CIME 2024: Innovations and interdisciplinary approaches in glaucoma management

Glaucoma treatment development has taken on new mechanism of action medications that are designed to treat natural outflow pathway. Deborah Restvedt, DO, led a session on the topic alongside Inder Paul Singh, MD, Arsham Sheybani, MD, and Melissa Tawa, OD, FAAO, titled "Innovations and Interdisciplinary Approaches in Glaucoma Management—Expanding the Treatment Arsenal" at this year's Controversies in Modern Eye Care meeting in Los Angeles, California.

Video Transcript

Editor’s note - The following transcript has been lightly edited for clarity.

Deborah Restvedt, DO:

Hi, I'm Deb Restvedt from Alexandria, Minnesota, part of Vance Thompson Vision. I am an anterior segment and glaucoma surgeon. Today at the Controversies in Eye Care symposium, I'm talking about the unmet needs in glaucoma treatment and therapy. We've had our tried and true medications and a lot of you may not know that we've only had our first line therapy prostaglandin analogues since 1997 and then there was kind of a lull when it came to how we treat glaucoma. We know that in the past we've had drops, we've had laser, and then we've had more invasive surgery in the form of trabeculectomy, or tube shunts. But now we're looking at the histology of the trabecular meshwork and what's happening in glaucoma and now we have new mechanism of action medications designed to treat just that, our natural outflow pathway.

This morning we talked about latanoprostine bunod, which releases nitric oxide to relax the trabecular meshwork. We talked about rho kinase inhibitors in the form of netarsudil, which works at the cellular level of the trabecular meshwork, as well as decreases episcleral venous pressure. So when we're talking about medication therapy, 1 of our main goals nowadays in intervention of glaucoma is to eliminate the need of stacking medications and to use some of these medications to get the biggest bang for our buck when it comes to lowering IOP.

Optometry is ever changing and so is glaucoma therapy. And so dealing with patients that are on multiple medications when it comes to glaucoma can be downright fatiguing. You're dealing with ocular surface disease, you're questioning whether patients are compliant with their medications. And so having dual delivery medication therapies to lower intraocular pressure, having preservative free eye drops as well as combination therapies can be a lot more efficacious when it comes to managing glaucoma.