How to Operationalize Your Practice to Provide Interventional Glaucoma Care
This content was developed in partnership with and is sponsored by Glaukos.
Advances in interventional glaucoma (IG), such as minimally invasive glaucoma surgery and procedural pharmaceuticals, continue to reshape how clinicians manage this condition. These innovations are empowering eye care teams to intervene earlier, reduce dependence on long-term topical therapy, and preserve vision more effectively. Achieving those outcomes depends on practice workflow and collaboration.
The Interventional Glaucoma Project series, hosted by Matt Jensen, of MJM / Marjen, and powered by Ophthalmology 360, offers insights from practice leaders who share what happens when they put their glaucoma operations under the microscope and use what they learn to optimize practice performance, treat patients better, and intervene earlier.
In the latest discussions in the series, Blake Williamson, MD, and Charles Williamson, practice administrator and CEO, both from the Williamson Eye Center, as well as Deborah Ristvedt, DO, and Mathew Walker, OD, from Vance Thompson Vision, reflect on how practice assessments sparked transformative change.
Systems and Collaborative Interventions
IG is as much about system efficiencies as it is about treatment interventions. Whether reducing visits in a high-volume practice or building co-management frameworks in rural communities, the protocol is the same: assess, communicate, and act.
“It’s more likely that patients will stick with an eye care provider if they’ve had an interventional procedure,” said Dr. Ristvedt. Mr. Jensen concurred, “Patients, when left to their own devices, if they’ve only been prescribed a drop, their lapse rate is higher than a patient who has had a procedural intervention. The patients almost view themselves as being under management now that they’ve had a procedure.”
Both the Williamson Eye Center and Vance Thompson Vision teams relayed the importance of conducting a practice assessment to truly understand how your facility is operating and to drive potential change when needed. “I encourage you to do a practice assessment,” said Dr. Williamson. “I think you’re going to be surprised what you [find] because I thought that…of course, we’re always thinking we’re better than what we are.”
Reducing the Path to Intervention
At the Williamson Eye Center, a practice assessment uncovered a surprising insight: On average, it took 6 visits for a glaucoma patient to reach the point of a procedural intervention. Those visits often spanned nearly 2 years, during which patients may struggle with adherence to topical medications while their disease continues to progress. Dr. Williamson called that statistic “shocking” and urged other practices to engage in a similar assessment to uncover potentially unknown patterns and pitfalls.
The Williamsons committed to re-engineering their workflow. “There’s no reason we can’t cut that in half,” said Dr. Williamson, highlighting a goal to move patients to more interventional approaches by their third, rather than sixth, visit. “From my perspective, every week represents a group of glaucoma patients who are coming in and may qualify for an interventional procedure,” said Mr. Williamson.
Mr. Williamson talked about the importance of evaluating patients who are set to come in each week and identifying patients who may be candidates for a discussion on more interventional approaches.
The goal is earlier intervention that improves both the patient experience and practice sustainability. Mr. Jensen shared, “I think we’re going to see the rise of an IG-style coordinator who is looking to try to reduce the [number] of visits it takes to get someone to intervention to a baseline and then drop therapies from there as a bridge.”
Building a Collaborative Care Model
While the Williamsons focus on internal efficiency, the Vance Thompson Vision team in Alexandria, Minnesota, has extended the IG model beyond their own walls, proving that collaboration can be just as powerful as optimization.
Dr. Ristvedt has built a co-management network that brings early glaucoma intervention to patients across a wide rural region. When Dr. Ristvedt made the decision to restructure her practice to focus on IG and surgical care, she took a leap of faith by partnering with local optometrists to manage ongoing care and shared decision-making.
The third-generation eye care provider called this approach a “risk.” She said, “A lot of these patients saw me grow up, and so they were personal to me.” But bringing in another family member, Dr. Walker, made the transition not only possible but successful.
Drs. Ristvedt and Walker explain that the co-management care model allowed their practice to provide more IG care by partnering with local optometrists to manage patients post-intervention for ongoing routine care.
“It wasn’t more surgery to do more surgery,” explained Dr. Walker. “It was because the need was here in our little rural community. There’s so much, especially pseudoexfoliation glaucoma, that these were being left to drops and at risk of progression, where we were [now] actually able to intervene.”
Through the practice assessment, they learned that 70% of their patients had mild to moderate glaucoma. “Why aren’t we doing [an] intervention? That’s [why] I get so passionate about [this]; we have the perfect opportunity with these patients before they lose vision,” said Dr. Ristvedt.
The assessment also highlighted an interesting finding: a 73% lapse rate post-procedure. But instead of signaling attrition, this reflected the success of their co-management system. “Our lapse rate in patients that had a procedure was extremely high, but what that means is that we’re co-managing effectively and that patients have gone back to their primary eye care doctor and are doing well.”
The operational benefits were equally clear. An analysis revealed that each technician spent 3 to 4 hours a week managing topical treatment pre-authorizations and refills, as well as patient communication, the equivalent of a full-time employee, Mr. Jensen pointed out. “Medication is awesome. It works, we know that, but there are better ways to prescribe that medication now via drug delivery,” said Dr. Ristvedt.
Dr. Ristvedt encourages other practices to evaluate their data. “It was interesting talking to my colleagues who did this assessment. They were shocked at the [number] of procedural interventions they thought they were doing [versus] actually what the data showed,” she said. She recommended 3 key features of an assessment:
- Assess your patient population. For example, how many have mild, moderate, and severe disease?
- Understand how often you are recommending a procedural approach to glaucoma care.
- Track retention and ensure patients who have not come back have found “a home” where they are getting the routine care they need.
Dr. Walker assured that when they partner with community optometrists, they keep a firm grasp on patients and maintain high levels of communication with those local clinicians. The firm provides guardrails, and if patients have pressure changes or face other complications, the local optometrist is directed to refer those patients back to Vance Thompson Vision. “If they fall outside of those guardrails, it’s not, ‘Good luck.’ It’s, ‘You better let us know. Text me, call me, send the referral back if they fall outside those guardrails,’” Dr. Walker explained.
From Assessment to Action
Both practices demonstrate that measuring what matters is the first step toward becoming truly interventional. Assessments uncover inefficiencies such as delayed intervention or inefficient patient management.
“IG is here, and it’s here to stay. We’ve just seen beautiful outcomes, stable pressures, and less vision loss,” said Dr. Ristvedt. “I can’t even imagine if we keep going at this rate, catching these mild to moderate patients at an earlier stage, how that’s going to totally transform what we’re having to manage when it comes to a glaucoma-heavy practice.”
Whether halving the number of visits to offering interventional care or co-managing patients more effectively, these tactics allow patients to receive timely, evidence-based treatment that helps preserve vision and strengthens the operational standards of these practices.
Learn more from the Williamson team.
Hear more from Drs. Ristvedt and Walker.
PM-US-2997
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.
Matt Jensen; Charles Williamson; and Drs. Blake Williamson, Deborah Ristvedt, and Mathew Walker were compensated by Glaukos for their time.
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