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. 2023 Dec;12(6):2823-2839.
doi: 10.1007/s40123-023-00831-9. Epub 2023 Oct 19.

Challenging the "Topical Medications-First" Approach to Glaucoma: A Treatment Paradigm in Evolution

Nathan M Radcliffe  1 , Manjool Shah  2 , Thomas W Samuelson  3
Affiliations

Challenging the "Topical Medications-First" Approach to Glaucoma: A Treatment Paradigm in Evolution

Nathan M Radcliffe et al. Ophthalmol Ther. 2023 Dec.

Abstract

Topical glaucoma medications are effective and safe, but they have numerous well-documented limitations that diminish their long-term utility and sustainability. These limitations can include high rates of nonadherence (with associated glaucoma progression), concerning side effects, inconsistent circadian intraocular pressure (IOP) control, complex dosing regimens, difficulty with self-administration, costs, and decreased quality of life. Despite these limitations, topical medications traditionally have been first-line in the glaucoma treatment algorithm, as no other minimally invasive treatment alternatives existed. In recent years, however, novel interventional therapies-including sustained-release drug-delivery platforms, selective laser trabeculoplasty, and micro-invasive glaucoma surgery procedures-have made it possible to intervene earlier without relying on topical medications. As a result, the topical medication-first treatment approach is being reevaluated in an overall shift toward earlier more proactive interventions.

Keywords: Early; Intervention; MIGS/micro-invasive glaucoma surgery; Medication; SLT/selective laser trabeculoplasty; SRDD/sustained release drug delivery; Treatment.

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Conflict of interest statement

Dr. Nathan Radcliffe: consultant/fees from Allergan, Alcon, Glaukos, Sight Science, New World Medical, Lumenis, Belkin, Bausch and Lomb, Thea, and Iridex. Dr. Manjool Shah: to be submitted separately. Dr. Thomas W. Samuelson: consultant for Aerie Pharmaceuticals, Alcon Surgical, Allergan, Bausch & Lomb/Valeant, BELKIN Vision, ELT Sight, Equinox, Glaukos, Imprimis, Irisvision, Ivantis, Johnson & Johnson Vision, Ocuphire, MicroOptx, New World Medical, PolyActiva, Ripple Therapeutics, Santen, Sight Science, TearClear, Vialase, and Zeiss Meditec; and stock options from Belkin Vision, Equinox, Ivantis, Ocuphire, Sight Science, Tear Clear, and Vialase.

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