Early adoption of a novel initial treatment paradigm for open-angle glaucoma: an evidence-based model

Introduction Glaucoma treatment is transitioning from a reflexive topical-medication-first approach to a proactive, procedure-based strategy of earlier laser, minimally-invasive glaucoma surgery (MIGS), and/or sustained-release procedural pharmaceuticals with the aim of improving quality of life and minimizing the burden of daily compliance – this is interventional glaucoma (IG). After years of resistance, Selective Laser Trabeculoplasty (SLT) increasingly has emerged as appropriate evidence-based first-line therapy. The next phase of IG is earlier implementation of MIGS and/or procedural pharmaceuticals.Areas covered This article discusses the evidence for SLT, the barriers to its adoption, and procedural pharmaceuticals and MIGS as the next phase of the IG treatment paradigm. Historic transitions in ophthalmology, such as the adoption of phacoemulsification for cataract surgery, are discussed.Expert Opinion Overcoming resistance to change will be driven by clinical evidence. Just as phacoemulsification changed cataract surgery, glaucoma care is undergoing a shift, with SLT increasingly adopted as first-line treatment instead of topical medications. The next logical step in this IG transition is the widespread adoption of MIGS and procedural pharmaceuticals. Using the breadth of evidence around lower-risk treatments now available, we can further evolve into an interventional subspecialty that provides better care for our glaucoma patients.