As a clinician-scientist and glaucoma specialist, I am always on the lookout for late-breaking research that can either provide new approaches to help me take better care of my patients now or alert me to innovations coming down the pipeline that will improve care in the future.

This is an exciting time for ophthalmologists, particularly for those who care for patients with glaucoma. New medications (including sustained-delivery formulations) are available and more are in development, the microinvasive glaucoma surgery landscape is ever-evolving, and neuroprotection seems like it is on the horizon.

With such widespread advances, it can be challenging to keep track of all the new tools and approaches at our disposal. In this issue of Ophthalmology Management, we’ve compiled articles designed to help eyecare professionals who treat glaucoma evaluate some exciting recent advances in the field, which may aid in our care of patients.

SOLVING ADHERENCE PROBLEMS

Anyone who prescribes eyedrops for glaucoma knows that medication adherence is probably the No. 1 barrier to treatment efficacy. Fortunately, research has been dedicated not only to studying this problem, but to solving it.

In “Medical adherence interventions that work,” Jay Rathinavelu and Dr. Kelly Muir review targeted interventions to improve glaucoma medication adherence that have shown efficacy in randomized clinical trials. Moreover, they provide a series of straightforward, actionable recommendations for approaches we can take to increase the proportion of our patients’ eyedrops that make it into their eyes.

HOME MONITORING PROVIDES A COMPLETE PICTURE

While IOP has long been known as the most important modifiable risk factor for glaucoma onset and progression, it seems the ophthalmology field is only catching up on what cardiologists have known for years — that static measurements of a highly dynamic biophysical measurement give clinicians only a partial understanding of overall disease risk. Home blood pressure monitors are now recommended for routine use by the American Society of Hypertension and the American Heart Association.

Fortunately, home IOP monitors are now widely available, and implantable telemetric IOP monitors are under development. But who should undergo home tonometry, how do we interpret the huge amount of new data derived from home IOP monitoring, and how do we logistically implement this in practice? In “Improving glaucoma care with home tonometry,” Dr. Barbara M. Wirostko answers these questions and more.

READY FOR PRIME TIME?

We’ve all heard about the promise of cutting-edge scientific advancements in ophthalmology and wondered when they will be ready for prime time. Medical genetics and artificial intelligence (AI) are no exception. While machine learning technologies to diagnose diabetic retinopathy are already hitting the floors of primary care clinics and pharmacies, translating this approach to glaucoma diagnosis and monitoring has been lagging.

What is the state-of-the-art in AI-based glaucoma diagnostics, and when will we see these in our clinics? Drs. Gabriele Afflitto and Swarup Swaminathan address this topic in “AI in glaucoma management.”

Also, with the rise of direct-to-consumer genetic testing, patients are now coming to clinic with printouts of their genetic risk factors for chronic disease. How do we interpret these genetic risk scores, how should they influence our management, and how do we counsel our patients about them? Sayuri Sekimitsu, Dr. Janey Wiggs and Dr. Nazlee Zebardast provide a primer in “Genetic predisposition to glaucoma.”

QUALITY PLUS EFFICIENCY

Finally, clinicians are always interested in how to care for their patients with both high quality and high efficiency. In “Saving time in the ophthalmology clinic,” Dr. I. Paul Singh discusses technologies that can enhance clinic efficiencies and workflows and augment care quality. For instance, sustained-release medications not only streamline treatments for patients and clinical staff, but they can obviate the adherence issues described above. By providing recommendations for steps that can be taken now, and by highlighting areas for future research that measures both quality and efficiency of care, Dr. Singh raises some valuable points to consider adopting in clinical practice. OM

Thomas V. Johnson, MD, PhD, is a glaucoma specialist, clinician-scientist and the Allan and Shelly Holt Rising Professor of Ophthalmology at the Wilmer Eye Institute at Johns Hopkins in Baltimore. In 2022, he was named to Ophthalmology Management’s 40 Under 40 list.