Glaucoma is the most common optic neuropathy. The only clinically proven treatment is to reduce IOP by using medical, laser, and surgical therapies. Treatment is typically selected depending on the level of IOP, stage of the disease, pace of progression, and current and past treatment history. Glaucoma management with drops can be problematic, mainly because they can be difficult for patients to instill properly and because of the related side effects.
In treating glaucoma, the typical route is often to prescribe medications.
If topical drops fail to achieve a reduction in intraocular pressure (IOP), then the alternative is to try laser trabeculoplasty, and finally surgery.
From 2019 to 2020, I co-chaired the European Glaucoma Society (EGS) Guidelines Committee with Carlo Traverso. The 5th Edition of the EGS guidelines was published in October 2020, after a superb team effort among a large number of colleagues (1). We aimed to promote evidence-based clinical practice and, to that end, followed GRADE methodology, including identification of key questions, critical evaluation of published literature, and formulation of recommendations.
Glaucoma is a leading cause of irreversible blindness affecting approximately 60 million people globally 40 years of age and older. Glaucoma is a disease that cannot be ignored, and the need for signicant changes in how we diagnose, manage, and treat must be examined and applied whenever possible.
Glaucoma management has traditionally taken a stepped approach based on the level of risk involved. The low-risk treatment option is medication. Next are laser/selective laser trabeculoplasty (SLT), MIGS, and incisional surgery. It ends with the highest risk option of cyclodestructive procedures.
Micropulse Transscleral diode laser cyclophotocoagulation (MP-TSCPC) is an established method of treatment for refractory glaucoma. This study evaluates the efficacy in terms of reduction in intraocular pressure and/or treatment amount, and safety and side effects of the ciliary bodies using a subthreshold laser with a duty cycle of 31.3% with Supra 810 nm Subliminal Quantel Medical, at one year in patients with refractory glaucoma.
Micropulse Transscleral Cyclophotocoagulation (MP-TSCP) is a recently developed cyclodestructive procedure less aggressive than conventional TSCP. In this study, we aimed to evaluate the safety and efficacy of MP-TSCP in a real-life setting.
To compare visual field outcomes of ocular hypertensive and glaucoma patients treated first with medical therapy with those treated first with selective laser trabeculoplasty (SLT).