Seen & Heard

Glaucoma Today

Improving MIGS Adoption Rates On MIGS Unplugged, Iqbal Ike K. Ahmed, MD, FRCSC, and Arsham Sheybani, MD, host an episode to talk about the low adoption rate of MIGS procedures in the United States and how surgeons can move the needle and overcome barriers to entry for increasing MIGS adoption. Drs. Ahmed and Sheybani share insights into training, reimbursement, and workflow improvements that could drive further innovation in glaucoma surgery. Determining the Next Path in a Case of Progressive Glaucoma In Glaucoma Case Files, Mitch Ibach, OD, FAAO, outlines a recent case for John P. Berdahl, MD, and Tanner J. Ferguson, MD, in which a woman in her early 80s with a history of severe glaucoma presented with rising IOP. The patient had a history of cataract surgery, iStent (Glaukos) implantation, and subconjunctival surgery with a Xen Gel Stent (AbbVie) 5 to 7 years ago. She reported difficulty instilling topical drops due to Parkinson disease. The three physicians discuss options for safely managing her disease progression.

Surprise Spikes

While rare, increases in IOP post-selective laser trabeculoplasty can occur and require prompt attention for the best long-term outcomes.

Khanh Hoang, OD

Modern Optometry

Selective laser trabeculoplasty (SLT) is a safe and effective method for lowering IOP. First introduced in 1995 and FDA approved in 2001, SLT is increasingly becoming the first-line treatment for open-angle glaucoma.1 The term “selective” refers to the laser’s precision in targeting pigmented trabecular meshwork (TM) cells while sparing adjacent nonpigmented tissue.1 Using a low-energy, frequency-doubled Q-switched Nd:YAG laser (532 nm), SLT induces a biological response that enhances aqueous outflow through the TM—achieved not by ablating tissue, but by stimulating cellular and cytokine-mediated remodeling.1 Traditionally performed by anterior segment surgeons, SLT is now being adopted by a growing number of optometrists in 11 states and counting, as the scope of practice expands.2 Despite its strong safety profile, the procedure can lead to rare complications, such as corneal haze, hyphema, and persistent inflammation.3 However, the biggest concern remains transient post-procedural IOP elevation.3 Identifying appropriate candidates for SLT is key to minimizing adverse outcomes. Although IOP spikes following SLT are rare, I recently encountered a noteworthy case featuring a significant post-laser IOP spike. Interestingly, this patient demonstrated substantial ganglion cell complex (GCC) loss in the absence of a corresponding visual field defect. This article explores the clinical course of this case and reviews the incidence, pathophysiology, risk factors, and management strategies for increases in IOP following SLT. CASE PRESENTATION A 58-year-old Asian man with a history of mild bilateral primary open-angle glaucoma was referred for a glaucoma evaluation. He had been managed with multiple IOP-lowering agents, including brimonidine tartrate 0.2%/timolol maleate ophthalmic solution 0.5% (Combigan, Allergan/AbbVie) and latanoprost ophthalmic solution 0.005% (Xalatan, Viatris). On initial examination, the patient’s BCVA was 20/20 OU and his IOP was 10 mm Hg OD and 8 mm Hg OS. Slit-lamp examination revealed periocular dermatitis localized to the right upper eyelid. Posterior segment evaluation demonstrated healthy optic nerves with cup-to-disc ratios of 0.7 OD and 0.6 OS and no other notable posterior pole pathology (Figures 1 and 2).

Staar Terminates Merger with Alcon

Eyetube

Shareholders vote on Alcon’s blockbuster acquisition proposal for Staar Surgical; the FDA responds to Outlook’s latest BLA submission for wet AMD drug Lytenava; and the FDA approves an interchangeable biosimilar to Lucentis.  Learn more about your ad choices. Visit megaphone.fm/adchoices