AAOpt 2025: Balancing the demands of glaucoma and the cornea

Brooke Messer, OD, FAAO, FSLS from Vance Thompson Vision in West Fargo, North Dakota, gave a presentation alongside Mitch Ibach, OD, FAAO, at this year's Academy meeting in Boston, Massachusets about the complex challenge of managing patients with both corneal and glaucoma-related eye conditions. The presentation centers on the delicate balance of treating compromised corneas while simultaneously protecting the optic nerve.

The primary medical challenge lies in treating corneal issues without compromising the optic nerve's health. When patients have undergone corneal transplants or have delicate eye structures, traditional glaucoma treatments can potentially cause more harm than good. Messer highlights the intricate nature of these cases, where treatments for the cornea and optic nerve can directly conflict with each other. One significant concern is the impact of glaucoma medications on the ocular surface. These treatments often lead to side effects such as corneal staining, eye redness, and irritation. The medications designed to manage intraocular pressure (IOP) can potentially damage the already fragile corneal tissue, creating a challenging clinical scenario. To address these complications, Messer proposes exploring alternative approaches to managing eye pressure. These alternatives include:

• Extended-release medications
• Minimally invasive glaucoma surgery (MIGS) devices
• Laser treatments
• Other innovative technologies that can control eye pressure without relying on traditional topical medications

The core objective is to develop a balanced clinical care approach that simultaneously maintains corneal clarity, controls intraocular pressure, protects the optic nerve, and minimizes potential damage from treatment.

By discussing these complex interactions between corneal health and glaucoma management, Messer emphasized the importance of personalized, nuanced medical approaches. The goal is not just to treat individual symptoms but to provide comprehensive care that preserves overall eye health and patient quality of life. This discussion underscores the sophisticated medical reasoning required when dealing with intricate eye conditions that involve multiple interconnected systems and potential treatment complications.