I. Paul Singh

About I. Paul Singh

What is the most exciting thing happening in glaucoma right now?

The most exciting thing happening is the mindset change amongst doctors. We use the term interventional glaucoma to describe this paradigm shift. Due to better diagnostics and multiple safe and effective therapeutic interventions, we are now treating much earlier in the disease process and addressing patient compliance related issues that can negatively affect disease progression. Doctors are thinking of the patient journey and appreciating we may need to use multiple technologies along this journey to aggressively reduce the intraocular pressure (IOP) and yet still maintain high quality of life. Our definition of “controlled glaucoma” has also evolved in this new paradigm. No longer are we defining “control” by just the static IOP, visual field (VF), and optic nerve head (ONH) analysis, but we are also taking into consideration how likely a patient will be able to stay on their current regimen. For instance, if a patient’s IOP is at target and no VF or retinal nerve fiber layer (RNFL) progression, that patient may not be considered controlled if their eye is always red, dry, or they are having a hard time affording meds. We now have so many options to intervene to reduce those potential compliance issues.

Make a bold prediction for the future of glaucoma treatment.

We will be diagnosing earlier with testing that can help us identify cells that are undergoing stress before they become apoptotic. We will also then be able to identify where the resistance to outflow is for an individual patient thus being able to tailor our technologies to the patient phenotype and genetic characteristics. We currently have genetic testing being introduced which will get even more predictive and precise as time goes by. This will also allow new genetic therapies to be customized on a cellular level.

What advice would you give to your younger self?

Be open to learning and trying out new technology. Don’t worry about any one procedure or technology not working enough or getting the IOP down to target. Every patient’s anatomy and physiology is unique and each treatment may benefit a patient differently. Learning how to have the discussion with the patient to expect multiple different treatments over time helps to decrease the stress of intervening early with the concern of the effect not being enough with any one procedure. Also, appreciate the impact of reducing the topical drops, this allows the doctor to re-define the true success of a procedure. For instance, even if the IOP is not lower post-procedure, if the patient is off a medication or two, that is still a successful procedure. I have more comfort in the IOP off medications than on them.