CCS 2025: Tackling the complexities of glaucoma management

Alongside Tanner Ferguson, MD, Mitch Ibach, OD, FAAO, focused on glaucoma management and minimally invasive glaucoma surgery (MIGS) in a Collaborative Care Symposium (CCS) 2025 presentation. Ibach emphasized interventional approaches and collaborative care between optometrists and ophthalmologists. Ibach highlights 4 primary modalities for lowering intraocular pressure (IOP):

1. Topical glaucoma drops
2. Drug delivery devices (2 FDA-approved options)
3. Laser trabeculoplasty (specifically direct selective laser trabeculoplasty or DSLT)
4. Glaucoma surgeries, including MIGS and incisional surgeries like tubes and traps

A key theme is the complexity of glaucoma treatment, with Ibach noting there's no single "magic bullet" cure. Patients often experience a dynamic treatment journey, cycling through different interventions like selective laser trabeculoplasty, medication adjustments, and surgical procedures. The presentation strongly emphasizes collaborative care, with several critical recommendations:

• Establish clear communication between referring doctors and surgical centers
• Set explicit expectations about patient management post-intervention
• Understand the interplay of various treatment technologies
• Always prioritize patient-centered care

Ibach passionately advocates for professional collaboration, highlighting that optometrists and ophthalmologists have complementary skills. Although optometrists don't perform intraocular surgeries, and ophthalmologists may not want to manage routine vision care, they can work together effectively to provide comprehensive patient care. A significant pearl of wisdom is not to miss opportunities for minimally invasive glaucoma surgery, particularly during cataract surgery. This moment represents a critical intervention point where patients can simultaneously address cataract removal and glaucoma management. The ultimate goals outlined include lowering eye pressure, reducing medication burden, minimizing ocular surface disease, and improving patient quality of life.

Ibach's approach emphasizes flexibility, continuous learning, and a commitment to patient-first care, viewing glaucoma management as a collaborative, evolving journey rather than a one-time intervention.