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    Early surgical intervention with stent advantageous for certain glaucomas

    Approach may help physicians, patients avoid compliance, other medical therapy issues


    Merits of early stent intervention

    By intervening earlier in the glaucomatous-disease process, patients avoid many of the challenges associated with medical treatment.


    1. Medical compliance is a significant issue for many patients with glaucoma. 

    Factors impacting adherence to drug therapy include medication costs, forgetfulness, and local and systemic drug side effects. If patients are unable to take their glaucoma medication consistently, its efficacy is adversely affected.

    2. Due to the healthier trabecular outflow system often present in earlier disease, the stent potentially offers improved efficacy than what might be achievable in at least some patients with more advanced disease.

    The risk-benefit ratio of placing an stent is extremely high in these patients. In fact, the safety profile and postoperative management of combined cataract and stent surgery is nearly identical to that of cataract surgery alone. Many surgeons consider the safety profile of the stent to be the gold standard in all of incisional glaucoma surgery. Even within the trabecular bypass category of procedures, the stent appears to largely avoid the risk of bleeding sometimes associated with more ablative angle procedures.

    With early intervention, it is common to achieve mid-teen IOPs with glaucoma medications completely eliminated, utilizing a single stent. As imaging technologies and surgeon-targeted stent placement improves, surgical outcomes have the potential to stop the glaucomatous-disease process in its tracks.

    3. By combining stent implantation with cataract surgery, not only will IOP control be improved, but patient quality of vision will also be enhanced.

    Monofocal or toric IOLs provide outstanding distance vision to most glaucoma patients. When intervening early in the glaucomatous-disease process, extended-range-of-vision multifocal IOLs can be utilized safely and offer glaucoma patients a significantly improved quality of life.

    By waiting until patients have more advanced visual field loss due to less than adequate glaucoma management, patients miss out tremendously on what these kinds of lenses have to offer. Accommodative IOLs offer enhanced range of vision, even in patients with more moderate-to-advanced glaucomas.


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