In the “Transforming Glaucoma Care” session at the 2024 Glaucoma 360 New Horizons Conference in San Francisco, panelists from 4 different areas of ophthalmology provided their perspectives on addressing unmet needs in glaucoma.
Kicking off the discussion was Rafael Chan, Vice President of the Alcon Vision Suite, Global Surgical Franchise at Alcon. From an industry standpoint, driving an interventional mindset is paramount. While praising glaucoma specialists for championing this approach, Mr. Chan advised that the rest of ophthalmology must also adopt the same mindset for it to gain traction. The future of glaucoma care will be treatments that go beyond traditional IOP management, he noted, and he stressed that partnerships between industry, community glaucoma specialists, and academia will be paramount to getting new interventional therapies approved and available to patients.
Jeffery Goldberg, MD, PhD, Professor & Chair of the Byers Eye Institute at Stanford University, shared similar ideas. His academic approach centered on research into earlier detection and neuroprotective/neuro-enhancing treatment options. According to Dr. Goldberg, there are certain small, early metabolic changes that indicate the retina is “unhappy.” Learning to recognize these changes could alert doctors to a window of opportunity “between damage and death” in which to intervene. Several studies are under way at Stanford and elsewhere focusing on ways to enhance neurotrophic factors, protect against cell death, preserve synapses, and promote existing cell activity.
Brandy Keys, MPH, Director of Health Policy at the Academy, presented a regulatory perspective. “Times have changed,” said Ms. Keys. “FDA approval doesn’t automatically give you [approval for] coverage and reimbursement.” She focused her discussion on recent local coverage determination reconsiderations for microinvasive glaucoma surgery and the increasingly more stringent requirements by Medicare Administrative Contractors (MACs) for coverage and reimbursement approval. In particular, MACs are requesting more randomized controlled trials, more clinically relevant and well-defined endpoints in those trials, and follow-up periods lasting >2 years. Ms. Keys encouraged researchers to maintain awareness of the changing landscape surrounding regulatory approval and to continually check in during the research process to ensure studies address MAC requests in order to maximize the likelihood of reimbursement approval.
The final panelist was glaucoma patient and advocate Tonian McDonald, MBA, LLB. A glaucoma diagnosis brings with it a significant mental health burden, emphasized Ms. McDonald. Promoting community support, particularly through more regular and personalized support group meetings, could be of great benefit to these patients. She also stressed the importance of doctors recognizing that there is no “one size fits all” when it comes to glaucoma treatment. Having the option to tailor treatment plans, especially considering the high cost burden and financial constraints for many patients with glaucoma, is important. Ms. McDonald asked that doctors consider alternative or complementary treatment options, including a focus on good nutrition. “Not every solution requires a prescription or a surgical procedure,” she said. “We must treat the person and not the condition.”