This content was developed in partnership with and is sponsored by Glaukos.
Real-world glaucoma treatment has undergone a significant shift driven by proactive disease management and minimally invasive procedures.
The growth of interventional glaucoma (IG) is impacting real-world practice patterns and every aspect of the patient care continuum.1-5 Generations of glaucoma specialists were trained to delay intervention for as long as possible; the standard of care was topical therapy first, then laser, then additional topical therapy, and—only if all else failed—filtration surgery.6
IG turns that model inside out, emphasizing early detection, proactive procedural intervention, and active monitoring.5 While topical therapy was once the mainstay of glaucoma treatment, mounting evidence on the downsides of topical therapy—such as inconsistent adherence and ocular surface disease—as well as the upsides of procedural intervention prompted a shift.2 As a result, procedural interventions have broken out of the adjunct-to-cataract-surgery role and are increasingly considered primary treatment options.5
Procedural Pharmaceuticals
The revolution is as exciting for early IG adopters—such as glaucoma specialist Lorraine Provencher, MD, of Vance Thompson Vision in Omaha, Nebraska—as it is for ophthalmologists who are more recently embracing IG. “With all of the advances, and a change in mindset, IG is rapidly becoming a standard of care,” said Dr. Provencher.
She shared examples of how the changing glaucoma treatment paradigm is influencing her practice specifically and the specialty in general. “Procedural pharmaceuticals are a growing area of IG that I think are going to take it to the next level,” said Dr. Provencher. “For instance, iDose® TR (travoprost intracameral implant) 75 mcg (Glaukos) is designed to control intraocular pressure for up to three years.7 There is a lot of excitement surrounding procedural pharmaceuticals from physicians and patients,” she said.
Bridge Therapy
By adopting IG, ophthalmologists aim to preserve vision and improve patient outcomes and quality of life.1-5 “With less reliance on topical therapy, the onus is no longer on the patient to adhere to a treatment regimen. Our outcomes show that IG is better for the patient and better for the disease,” said Dr. Provencher.1 However, there are instances when topical therapy is necessary, either as a temporary measure or a supplemental one.8
“When I sit down with a patient to discuss their prognosis and treatment options, I explain that I try to avoid topical therapy for their glaucoma. We want to keep the ocular surface healthy by avoiding decades of eye drops, which will enhance their quality of life,” said Dr. Provencher. “But it’s still important to convey that sometimes we do have to use topical therapy. I don’t want that patient to feel like they were misled if we have to bridge in this way or if we decide a topical therapy is safer than another interventional procedure. In those instances, we supplement with topical therapy, and it’s important for the patient to understand and be prepared for this to potentially happen,” she explained.
Patient Counseling
Counseling regarding IG treatments is most effective when the patient receives clear, comprehensive communication that educates without being overwhelming. “It’s important to avoid technical jargon or descriptions that sound invasive or frightening. For instance, instead of saying, ‘We’re going to do a laser surgery on your eye,’ which may alarm patients, it’s more effective to explain that selective laser trabeculoplasty (SLT) is a gentle, quick, stimulating laser that doesn’t cause pain, doesn’t burn or scar, and takes only minutes to seconds to perform,” she said. “Similarly, when discussing procedural pharmaceuticals, framing them as a way to avoid daily topical therapy—while still controlling the disease—is key. Patients appreciate knowing that the procedural pharmaceutical slowly releases medication inside the eye, can last months (Durysta) to years (iDose TR), and they can quickly return to normal activities. Addressing postoperative care with simple, reassuring language—for example, ‘You’ll use antibiotic drops to prevent infection,’—helps set expectations without causing undue worry,” she explained.
Overall, the goal is to help patients understand that glaucoma treatment is a journey and that interventions may need to be adjusted over time—but with proactive care, their vision and quality of life can be preserved.
Patient Education
Well-designed patient education materials are essential to support informed decisions about IG care. “In our practice, we provide brochures specifically focused on SLT, procedural pharmaceuticals, and minimally invasive glaucoma surgery (MIGS) to help patients understand that these are evidence-based treatments—not experimental—and that multiple options are available. Many patients feel overwhelmed during clinic visits, so giving them printed materials to take home allows them to process information at their own pace and discuss it with family members,” said Dr. Provencher. “We also provide customized handouts listing treatment options, with the specific recommendation circled—reinforcing that glaucoma care is personalized and may involve several steps over time. Additionally, we offer similar materials to referring doctors, ensuring they can confidently introduce patients to interventional options and feel reassured about the continuity of care.”
Because some patients may receive treatment the same day as their consult, these resources offer multiple touchpoints of reassurance—supporting both patient comfort and clinic efficiency, she explained.
MD/OD Collaboration
Collaboration between optometrists and ophthalmologists is essential—especially as the population ages and the number of glaucoma patients continues to grow. When optometrists, who are on the front lines in their communities, and ophthalmologists, who offer specialized procedural interventions, work together in a coordinated way, patient care improves significantly. Patients benefit from seamless transitions between monitoring and intervention, and both providers can focus on what they do best.
Ideally, optometrists should feel confident referring their patients for interventional procedures knowing those patients will be returned to their care post-procedure, often more stable and with fewer topical medications and side effects to manage.
This shared care model, where patients move between the optometrist and ophthalmologist as needed throughout their lifetime, supports better outcomes and reinforces patient satisfaction. It also reduces the burden on optometrists to manage complex medication regimens and prior authorizations, which can be time-consuming and frustrating. “Strong communication and mutual respect between providers are the foundation. When those relationships are in place, referrals happen naturally, and patients receive timely interventions and then return to their primary eye care provider for ongoing monitoring. It’s a win-win for providers—and most importantly—for patients,” said Dr. Provencher.
Patient Assessment
The convergence of innovative technology and proactive treatment has prompted enthusiasm but also some apprehension. “Some ophthalmologists initially worried that patients who underwent MIGS or SLT might be lost to follow-up because they no longer relied on topical therapy to manage their condition,” Dr. Provencher explained. “There was concern that patients would think the procedure ‘cured’ them so there was no need to return for care. However, we’ve looked at our own patient lapse data and found the opposite effect—patients who receive an intervention are less likely to miss their follow-up visits compared to medically treated patients.”
Clinic Schedules
For many surgeons, a significant portion of the day is spent managing postoperative visits, especially in high-volume glaucoma clinics. However, patients treated with SLT, procedural pharmaceuticals, or MIGS typically require fewer follow-up appointments than those on topical therapy. “It’s striking how early use of IG procedures versus waiting for more invasive surgeries can drastically reduce postoperative demand—sometimes from as many as 15 visits to just a few. From a business standpoint, this reduction in clinic burden makes IG an efficient and effective treatment approach, as well as a smart and sustainable choice for practice management,” she said.
From the use of procedural pharmaceuticals and SLT as first-line therapy to reconfigured clinic schedules that focus more time on treatment and less time on follow-up, today’s proactive glaucoma treatment paradigm differs from the previous reactive model.
Disclosures: Dr. Provencher is a consultant for Glaukos.
References
- Bedrood S, Berdahl J, Sheybani A, Singh IP. Alternatives to topical glaucoma medication for glaucoma management. Clin Ophthalmol. 2023;17:3899-3913. doi:10.2147/OPTH.S439457
- 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
- Gallardo M, Smith O, Trubnik V, Reiss G. Interventional glaucoma and the patient perspective. Expert Rev Ophthalmol. 2024;19(5):311-318. doi:10.1080/17469899.2024.2382149
- Kamat S, Baudouin C, Shah M, Radcliffe N. Long-term chronic drop therapy vs. intracameral procedural pharmaceuticals for glaucoma: what does the evidence support? J Clin Exp Ophthalmol. 2024;15(5):986. doi:10.35248/2155-9570.24.15.988
- Micheletti JM, Brink M, Brubaker JW, Ristvedt D, Sarkisian SR. Standalone interventional glaucoma: an evolution from the combination-cataract paradigm. J Cataract Refract Surg. 2024;50(12):1284-1290. doi:10.1097/j.jcrs.0000000000001537
- Marquis RE, Whitson JT. Management of glaucoma: focus on pharmacological therapy. Drugs Aging. 2005;22(1):1-21. doi:10.2165/00002512-200522010-00001
- Berdahl JP, Sarkisian Jr. SR, Ang RE, et al. Efficacy and safety of the travoprost intraocular implant in reducing topical IOP-lowering medication burden in patients with open-angle glaucoma or ocular hypertension. Drugs.2024;84(1):83-97. doi:10.1007/s40265-023-01973-7
- Gazzard, G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505-1516. doi:1016/S0140-6736(18)32213-X
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.
PM-US-2756
Dr. Provencher was compensated by Glaukos for her time.
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