“The best way to invent the future is to invent it.” With that statement, Iqbal (Ike) Ahmed, MD, FRCSC, set the stage for his talk on “The Future of Interventional Technology,” presented at the 2024 Glaucoma 360 New Horizons Conference in San Francisco.
Dr. Ahmed began by reminding the audience that glaucoma specialists’ main concern should be in helping patients. Glaucoma treatment goals should not only be concerned with preventing blindness and reducing visual disability, but also with improving treatment access and patient quality of life (such as enabling patients to continue to drive).
However, there are challenges in treatment innovation, including unknown risks, clinician bias, costs, and mindset shifts. Dr. Ahmed noted that the glaucoma management mindset has often been passive, focusing on watching and waiting for progression and relying on medications, only resorting to surgery for refractory disease. Noting that “glaucoma is only young once,” meaning that clinicians have just one chance to make a difference before the disease potentially becomes irreversible, he emphasized that providing treatment early is important.
As “elevated IOP is an interventional problem,” Dr. Ahmed believes that the future of glaucoma therapy will include interventional treatments such as first-line selective laser trabeculoplasty, non-incisional minimally invasive glaucoma surgery (MIGS), phacoemulsification (“phaco”)–MIGS combinations, and microinvasive bleb surgery. While medications and trabeculectomies will continue to be important treatment tools, Dr. Ahmed envisions medications as bridge therapies given between interventional procedures. A combination of different approaches, depending on glaucoma severity, will work best.
Dr. Ahmed reiterated that “interventional glaucoma is an attitude.” Some key aspects of this attitude include being proactive vs reactive, incorporating early predictive diagnostics and active advanced monitoring, intervening earlier and more aggressively, and addressing treatment risks and patient adherence. Studies focusing on comparative efficacy, long-term treatment (>24 months) health-related quality of life outcomes, and cost-effectiveness are especially needed.
Towards the end of his talk, Dr. Ahmed noted that “The biggest challenge to effect change isn’t technology—it’s people.” Clinical evidence, access/cost, practice workflow and staffing, and patient acceptance of nonmedication interventions all present barriers to adopting more interventional approaches, but he was optimistic that these barriers can be overcome.