Because it is a busy time for glaucoma specialists, all comprehensive ophthalmologists must recognize their role in the treatment of glaucoma. The US population is aging, the prevalence of glaucoma is increasing, and our options for diagnosis and treatment are advancing.

It is easy to get caught up in the excitement of new surgical techniques and devices. One cannot open a journal or attend a glaucoma meeting without attention being paid to MIGS. We now have devices to bypass Schlemm’s canal, access the suprachoroidal space, or divert aqueous to the subconjunctival space — all without the complexities of trabeculectomy. If that’s not enough, there are two novel medications on the horizon — one in an entirely new class. Glaucoma innovation is in fast forward mode.

But I don’t want to talk about any of that!

Of course, we need these innovations to provide better care for our patients. In this issue of Glaucoma Physician, we highlight some things we already know or can do — but could know or do better. Glaucoma is a chronic disease and, according to the World Health Organization, it is the second leading cause of blindness worldwide. There aren’t enough providers around the world to diagnose or treat all glaucoma cases. The understanding and innovation that will originate with work in the developed countries can be translated into opportunities in the developing world. We have the ability and the resources to make a difference. The first step will be identifying the disease. But that alone doesn’t have value unless there are accessible and affordable interventions. Some of these challenges and opportunities are discussed in this issue.

I often remind myself that I’m not in the business of lowering eye pressure, but rather, I am dedicated to preserving sufficient vision for patients so they can live independent lives with quality and dignity.

We have long been teaching that early glaucoma has no symptoms. Any ‘symptoms’ are actually the result of topical treatments prescribed to reduce IOP. With the publication of the latest DEWS II report this summer, it is a good time to reflect upon how we can minimize at least some of the symptoms associated with topical therapy.

Glaucoma is a slow game. It is not characterized by dramatic wins or quick fixes. Glaucoma specialists must be dedicated to a lifetime of caring about our patients. While one could think of a chronic progressive blinding disease as a losing game, I prefer to think that the art of glaucoma management demands that we slow down the game so it ends before there’s a final score. Because I believe that life with vision, dignity, and independence is a win. GP

Cover image courtesy of Inder Paul Singh, MD, The Eye Centers of Racine and Kenosha, WI.