AOA 2023: Surgical interventions should be considered earlier in glaucoma treatment

Justin Schweitzer, OD, FAAO, and Nathan Lighthizer, OD, are presenting, "Beyond drops: Surgical considerations in glaucoma," alongside Walter Whitley, OD, MBA, FAAO, at Optometry's Meeting in Washington, DC, June 21-24, 2023.

Video transcript

Emily Kaiser:
Hi everyone. I'm Emily Kaiser with Optometry Times and then sitting down with Drs. Justin Schweitzer and Nathan Lighthizer, who are presenting a course entitled, "Beyond drops: Considerations in glaucoma," at Optometry's Meeting, which is hosted by the AOA in Washington, DC. Welcome Drs. Schweitzer and Lighthizer! Thanks for taking the time to talk to us.

Justin Schweitzer, OD, FAAO:
Thank you. We're really excited to be here.

Kaiser:
Awesome.

Nate Lighthizer, OD:
I second that. Awesome. Looking forward to it.

Kaiser:
So first, can you give us a brief overview of your course?

Schweitzer:
You bet. Yeah, I'll jump in and start with that. So number one, really a fun course to give with, you know, one of my my good friends, 2 of my good friends, really, 2 of my best friends in this profession, Dr. Nate Lighthizer and Walter Whitley. And we really focused on what do you do after you're treating glaucoma patient with drops that may not have gotten them where they need to be—whether to target intraocular pressure or their progression on the visual field, OCT—and so we focused on some surgical things, minimally invasive glaucoma procedures, we talked a little bit about drug delivery, and we talked a lot about selective laser trabeculoplasty [SLT]. And couldn't ask for a better partner [for] talking about selective laser trabeculoplasty then really one of the gurus in that arena. Nate, Dr. Lighthizer, why don't you tell us a little bit about the section that you covered with with SLT.

Lighthizer:
Yeah, focusing on SLT, there's really been a paradigm shift over the last 10-12+ years. Laser trabeculoplasty has traditionally been second line therapy; you know you're on drops first, they've been exhausted. But because of the SLT med study and really the Light trial over the last 3 or 4 years, that has really changed our focus and going SLT should be offered earlier in the course of therapy. There's 6-year data now from the Light trial that we covered. That said, patients are more likely to progress through a 6-year period on drops compared to SLT. So there's data now that says maybe SLT is even a little bit better than eye drops because of the compliance perspective. So gone I think are the days of drop 1, drop 2, drop 3, drop 4. SLT has incredible benefits, diurnal control, easing the burden on patients. I'm just urging docs to consider SLT early in the course of their glaucoma treatment.

Kaiser:
Fantastic. That sounds really interesting. What do you hope that optometrists take away from your talk?

Schweitzer:
Well, I hope they come out of it thinking [that] when you manage glaucoma, when you're treating glaucoma, to have this kind of interventional glaucoma mindset. And what that really means is we now have the tools to intervene earlier in the disease process than ever before. And one prime example is the data that Nate just described. You know, with the SLT data, we can use SLT earlier in the disease process. [With] minimally invasive glaucoma [MIGS] procedures: It used to be you do 1 drop, 2 drops, 3 drops, and then you would send someone to have a big surgery like a trab or a tube. Those days, in my opinion, are gone, and we can intervene earlier with was safer procedures like drug delivery, SLT, minimally invasive glaucoma procedures. So I guess one of our take homes would be [to] have that interventional glaucoma mindset when you're managing your glaucoma patients now.

Lighthizer:
Yeah, I think if you ask most optometrists, and I've polled the audience hundreds of times, and said if it was your eye, expert eye doctor, what would you want for your eye first-line therapy? And it's usually 90-95% SLT. If it was my eye, Justin, you know I would want an SLT earlier in the course, I would consider drug delivery if I needed an additional 6, 12, 18 months to stay off drops. And boy, you're anywhere around cataract surgery or even not around cataract surgery, these MIGS procedures are so slick now. And then mixing drops where I need them here and there. But I would want to ease the burden on myself. I think we want to ease the burden as much as possible on our patients as well.

Kaiser:
Yeah, absolutely. And you guys have already kind of touched on this, but how do you expect this to trickle down to patient care?

Schweitzer:
Well, I think, you know, we talked a little bit about the interventional mindset. But I also think Nate said something really important at the end with patient care. If you have a glaucoma practice, you also have a dry eye practice. And if you can minimize the medication burden on these patients with the different procedures that we just talked about, you're going to be providing some excellent patient care, not only are you going to be decreasing risk of progression in glaucoma, but we know from a variety of different ocular surface disease studies that that affects their quality of life. So you're gonna make their quality of life better, and, by the way, you'll probably decrease progression because a lot of times patients aren't taking their drops because they're uncomfortable taking them as well.

Lighthizer:
Agreed.

Kaiser:
Fantastic. Well, thank you so much for taking the time, and I can't wait to see you both in Washington, DC.