The year 2009 has been tumultuous: a bad economy, a high rate of unemployment, wars in Afghanistan and Iraq with no end in sight, hotly contested plans for nationalized health care, and a 21% decrease in reimbursement to physicians. Glaucoma remains without a cure. As the bad news mounts, I find myself thinking of the old joke, “Other than that, Mrs. Lincoln, how was the play?”

As 2009 draws to a close, my optimism for 2010 grows. Why? First, we are due for a good year, at least in and around the areas of interest to physicians caring for patients with glaucoma. Even if I am not 100% correct, 2010 hints at a very good visual outcome. Here are my 10 predictions:

1. The FDA will approve a new glaucoma device, which will open the door for the next generation of surgical technologies in this field. The pioneers struggling with the FDA, CPT coding, and the like are paving the way for our field to move forward.

2. The volume of trabeculectomy procedures will continue to decline, while the number of laser procedures (such as selective and argon laser trabeculoplasty) will continue to rise. We are getting past our dependence on the health of the conjunctiva for the surgical control of IOP and shifting our focus to the site of the pathology (ie, the trabecular meshwork, Schlemm's canal, and the collector system).

3. A new class of IOP-lowering medication will enter phase 3 trials. This will be the first new class of glaucoma drugs in 12 years. All the usual questions will be asked. Is it better than current drug therapy? Is it additive to existing medications? How does it work? What else does it do?

4. Drug-delivery devices will drive the FDA to a standstill. Which area of the agency is responsible for their review, devices or pharmaceutical? I expect some finger pointing.

5. The results of neuroprotective studies will be readdressed. Optical coherence tomography will be approved as the primary outcome rather than visual fields.

6. PHARMA guidelines will become more stringent. Not only will speakers show the full PDR listing of each drug (in a font that no one in the audience can read), but attendees at meetings will be required to bring their own personal water supply, pens, and seating. The lawyers will rule the day. (What else is new?)

7. Cataract surgeons will continue to try to increase their sphere of influence with combined procedures at least as far as “low-hanging fruit.” Glaucoma specialists will retain their complicated cases.

8. Discussed for years, a 24-hour IOP monitor will debut, but will it have an impact on preventing visual loss in glaucoma?

9. Glaucoma surgery will assume an earlier place in the treatment paradigm and be customized to the specific form of glaucoma.

10. Glaucoma will remain a specialty appreciated by patients and doctors alike. Despite the recession, practitioners in this field will remain employed.

Reusable water bottles make great gifts. Happy holidays to all!