Glaucoma affects more than 3 million Americans, and that number is expected to increase significantly in the next decade.1 Glaucoma is like a large puzzle—it has many pieces that need to fit together in order to make an accurate diagnosis and choose the correct

treatment options for our patients.This issue of Modern Optometry focuses on glaucoma and the

advances in technology and treatment options that have led to its earlier diagnosis and better control of progression. The Ocular Hypertension Treatment Study identified critical risk factors for glaucoma such as increased age, untreated elevated IOP, larger cup-to-disc ratios (greater than 0.5), thin central corneal thickness, and higher visual field pattern standard deviation.2 Thanks to the findings of this and other landmark glaucoma studies, diagnostic technology has evolved and continues to do so today. A perfect example of this is OCT angiography, which allows imaging and monitoring of capillaries located in the retina and surrounding the optic nerve without injection of dye. Greg Caldwell, OD, FAAO, discusses this technology on page 26. New and emerging imaging modalities such as en face imaging, enhanced depth imaging, and adaptive optics of the lamina cribrosa could be the future of glaucoma management. Read about them on page 22. A common theme exists among these technologies: helping clinicians detect glaucoma in its earliest stages and initiate treatment.

The treatment toolbox for glaucoma is larger than ever. Recent approvals of glaucoma medications that target the trabecular meshwork have given eye care providers new options for lowering IOP that could delay the need to collaborate with an ophthalmologist for surgical intervention. A push to include selective laser trabeculoplasty as a first-line treatment option occurred this year with the publication of the Selective Laser Trabeculoplasty Versus Eye Drops for First-Line Treatment of Ocular Hypertension and Glaucoma trial,3 which also addressed quality of life, cost, safety, and clini-cal effectiveness. Surgical glaucoma continues to transform with new microinvasive glaucoma surger-ies (MIGS) being introduced to the market yearly, which Dr. Schweitzer explores on page 36. MIGS serves a much-needed bridge between conservative treatments, such as topical glaucoma medica-tions, and more aggressive, higher-risk filtration surgeries.

Optometrists will play an integral role in piecing this puzzle together and protecting patients from permanent vision loss. It is imperative that we stay informed of the ever-changing advances in diagnostic technology and treatment options so that we can provide the highest quality care to our patients with glaucoma.

We hope this issue gives you a more in-depth understanding of the latest glaucoma care trends so that you can help better the lives of your patients. Please contact us via email at modernOD@bmctoday.com with questions, comments, or best practices that you would like to share. n

1. January is glaucoma awareness month. Glaucoma Research Foundation. www.glaucoma.org/news/glaucoma-awareness-month.php. Accessed September 25, 2019.2. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120(6):701-713.3. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al; LiGHT Trial Study Group. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicenter randomized controlled trial. Lancet. 2019;393(10180):1505-1516.

FORWARD PROGRESS IN GLAUCOMA MANAGEMENT

LESLIE O’DELL, OD, FAAO

CO-CHIEF MEDICAL EDITOR

JUSTIN SCHWEITZER, OD, FAAO

CO-CHIEF MEDICAL EDITOR

6 | OCTOBER 2019