CRU 2025: Exploring minimally invasive glaucoma surgeries

Melissa Tawa, OD, FAAO, from Marshall B Ketchum University's Southern California College of Optometry discusses the evolving landscape of glaucoma management, focusing on a proactive and comprehensive approach to patient care. In collaboration with Deborah Ristvedt, DO, she delivered 3 lectures on glaucoma, specifically exploring minimally invasive glaucoma surgeries (MIGS). The lectures delved into the various devices available, their mechanisms, and patient selection criteria. Key considerations include whether procedures bypass the trabecular meshwork, their invasiveness, and whether they can be standalone or combined with cataract surgery. Tawa emphasizes a shift from reactive to proactive glaucoma management. Modern technologies like optical coherence tomography (OCT) now enable early glaucoma detection before visual field defects occur. New medications, drug delivery systems, and surgical procedures allow clinicians to control intraocular pressure (IOP) more effectively and prevent progressive vision loss. She stresses the importance of communication with ophthalmological specialists, recognizing that access and comfort levels with glaucoma management vary among practitioners. When making referrals, Tawa recommends creating comprehensive patient history packets that provide a holistic view of the patient's condition. These packets typically include:

• Detailed medication history
• Adverse reaction records
• IOP flow charts
• OCT and visual field progression data
• Patient treatment preferences
• Previous discussions about potential interventions

The goal is to make the referral process seamless, giving receiving ophthalmologists immediate insight into the patient's background. By understanding patient preferences and previous conversations, specialists can approach treatment discussions more effectively. Tawa's approach underscores the importance of personalized, proactive glaucoma management, leveraging technological advancements and fostering collaborative communication between optometrists and ophthalmologists to optimize patient outcomes.