Diagnosis and treatment technology in ophthalmology continue to evolve at an incredible pace. The impact of genomics and artificial intelligence holds immense promise of providing personalized medicine for our patients, while new treatment modalities add to the clinician’s armamentarium. In recent years, we have witnessed the incredible impact of retinal gene therapy in improving the eyesight of children with inherited retinal disease, while rigorous evaluations of micro-invasive glaucoma surgical instruments have strengthened their role in the toolbox of glaucoma surgeons.
In this issue, we focus on both exciting and challenging aspects of care for glaucoma patients. Some of the questions we address:
- What are practical considerations to glaucoma screening?
- How often should we complete visual field testing for glaucoma patients?
- Can artificial intelligence help identify individuals with glaucoma in non-eyecare provider offices or retail spaces?
- How do we differentiate between myopic degeneration and glaucomatous changes?
- What are the new and upcoming therapeutics in the glaucoma space?
These articles speak to the salient aspects of glaucoma management in 2024.
FOCUS ON MEDICATION ALTERNATIVES
When considering innovation in the glaucoma space, the development of alternatives to topical glaucoma medications is an area of immense potential growth. Given the crucial impact of treatment adherence on disease progression, eliminating the burden placed on the patient to use daily topical medications is a major aim — particularly for populations that struggle with adherence to treatment plans.
In addition, the use of topical glaucoma medications increases inflammatory markers on the ocular surface.1 Daily use of these medications for decades likely leads to toxicity of the ocular surface, fluctuations in visual acuity and vision quality.
Can we help patients maintain IOP control and improve their ocular surface without relying on the daily use of topical medications? What type of drug-eluting options are safe yet efficacious in helping our patients maintain IOP control? I am excited to see how innovation occurs in this space.
SCREENING COMES FIRST
Of course, treatment is only possible when the patient presents to the clinic for management. The severity of glaucomatous disease at baseline has significant impact on the subsequent disease course and risk of blindness.2
Screening efforts, using active community outreach as well as cutting-edge technology, can improve ophthalmology’s footprint in the public health sphere. Outreach efforts can make a substantial difference in areas populated by those at greater risk of developing glaucoma.
However, the promise of artificial intelligence hints at screening without the need for a vision specialist at all. Imagine sitting in front of a machine at your primary care physician’s office that takes an undilated photo of your optic nerve, estimates the retinal nerve fiber layer thickness and subsequently predicts a possible visual field scotoma. While many regulatory steps would need to be taken and scientific rigor would need to be met before this scenario is a reality, such a scenario is no longer a pipe dream.
I hope you find this Glaucoma issue of Ophthalmology Management to be engaging. This mixture of both practical and future-oriented articles can serve as a guide to what we can do for our glaucoma patients today and potentially tomorrow. OM
References
1. Tovar A, Gomez A, Serrano A, et al. Role of Caspase-1 as a Biomarker of Ocular Surface Damage. Am J Ophthalmol. 2022;239:74-83.
2. Kastner A, King AJ. Advanced glaucoma at diagnosis: current perspectives. Eye (Lond). 2020;34(1):116-128.
