Meeting the glaucoma challenge

The number of Americans age 55 and older will almost double between now and 2030 as the Baby Boomers reach retirement age. Since the prevalence of glaucoma also increases with age, the treatment of glaucoma in our practices will also grow. As a consequence of this growth, all of us who care for glaucoma patients have many challenges and questions, many of which are addressed in this issue of EyeWorld. Along with our increasing population of patients, we have increasing and ever-changing technologies for diagnosis and monitoring of glaucoma. We need to make informed choices on what types of testing to incorporate into our practices to help us provide efficient, cost-effective diagnostics. What tools should we be using and what are the pros/cons of their use? As we use these new devices, how do we include the less glamorous but tried and true diagnostic tests like gonioscopy in our diagnostic routine? Once we diagnose glaucoma, we have many options for initial treatment. What approaches to medical and surgical treatments do our specialists recommend? When should laser trabeculoplasty be used in the sequence of treatment? Are there new medications on the horizon? What about generics? Many of our patients have limited incomes and are faced with debilitating medication costs and limited choices imposed by their insurance coverage. How do we incorporate concerns about costs and compliance in our practices? Are there new solutions on the horizon? For our patients with advanced disease or co-existing cataracts, we need to turn to our surgical options. What is an appropriate algorithm for surgical management? When do you do cataract surgery alone vs combined surgery? Where do tube shunts fit in? We hope this issue will help to address the dizzying array of options that face the practitioner caring for glaucoma patients today. And if it whets your interest, consider attending the ASCRS Glaucoma Day this year for more in-depth coverage of each of these topics.

Barbara Smit, M.D., Ph.D.
ASCRS Glaucoma Clinical Committee