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    What advent of MIGS means for earlier glaucoma intervention


    Glaucoma treatment is ripe for disruption because it is failing so many patients, he said. Open-angle glaucoma progresses in 89% of people diagnosed with the disease, he said citing a 2013 study by Heiji et al. in Acta Ophthalmologica.

    As a result, glaucoma remains a leading cause of blindness, Dr. Ahmed noted. A 2013 study of 592 people with open-angle glaucoma found that 26.5% were blind in at least one eye after 10 years after diagnosis, he said citing a 2013 study by Peters et al. in AJO. At the time of their last visit, 42.2% were blind in at least one eye and 16.4% were blind in both eyes.

    In addition, nearly 50% of patients with glaucoma experience complications within 3 years of initiating treatment, he said, citing Market Scope. That compares with less than 10% for retinal, oculoplasty, cataract, and refractive treatments.

    The reasons aren't hard to find. Glaucoma is often undiagnosed or improperly treated, with widespread lack of compliance, he said, citing a 2015 article by Remo et al. in Trans Vis Sci Tech. The severity of damage is underestimated, IOP is insufficiently reduced, IOP peaks and means are not adequately assessed, and it is difficult to evaluate the rate of progression, these researchers found.

    Even when patients are treated carefully in trials, they still progress, Dr. Ahmed said. For example, 20% of those treated progressed over 24 months, compared with 34% of those untreated in the 2016 United Kingdom Glaucoma Treatment Study (Garway-Heath et al. Lancet).

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