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    New world order of glaucoma presenting strong challenges


    MIGS soaring

    When it comes to glaucoma surgery, “the big change is the significant drop off in the number of trabeculectomies that are being coded and I assume being done since 1995-1996 when PGAs were introduced.”

    Microinvasive glaucoma surgery (MIGS) is soaring in popularity, Dr. Iwach noted. As of 2016, the number of iStents placed exceeded the number of trabeculectomies, he said. Market Scope projects a continued rise for MIGS.

    The new devices do still face some hurdles. “For example, with the Cypass (MicroStent, Alcon Laboratories) at our surgical center we’re having trouble getting reimbursement figured out,” Dr. Iwach said. “If the hospital doesn’t get paid, it’s hard to do some of these new procedures.”

    Demographic stressors

    Stress on providers is rising. “We’re busy, we’re doing more cases, and down the road the demands for eye care are going up,” Dr. Iwach said.

    By 2025, the demand will have increased by 25% while the number of ophthalmologists will have dropped by 8%, he said, again citing Novartis Alcon data. “These patients are coming so we need to make sure we take a leadership role to make sure we guide them to the right place for the care at the right time,” Dr. Iwach added.

    The deficit is projected to occur even though more women are coming into the profession. While about 22.5% of ophthalmologists are now women, 44% of those in training are women, Dr. Iwach said, while already 42% of optometrists are women.

    Perhaps because of the intense work load, many ophthalmologists are reporting musculoskeletal injuries. Over the course of 16 or more years, about 30% of ophthalmologists have neck injuries, he said. Others are experienced repetitive motion injuries to their hands and back pain.

    Reimbursement complexities

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