Glaucoma
Winter 2025
by Manjool Shah, MD
Glaucoma Editor
As clinicians, our journey in glaucoma care requires us to honor the past while eagerly embracing the future. Progress demands that we deeply understand the established principles of this disease so we can be fully open to exciting innovations. This issue reflects that duality by exploring two profound evolutions: the expansion of our surgical techniques and the critical recognition of the complete, human dimension of patient care.
The last decade has been generous, granting us safer interventions like the MIGS revolution and sustained drug delivery. This movement, now known as “interventional glaucoma,” is a new paradigm taking us to more precise, patient-oriented care.
Progress demands that we deeply understand the established principles of this disease so we can be fully open to exciting innovations.
A major technical evolution we explore is the necessity of integrating glaucoma procedures into cataract surgery. Not adding a beneficial glaucoma procedure during a cataract operation is a missed opportunity. Expanding into angle-based surgery (such as canal-based stenting or goniotomy) is a natural and recommended progression for any anterior segment surgeon comfortable with standard cataract skills, given its favorable safety profile. Furthermore, sustained drug delivery provides a valuable tool to improve IOP control and reduce dependence on topical medications, significantly benefiting quality of life. By embracing these skills, comprehensive ophthalmologists actively contribute to broadening our collective glaucoma toolkit.
While we celebrate advancements that maintain physical vision, we must also address the profound emotional and psychological landscape faced by our patients. For those battling degenerative conditions like glaucoma, vision loss can feel like the closing of essential life opportunities, leading to fear and anxiety.
Ophthalmologists have the opportunity to frame the new diagnosis conversation as a partnership, assuring the patient that they will work together to maintain good vision. Mental health specialists recommend ophthalmologists “lead with curiosity,” recognizing the patient is the expert in their own support needs.
Strengthening partnerships with mental health specialists or even integrating counseling directly into the treatment protocol could remove systemic barriers like stigma and provide invaluable support. Moreover, approaching care as a partnership and staying engaged with new research helps keep the passion alive and provides hope for both the physician and the patient, countering the risk of empathy burnout.
Our profession moves forward by prioritizing both technical skill expansion and holistic patient support, ensuring our journey is defined by continuous innovation and growth.
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Opening doors
When asked about “opening doors,” Jeff Pettey, MD, EyeWorld Cataract Editorial Board member, said, “I enjoy the new doors that open to patients with improved generations of advanced-technology lenses.”
