Customizing Care and Minimizing Risk With MIGS

Two scenarios highlight how various minimally invasive procedures can be used to address specific obstacles in glaucoma management.

Reay H. Brown, MD; Shibandri Das, MD; and Shivani Kamat, MD

Glaucoma Today

KEY TAKEAWAYS For a 61-year-old patient with pseudoexfoliation glaucoma and Alzheimer disease, surgical intervention helped to address compliance issues and decrease the risk of vision loss. For a 24-year-old patient with keratoconus, angle surgery achieved sustained IOP control on fewer medications, preserved the integrity of a penetrating keratoplasty graft, and avoided the risks of incisional glaucoma surgery. MIGS in a Patient With Alzheimer Disease and Uncertain Compliance A 61-year-old White man with pseudoexfoliation glaucoma underwent cataract surgery with placement of a posterior chamber IOL in both eyes in 2020. He did not undergo a glaucoma procedure in either eye. At the time of the surgery, the therapeutic regimen for both eyes consisted of a fixed combination of timolol 0.2% and brimonidine 0.5% (Combigan, AbbVie), latanoprost, and dorzolamide. Two years later, selective laser trabeculoplasty was performed on both eyes, but no medications were discontinued after the procedure. His visual fields were normal. GLAUCOMA EVALUATION The patient was referred for glaucoma management in 2024, 1 year after he was diagnosed with Alzheimer disease. His vision was 20/20 OU, and the IOP was 16 mm Hg OD and 17 mm Hg OS. His glaucoma medication regimen had not changed since his cataract surgery.

Conjunctivochalasis and Hyaluronic Acid in the Dry Eye Space

Eyetube

Co-hosts Jackie Garlich, OD, FAAO, and Jessilin Quint, OD, FAAO, sit down with Damon Dierker, OD, FAAO, on To the Point to talk about his approach to conjunctivochalasis. Dr. Dierker notes that he prefers to start the dry eye management process by addressing more common patient symptoms, such as inflammation. If symptoms persist, it’s time to introduce conjunctivochalasis as a diagnosis into the conversation. Dr. Dierker covers what to look for and different treatment options, including a more significant intervention that he has found success with: plasma-based conjunctivoplasty. Drs. Garlich and Quint then pick Dr. Dierker’s brain on hyaluronic acid, how he’s integrated it into his clinic, and patient candidacy.

In Praise of Industry Partners

Walter O. Whitley, OD, MBA, FAAO; Selina McGee, OD, FAAO; Justin Schweitzer, OD, FAAO

Modern Optometry