Glaucoma expert endorses ‘interventional glaucoma’ treatment
NEW ORLEANS – It is time to change the glaucoma treatment paradigm, Ike K. Ahmed, MD, said here at SECO.
The opportunity is now for disruption and innovation in the glaucoma space, he stated.
“To overtake the existing market to create new space for interventional glaucoma (IG) is very much what MIGs [minimally invasive glaucoma surgeries] is about,” Ahmed said.
The goal of this philosophy is about improving quality of life with the disease and also the impact of treatment on a patient, he said.
“Treatment philosophy of glaucoma needs to move from disease-centric to patient preference and quality of life,” he said.
“IG is very much an attitude to be proactive rather than reactive, using advanced diagnostics to determine high-risk patients more actively, to be more aggressive in therapy and intervening earlier in the disease process,” Ahmed explained. “Adherence has to be a major factor in our choice of therapies.”
Sustained drug release is on the horizon in IOP control and wound healing, he said. There are also new MIGs approaches and ways to do bleb surgery.
“All of these are early,” he said. “We have to be careful without making too many conclusions and we will have to learn from our failures and pick up and move forward.”
The current treatment paradigm is not working, and software and technology have improved but still lag behind the disease, he said.
“One big reason eye care is in this predicament is because we aren’t looking at IOP properly and we aren’t addressing adherence properly,” Ahmed said.
Ahmed is well known for his groundbreaking work in the diagnosis and surgical treatment of complex eye diseases, including glaucoma.
“We have a crisis here. We aren’t treating the disease right,” he said.
The current paradigm is treatment via topical solutions, with glaucoma having a small share of the surgical pie, which may be due to potential complications, he said.
“We only push for surgery when patients are on retinal nerve fiber layer deathbed, when we are out of options,” Ahmed said.
Glaucoma therapy will change because the current paradigm is not working, and there is an unacceptable rate of blindness, he said.
“Studies show that despite medical therapies that lower pressure, the risk of blindness in one eye by the time someone dies is 40%,” he said.
In the Early Manifest Glaucoma Treatment trial, which randomized glaucoma patients to therapy vs. no therapy, he said the real takeaway was that with even a 25% average IOP reduction, the progression rate was still 60% in treated patients, Ahmed said.
“Studies are showing that treatment helps, but not enough,” he added.
He said there are issues with compliance, of not understanding IOP properly and challenges assessing progression. The methods around these principles need to change. – by Abigail Sutton
Ahmed I. Glaucoma and MIGs. Presented at: SECO; February 20-24, 2019; New Orleans.
Disclosure: Ahmed is a consultant for Acucela, Aerie, Alcon, Allergan, ArcScan, Bausch + Lomb, Beaver Visitec, Carl Zeiss, Centervue, ElutiMed, Equinox, ForSight Labs, Glaukos, Gore, Iantech, InjectSense, Iridex, iStar, Ivantis, Johnson & Johnson, KeLoTec, LayerBio, Leica Microsystems, New World Medical, Omega Ophthalmics, PolyActiva, Sanoculis, Santen, Science Based Health, Sight Sciences, Stroma, TrueVision and Vizzario. He receives research support from Alcon, Allergan, ArcScan, Carl Zeiss, Glaukos, Iridex, Ivantis, Johnson & Johnson and New World Medical and speakers honorarium from: Carl Zeiss, Glaukos and Johnson & Johnson.