iDose® TR (travoprost intracameral implant) 75 mcg (Glaukos) and Durysta® (AbbVie) further expanded the growing glaucoma treatment toolbox.3,4 “Over the past 5 years, this shift has been evolutionary. The result is an array of non-drop-based options to manage glaucoma more proactively, and now the data supports the model. We just have to keep executing it,” said Dr. Teymoorian.
How It’s Going
Dr. Teymoorian sees IG as a philosophical shift toward proactive management. “It’s not just about earlier treatment. It’s about earlier diagnosis, improved patient education, and using technology to stay ahead of disease progression,” he explained. Glaucoma is the second leading cause of blindness.5 Rather than reacting to structural damage after it occurs, the goal is to preserve functional vision by intervening sooner. “By taking a more proactive role and shifting some treatment responsibility from the patient to the physician, we can deliver more consistent care,” he said.
Interventional strategies often align with natural milestones in a patient’s visual journey. “For example, when patients are ready for cataract surgery, we can combine that with a MIGS procedure to better manage IOP and reduce reliance on glaucoma eye drops,” Dr. Teymoorian explained. “It’s about using every opportunity to protect vision in a forward-thinking way.”
Assessing Practice Patterns
Assessing current practice patterns is essential when considering a shift toward IG. “We often think we’re practicing a certain way, but when we actually examine the data, it may tell a different story,” Dr. Teymoorian noted. A clear-eyed review of metrics can reveal gaps, highlight opportunities, and identify barriers that may be limiting adoption. “IG isn’t defined by any one product or procedure—it’s a mindset. Changing that mindset requires alignment across the care team, including providers, patients, and even payers,” he said.
To support that shift, Dr. Teymoorian emphasizes the importance of documenting an ideal treatment protocol. “Everyone involved in glaucoma care needs to be on the same page. The patient is more likely to trust the plan when the messaging is unified between the optometrist and ophthalmologist,” he explained. At Harvard Eye Associates, regular meetings between ophthalmologists and optometrists help sustain this shared approach. “That shared protocol improves efficiency, reinforces trust, and ultimately leads to better patient care.”
A recently published IG treatment consensus protocol6 provides a stepwise procession of IG treatments, including rationale behind each step, and can help guide providers seeking to incorporate IG principles into their practices.
Practice Management Perspective
Harvard Eye Associates Chief Operating Officer, Arsen Grigoryan, MBA, COE, sees IG as a strategic imperative. Mr. Grigoryan, who started at the Orange County practice as an ophthalmic technician over a decade ago and continued to serve in various roles while advancing his education, approaches the evolution and execution of IG in the way he approaches everything in the practice: define the problem, identify the solution, and execute the strategy. He describes key steps to implement an effective IG model.
- Practice Assessment
“The first step was asking: what does IG mean for our patients?” said Mr. Grigoryan. “We had to stop and assess where we truly stood, such as what our current patterns were, how we defined ‘best care,’ and where we could improve.” Having worked on the clinic side, he recognized firsthand how patients struggled with medication adherence, side effects, and cost. “Drops can be a barrier,” he noted. “When patients can’t squeeze the bottle, forget to refill it, or get hit with sticker shock at the pharmacy, we’re setting them up to fail.” - Document Your Treatment Protocol
From a management perspective, consistency is key. Mr. Grigoryan underscores the importance of codifying the glaucoma treatment protocol. “When you define the clinical standard, you empower every member of the team—from technician to optometrist—to reinforce the same message. That alignment is essential for both trust and efficiency,” he explained. - Teach Your Teams
Grigoryan also emphasizes training. “You can’t expect uniform outcomes if people aren’t taught the same approach,” he said, noting the need to build internal systems that follow clinician recommendations. - Hold Yourself Accountable
Grigoryan stresses the importance of documentation as a mechanism for accountability: “Once you write down your ideal pathway, it becomes a benchmark. You start noticing where you’re falling back into old habits and where you can improve.” - Teach Your External Partners
The protocol also facilitates collaborative care. “We share our treatment approach with referring optometrists so they can start the conversation,” he said. “It makes the handoff smoother, and the patient feels supported instead of confused.” - Streamline Collaborative Care
With alignment comes efficiency. “When internal teams and external partners are on the same page, referrals become easier to manage, and we can provide better service with less administrative friction,” Mr. Grigoryan explained.
Act Now
From a clinical perspective, Dr. Teymoorian says the ultimate rationalization for implementing an IG model sooner rather than later is that early intervention preserves quality of life. “It’s simple,” he said, “by leveraging IG techniques before optic nerve damage occurs, we can help patients avoid visual field loss and maintain functional vision.”
From a practice standpoint, Mr. Grigoryan said the IG model alleviates downstream burden. “When patients rely on chronic drops, it leads to more refill requests, more prior authorizations, and more symptom-related calls, which can overwhelm staff resources. IG solutions like SLT and iDose TR relieve that pressure and allow us to redirect time toward delivery of care,” he explained.
Mr. Grigoryan also points out: “If you’re not evolving, you risk falling behind. What might have worked yesterday becomes imperfect today and unacceptable tomorrow.”
Savak “Sev” Teymoorian, MD, MBA, is a glaucoma specialist at Harvard Eye Associates in Laguna Hills, California. He can be reached at [email protected]. Disclosure: He is a paid consultant, speaker, and researcher for Glaukos and AbbVie.
Arsen Grigoryan, MBA, COE, is the Chief Operating Officer at Harvard Eye Associates in Laguna Hills, California. He can be reached at [email protected]. Disclosure: He is a paid consultant for Glaukos.
References
- Radcliffe NM, Shah M, Samuelson TW. Challenging the “topical medications-first” approach to glaucoma: a treatment paradigm in evolution. Ophthalmol Ther. 2023;12(6):2823-2839. doi:10.1007/s40123-023-00831-9
- Gazzard G, Konstantakopoulou E, Garway-Heath D, et al; LiGHT Trial Study Group. Laser in glaucoma and ocular hypertension (LiGHT) trial: six-year results of primary selective laser trabeculoplasty versus eye drops for the treatment of glaucoma and ocular hypertension. Ophthalmology. 2023;130(2):139-151. doi:10.1016/j.ophtha.2022.09.009
- Sarkisian SR, Ang RE, Lee AM, et al. Travoprost intracameral implant for open-angle glaucoma or ocular hypertension: 12-month results of a randomized, double-masked trial. Ophthalmol Ther. 2024;13(4):995-1014. doi:10.1007/s40123-024-00898-y
- Bacharach J, Tatham A, Ferguson G, et al. Phase 3, randomized, 20-month study of the efficacy and safety of bimatoprost implant in patients with open-angle glaucoma and ocular hypertension (ARTEMIS 2). Drugs. 2021;81(17):2017-2033. doi:10.1007/s40265-021-01624-9
- About glaucoma. Centers for Disease Control and Prevention. May 15, 2024. Accessed September 5, 2025. https://www.cdc.gov/vision-health/about-eye-disorders/glaucoma.html
- Funke CM, Ristvedt D, Yadgarov A, Micheletti M. Interventional glaucoma consensus treatment protocol. Expert Rev Ophthalmol. 2025;20(2):79-87. doi:10.1080/17469899.2025.2465330
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-3005
Dr. Teymoorian and Arsen Grigoryan were compensated by Glaukos for their time.
Related Content
