Embracing a rapidly changing landscape.

I was born in the middle of the 1970s, the son of a radiologist, in a time now known as the “golden age” of radiology. My father, who finished medical school in 1968, completed his residency just as the first use of ultrasound was making its way into the clinic. This was the era of pneumoencephalography for neuroimaging, and CT and MRI did not yet exist. As I prepared for my own medical training in the 1990s, I would observe my father at work reading countless imaging studies and performing procedures from CT-guided biopsies to ultrasound-guided fine needle aspirations to arteriography. The most impressive part of this was that not a single one of these imaging modalities existed when he finished his training. He had to learn it all on weekends and evenings after his training finished, while working full-time.

I believe, and hope, that I am now practicing in the golden age of glaucoma. I have adopted roughly 10 different MIGS procedures since Glaukos’s iStent came to be in 2012 (it will be 11 procedures soon, with iStent inject). As I look at my OR schedule this month, 90% of the procedures I am performing were not taught to me during fellowship. Don’t get me wrong: I had a fantastic fellowship filled with tremendous opportunities for learning the intricacies of complex glaucoma care. But that was just the beginning. For comprehensive ophthalmologists, this is an opportunity, because those who familiarize themselves with new technology early will naturally develop the skills to continue doing so. 

We are all challenged today to do our best to thrive within the evolving glaucoma landscape, and that is exactly where Glaucoma Physician aims to help. In this issue you’ll find articles that present early data on the iStent inject, discussion of the durability of MIGS devices, glaucoma risk factors, deep learning in glaucoma, and Rho kinase inhibitors - all examples of the evolution of care and surgical devices for glaucoma. We hope you find this to be a useful resource for your continued learning. GP

Dr. Radcliffe is a clinical assistant professor in the department of ophthalmology at the New York Eye and Ear Infirmary and a surgeon at the New York Eye Surgery Center.

On the cover: Patient 1 month post CyPass Micro-Stent (Alcon) implantation, with well-controlled IOP off of medications; image courtesy E. Randy Craven, MD.