INTRODUCTION
Glaucoma, a group of eye conditions that lead to deterioration of the peripheral visual field and irreversible central vision loss, is characterized by the progressive dysfunction, degeneration, and loss of both retinal ganglion cells and axons in the optic nerve.1,2 Although it is the leading cause of irreversible blindness, the only modifiable risk factor currently supported by clinical trials is IOP control.3 As a result, timely treatment to lower IOP is imperative to slow the rate of vision loss from glaucoma, with common methods including topical medication, sustained-release (SR) drug delivery, laser treatment, and surgical techniques ranging from minimally invasive options including minimally invasive glaucoma surgery (MIGS) and minimally invasive bleb surgery (MIBS) to more invasive options such as trabeculectomy and tube shunts.
As the landscape of glaucoma treatments evolves and minimally invasive options are integrated into clinical practice, early-stage disease management represents a pivotal therapeutic window through which timely intervention may prevent lifelong visual disability. In recent years, advancements in both procedural and pharmacologic modalities have transformed clinicians’ approach to managing this phase of the disease.
The following consensus statement reflects the perspectives of experienced glaucoma specialists and comprehensive ophthalmologists, drawing from current survey data and clinical practice patterns. Developed with clinician insights to address five prevailing practice gaps (see Practice Gaps in Early-Stage Glaucoma Management), the consensus statement outlines a harmonized view of how selective laser trabeculoplasty (SLT) and SR drug delivery systems may function as complementary tools in the early-stage glaucoma treatment algorithm.
Among the expert consensus group, 80% have been in clinical practice for 6 to 10 years and 20% for 21 to 30 years. All see more than 100 patients per month who they consider as having glaucoma, and 80% perform between 100 and 500 MIGS procedures annually. The remaining 20% perform up to 1,000 MIGS procedures annually.
PRACTICE GAPS IN EARLY-STAGE GLAUCOMA MANAGEMENT
1. There is a need to refine diagnostic protocols by incorporating risk-based monitoring strategies and more sensitive testing modalities that enable earlier detection and intervention.
2. Clinicians must move beyond reliance on preset OCT scans by developing greater proficiency in scan acquisition and interpretation to avoid missed or mischaracterized pathology.
3. Given the well-documented challenges with medication adherence compounded by the cost and complexity of multidrop regimens, ophthalmologists must reconsider the default reliance on topical therapy and pursue more durable, patient-friendly treatment options.
4. Despite the availability of safe and effective first-line alternatives such as SLT, SR drug delivery, MIGS, and MIBS, these options remain underutilized, signaling the need for broader integration into early-stage treatment algorithms.
5. Clinicians must be prepared to engage patients in transparent, expectation-setting conversations that balance hope for reduced treatment burden with the reality that current therapies aim to slow progression, not cure the disease.
1. Goel M, Picciani RG, Lee RK, Bhattacharya SK. Aqueous humor dynamics: a review. Ophthalmol. 2010;4:52-59.
2. Quigley HA. Glaucoma. Lancet. 2011;377:1367-1377.
3. Xu Z, Hysi P, Khawaja AP. Genetic determinants of intraocular pressure. Annu Rev Vis Sci. 2021;15(7):727-746.
