Controversies in Modern Eye Care 2023: Controlled glaucoma is not just IOP and stability

I. Paul Singh, MD, of The Eye Centers of Racine and Kenosha in Wisconsin, gives an overview of the glaucoma panel and featured symposium, "Pearls in comanaging glaucoma," which he moderated during the 17th annual Controversies in Modern Eye Care symposium at the Skirball Cultural Center in Los Angeles, California.

This transcript has been edited for clarity.

I. Paul Singh, MD:

Hey everybody, my name is Paul Singh. I'm the president of The Dye Centers in Racine and Kenosha out in southeastern Wisconsin. I'm a glaucoma specialist, and I'm here at the Controversies meeting [in] beautiful LA area.

We just gave our talk on glaucoma—really an update on glaucoma and comanagement and really what's changed over the last few years, but really over the last decade, if you think about it. There's been an incredible proliferation of technology, from the drop molecules from lasers to drug delivery to MIGS ... surgery, and it's a lot to take in.

But I think the overarching paradigm shift that we're seeing and glaucoma really has to do with our kind of philosophy of how we're addressing the patient, and appreciation now for compliance and how compliance—and poor compliance—can really be a risk factor for progression in glaucoma.

And, you know, I used to think we had to choose between addressing IOP and doing it safely, or addressing compliance and doing it earlier or later, right? But now we can do both. We don't have to choose between those, we can actually address compliance, address glaucoma earlier in a safe fashion. But I think it's important to understand it's not one or the other.

We think of glaucoma as this kind of linear fashion on the drops first, then laser, then MIGS. But I think what we're seeing also in glaucoma is that we can draw from all of these different tools that we have at our disposal, and we can say okay, for a certain patient, we may go right to a surgical option or an intervention like a SLT right away first-line, there's some patients we may go to a drop. And even the type of drop we use with some of the newer molecules, understanding mechanism of action.

Now that we have procedures and devices that work on different levels of the outflow pathway, trabecular meshwork, canal, or the distal channels, now we're paying attention to what are we doing? It's not just bringing the pressures down, but how are we bringing the pressure down? What are we doing to the outflow pathway?

So that was really the general gist of our our session today, as well [as] talking about these different technologies but understanding the importance of not ignoring compliance, poor compliance, compliance, defining really what is controlled glaucoma.

Controlled glaucoma now is not just IOP and [stability]. It's what is the patient's risk factor for noncompliance over time? If we think they have a poor chance of staying on that medication long-term, that patient's not controlled. We now think about other options for that patient. Hope that helped. Thank you so much.