Glaucoma
Winter 2024

by Manjool Shah, MD
Glaucoma Editor

Some say, “everything old is new again.” When it comes to glaucoma, we are fortunate to not necessarily be shackled to the antiquated notions that questioned the basic nature of the disease, but we cannot overlook the fact that some of the newest innovations in our world stand firmly on the foundations of the past. As we embark on interviewing fellows for next year’s class, I like to remind the eager residents how important it is for them to “learn the textbook” before they show up to fellowship so that we can quickly jump off of that knowledge and tackle the challenges that show up in our tertiary care practice daily. In order to think outside of the box, you have to know the box.

In this issue of EyeWorld, we delve into some well-worn topics that warrant their place on the main stage. Benjamin Y. Xu, MD, PhD, and Shakeel Shareef, MD, discuss the importance of gonioscopy, a topic that is near and dear to my heart. While gonioscopy has been around for decades, it is woefully underutilized. In an era when surgery in the angle has become the main form of glaucoma surgical intervention, the importance of knowing what you’re treating and understanding the anatomy is paramount. While new technology might help us understand the angle, there still is no replacement for the tried and true.

Jullia Rosdahl, MD, PhD, and Alan L. Robin, MD, discuss the importance of engaging and educating our glaucoma patients. Many published studies over the years have demonstrated the fear of blindness that glaucoma patients face when initially diagnosed and the opportunity to educate patients in an effort to achieve better medication adherence and participation in clinical care. The fact is these are not new ideas in and of themselves—we have long recognized the value of patient education in chronic disease management. It is great to see that innovations in patient-directed education are indeed advancing, and Drs. Rosdahl and Robin have truly been leaders in this space.

Lastly, we feature an exciting new technology utilizing fundamental principles of physics in order to achieve non-pharmacologic intraocular pressure reduction. The FSYX Ocular Pressure Adjusting Pump is a novel set of goggles that can be worn by patients overnight to non-invasively lower IOP consistently. By applying a gentle negative pressure in the goggle chamber, John Berdahl, MD, and Tanner Ferguson, MD, have demonstrated the ability to achieve additive IOP reduction on top of patients’ medication or laser-based therapy. Leon Herndon Jr., MD, noted that this therapy provides IOP control at night, which has historically been a particularly difficult time of day to achieve it. To have a technology that adds to pre-existing solutions and potentially tackles patients with difficult glaucomas, like normal tension glaucoma, is an exciting prospect indeed.

It is so important to have one’s feet firmly planted in the foundations of our past and recognize how these principles can be evergreen and guide us in our future. However, we should not be deluded into thinking our feet are planted in cement, holding us back from achieving new heights. Progress requires owning and understanding the past in order to be open to the future, and it is clear that the future of glaucoma is an exciting one.

Article sidebar

Nathan Radcliffe, MD, Glaucoma Editorial Board member, shared what evolving treatments and techniques in ophthalmology he is excited about:

“What we are seeing in the field of glaucoma is that a lot of treatments are evolving in the same direction … away from drops that can be challenging from an ocular surface and compliance standpoint and in the direction of procedures, whether they are novel lasers, drug delivery, or MIGS and other techniques. We are entering the era of interventional glaucoma.”