Glaucoma is a common condition where increased pressure within the eye causes damage to the optic nerve. It can affect anyone but is more common in those aged 60+.
The condition is the result of increased fluid in the front element of the eye and, if not treated, can lead to loss of vision. The optic nerve is the link between the eye and the brain.
For optimal vision, this pathway must work uninhibited. In the early stages of glaucoma, most people are asymptomatic, meaning that the only way the condition is diagnosed is through regular eye checks.
While this can occur in anyone, the condition is known to be hereditary. This means if an immediate member of your family has glaucoma then this places you at a higher risk of developing the condition.
Eye Drops work in one of two ways. They either increase the flow of fluid from the eye or decrease the creation of it. Either way, this helps reduce the pressure.
Oral medication can also do the same, with carbonic anhydrase inhibitors or beta-blocker being the most commonly used. This drug route often has unwanted side effects. These include redness and stinging of the eyes, blurred vision and irritation, and allergies.
In some cases, the drugs can affect the cardiovascular system. It’s important to tell your glaucoma specialist about any other medication you take to prevent undesirable drug interactions.
Since people suffering from glaucoma are facing so many issues with the glaucoma medication eye drops treatment, many people share their trouble of remembering their drops on time while others face some issues of allergies such as dry or red irritated eyes and the most common reason for getting tired of huge bills for medications as well always having to go to pharmacy or call in for refills.
For people who would prefer to manage their eye pressure without the use of eye drops, dropless glaucoma therapy can be a suitable option for various reasons: patient comfort, trouble recognising or instilling eye drops, eye drop prices, eye drop allergies such as red or dry irritable eyes, or suboptimal eye pressure when using eye drops.
Glaucoma treatment without eyedrops has long been a goal, and while it may be possible one day. There are a number of considerations for individual patients.
Numerous surgical procedures and minimally invasive devices are available to lower the IOP. Some have been around for a long time, but within the last few years numerous devices have entered the market with unknown long-term results, and more are in the pipeline.
Antiglaucoma drops currently remain the first-line choice for many ophthalmologists. However, the question remains about which treatment(s) can achieve and maintain the desired IOP level and prevent progression.
Clinicians can adhere to the general guidelines that have been established for target IOPs for different glaucoma stages, but how well they work for individualized patients remains to be seen. For each patient it is important to assess the risk parameters in addition to the stage of the disease.
In some patients, we can hopefully get ahead of progression by treating the glaucoma aggressively and in other patients we may be able to step back, accept higher target IOPs, and carefully assess the most appropriate therapies.
Many large clinical trials have evaluated different procedures over different follow-up periods and generated widely varying outcomes regarding medication use and wide ranging IOP results postoperatively.
These range from no medications needed in 78% of patients followed for 3 years after selective laser trabeculoplasty (SLT)1 to studies of minimally invasive glaucoma surgeries (MIGS) and gonioscopyassisted transluminal trabeculotomy that resulted in a wide range of medications needed postoperatively.
Surgeons should look outside the treatment box and rethink the current order by which they select treatment and determine if they should adjust that order.
For example, should surgeons consider an SLT, an earlier SLT, or a MIGS procedure if appropriate, or should patients be treated more aggressively earlier in the disease process, especially in the case of young patients with potentially longer life spans.
Another challenge is identifying and diagnosing patients with early disease. It is not time to abandon the traditional more invasive procedures, particularly in advanced disease, because these more consistently result in lower IOPs.
Currently, however, although there are numerous nonmedical options that are available for glaucoma management, physicians cannot now achieve successful IOP control in all patients without relying on medical therapy.
To manage and control glaucoma without eyedrops, there must be a more “robust” way to identify patients with glaucoma, especially those with early disease.
Acceptance and incorporation of other newer treatment options by patients and physicians should occur. If intervention is successful, the progression curve may change. The important side is to see that surgical devices and procedures achieve satisfactory target IOPs for long durations during a patient’s life.
The current devices meet the target IOPs in some patients, but the long-term results are unknown.
It should be a goal to reduce the medication burden as much as possible. Physicians can think about how they select treatment. For patients with early-stage glaucoma, consider options other than medications.
In moderate and late-stage disease, treatment with laser and/or MIGS and/or traditional surgery may reduce or eliminate the need for medications in some patients. For late-stage disease, more invasive surgeries may be more successful at achieving the required IOP with fewer or no medications.