Alternatives to Topical Glaucoma Medication for Glaucoma Management

Abstract

Topical glaucoma medications have favorable safety and efficacy, but their use is limited by factors such as side effects, nonadherence, costs, ocular surface disease, intraocular pressure fluctuations, diminished quality of life, and the inherent difficulty of penetrating the corneal surface. Although traditionally these limitations have been accepted as an inevitable part of glaucoma treatment, a rapidly-evolving arena of minimally invasive surgical and laser interventions has initiated the beginnings of a reevaluation of the glaucoma treatment paradigm. This reevaluation encompasses an overall shift away from the reactive, topical-medication-first default and a shift toward earlier intervention with laser or surgical therapies such as selective laser trabeculoplasty, sustained-release drug delivery, and micro-invasive glaucoma surgery. Aside from favorable safety, these interventions may have clinically important attributes such as consistent IOP control, cost-effectiveness, independence from patient adherence, prevention of disease progression, and improved quality of life.

Keywords:

• intervention
• treatment
• sustained release drug delivery
• MIGS
• medication
• selective laser trabeculoplasty

Data Sharing Statement

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Acknowledgment

Editorial assistance (Dana M. Hornbeak, MD, MPH; Tony Realini, MD, MPH) was provided by Glaukos Corporation.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

SB: Allergan: speaker, consultant; Glaukos: Speaker, consultant; Thea Laboratories: consultant; Ocular Therapeutix: consultant; BVI: consultant; MST: consultant; Belkin: consultant; Elios Vision: consultant. JB: AbbVie (C, L); Aerie (C); Aerpio (C); Alcon (C, L); Aldeyra (C); Aurea Medical (C)

Aurion Biotech/CorneaG (C, O); Balance Ophthalmics (C); Bausch + Lomb (C); Dakota Lions Eye Bank (C); Elios Vision INC (C); Equinox (C, O); Expert Opinion (C, O); Glaukos (C, L); Gore (C); Iacta Pharmaceuticals (C); Imprimis (C, P); Interfeen (C); iRenix (C); IVERIC Bio, Inc (C); Johnson & Johnson (C); Kala (C); Kedalion (C); MELT Pharmaceuticals (C); MicroOptx (C); New World Medical (C); Ocular Surgical Data (C, O); Ocular Theraputix (C); Omega Ophthalmic (C, O); Orasis (C); Oyster Point (C); RxSight (C); Santen (C); Sight Sciences (C); Surface Inc (C, O); Tarsus (C); Tear Clear (C); RxSight (C); Vance Thompson Vision (C, O); Verana Health (O); Versea Biologics (C); Vertex Ventures (C); ViaLase (C); Visionary Ventures (C); Visus (C); VittamedB40 (C); Zeiss (C, O). A.S. reports the following disclosures: Alcon, Nova Eye, AbbVie, and Glaukos. IPS is a speaker and consultant for Glaukos, Allergan, BVI, New World Medical, Ivantis, Sight Sciences, Ocular Therapeutix, Sun Pharmaceuticals, Novartis, Nova Eye, Bausch + Lomb, Kala Pharmaceuticals, and EyePoint Pharmaceuticals. The authors report no other conflicts of interest in this work.

Additional information

Funding

No funding was provided for the creation of this manuscript. Publication fees were provided by Glaukos Corporation.