Standalone interventional glaucoma: evolution from the combination-cataract paradigm

Abstract

One of the most impactful recent developments in the glaucoma community has been the concept of interventional glaucoma. In brief, this paradigm shift involves proactive rather than reactive intervention to address glaucoma earlier in the disease process, including in both standalone and combination-cataract settings. By intervening earlier with minimally invasive surgical, laser, or drug-delivery treatments instead of prolonged topical medications, interventional glaucoma aims to take the burden of medication compliance off the patient. It also allows for standalone surgical interventions rather than letting cataract surgery dictate the glaucoma treatment plan. This interventional mindset has been made possible by the increasing diversity and availability of effective minimally invasive treatment options. With these options as a springboard, it is time to reevaluate and advance the traditional glaucoma treatment paradigm.

Figure 1.

Composition of glaucoma surgical procedures in the United States from 2013 to 2018. Reprinted with permission from Elsevier from Yang SA, et al. All permission requests for this figure should be made to the copyright holder.

Figure 2.

Effect on visual disability of patients with glaucoma as a function of time of intervention and rate of progression. Reprinted with permission from Elsevier from Caprioli J. The importance of rates in glaucoma. Am J Ophthalmol 2008;145(2):191–192. All permission requests for this figure should be made to the copyright holder.