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Subspecialties Glaucoma, Cataract

The Fewer the Meds, the Better the Outcome?

At a Glance

  • Current glaucoma therapies lower intraocular pressure (IOP), but don’t address the primary cause of raised IOP
  • Multiple topical medications for IOP management can be a regimen compliance nightmare
  • Micro-invasive glaucoma surgeries (MIGS) directly address outflow resistance and avoid many of the risks associated with traditional surgical treatments like trabeculectomy
  • Not only can MIGS devices reduce IOP, but also the number of topical drops needed to control it

Topical hypotensive glaucoma medications have been the cornerstone of glaucoma therapy for over four decades. This is partly because they work – when used exactly as directed, they reduce patients’ intraocular pressure (IOP). But it’s also partly because there wasn’t really an alternative other than trabeculectomy – with all of the issues that can involve. The problems with topical glaucoma medications are well-known: many patients need multiple drops to control their IOP (e.g. a β-blocker and a prostaglandin analog). If patients take one drop after another, the second drop can wash out the first, and multiple, multi-instillation-per day regimens mean that considerable discipline is required to adhere to them. If patients don‘t comply, IOP control goes out the window, with inevitable consequences for their outcomes.

Other MIGS technologies

Hydrus Microstent (Ivantis Inc.)

The world’s first “intracanalicular scaffold,” the Hydrus Microstent is approximately the size of an eyelash and is made from an elastic, biocompatible nickel-titanium alloy. When inserted, it bypasses the trabecular meshwork and dilates Schlemm’s canal to lower IOP. The implant is currently under evaluation in the Hydrus II and Hydrus IV clinical trials.

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About the Author

Steven Vold

Steven Vold

Steven Vold is the Medical Director of Vold Vision, Fayetteville, Arkansas, US, and is a co-founder of the American-European Congress of Ophthalmic Surgery. Vold also co-founded the Silicon Valley-based ophthalmic device company Ocunetics, Inc. whose intellectual property was exclusively licensed by IRIDEX Corporation in 2011.

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