Sponsored by Sight Sciences

More than 3 million individuals in the United States—and about 60 million worldwide—are affected by glaucoma.1

Those statistics help underscore the urgency in bringing greater awareness to the leading cause of irreversible blindness. Yet, there is a human aspect to those numbers that we should never lose sight of: Patients with glaucoma live each and every day with a condition that threatens their vision, and there are countless others who are not aware they are at risk for glaucoma or who are in the earliest stages when symptoms are not yet apparent. We owe it to them to be vigilant in educating about the disease process and about the array of interventions we have at our disposal to slow or stop the insidious disease process.

Below we share some thoughts on how we raise awareness about one very specific area of glaucoma management: MIGS as an option that offers patients the ability to achieve better control of IOP (the only known modifiable risk factor in glaucoma) while also positively impacting quality of life.

Trust is Built on Small Encounters

By Deborah Ristvedt, DO

Educating about MIGS and growing awareness about treatment options is a lot easier when you believe in what they can offer for patients—and it is a whole lot simpler when your patients trust that you have their best interest in mind.

The number one tip I would offer for educating patients about MIGS is to start with the proper mindset. That means understanding the risk-benefit profile associated with MIGS and having informed conversations. When you know the pros and cons, you can tailor the approach and offer a solution that makes sense to the individual patient.

There is a lot of information for the patient to digest, so we focus on sharing some simple key messages:

The earlier the better

Early recognition of glaucoma and prompt intervention improves the chance of slowing glaucomatous progression before additional irreversible damage occurs.

Emerging treatment options

Because of the expansion of the MIGS category, there is a very good chance we can match the best option to each patient.

Help them understand proven outcomes

Some of the most common questions we get from patients is “what if the treatment option you are suggesting doesn’t work?” and “will drops have to be restarted if the pressure goes back up?” Fundamentally, what these kinds of questions highlight is that patients want to know that there are treatment options and understand what those are. This is where it is helpful to bring in data. For instance, we have learned that between 50-75% of resistance may be in the trabecular meshwork,2-4 and about 50% of resistance may be in Schlemm’s canal and the distal collector channels.2-4 As a result, options like the OMNI® Surgical System (Sight Sciences), which targets all three of those areas, can help to restore physiologic outflow. We can point to published studies that have demonstrated consistent and reliable IOP and medication reduction from baseline in standalone procedures and in combination with cataract surgery.5,6 Published studies demonstrate efficacy and help us understand mechanisms of action, but safety is the hallmark characteristic of the MIGS class.

A Partner in the Patient’s Journey

By Mitch Ibach, OD

If there is one overriding point we want to make to every patient when they come to see us about their glaucoma it is that we are on this journey together. We’re going to do what’s right for them specifically and individually. We let them know we have a lot of paths we can go down based on the various options, and when it comes time to making recommendations, we let them know we’re always going to do something that we would do for our own family member. Personalizing the message, and allowing yourself to be vulnerable in that moment, helps the process of building trust with the patient.

Conversation Starters

In our practice, educating patients starts well before the first encounter. Our clinic has made a priority of building our website with solid information, and we also offer patients the opportunity to receive text messages with links to good sources of information. Those efforts subtly tell patients (and referral sources) that they will be working with a clinic with a deep set of tools. More overtly, they are designed so patients become aware of their options before coming to us, and in that way, they become conversation starters so we can have more fruitful conversations during the visit.

I am a big advocate of active listening to understand where patients are in the treatment journey. For me, one of the compelling aspects of working with glaucoma patients is that everyone’s circumstance is going to be different. Every patient will have different experiences with their treatment, and each individual will have different goals and objectives. And so, probing a bit to understand how treatment is affecting quality of life can be informative. For example:

How are you doing with your glaucoma medications?

Are you having any struggles with your current regimen?

Do you have any discomfort when you put your drops in?

Answers to any of the above will quickly tell me if the patient is receptive to hearing about alternative options, like MIGS. From there, we can tailor the recommendations to the patient’s goals. The art of glaucoma management is that it is very customizable for every patient.

It Really Does Take a Team

In addition to patients’ education, building close collaboration with the referral network is a point of emphasis in our practice. When we can act as an extension of someone else’s care, it can help strengthen the long-term relationships patients have with the optometrist or ophthalmologist who referred them. But there are also practical reasons to foster a team-based approach. Namely, if all goes according to plan, our clinic is managing the surgical step, and the referral source is managing the after care. It’s a win-win-win scenario: The patient receives premium care, the referral source never loses a patient, and we get to be more efficient with the services we can offer.

There can be little doubt that the prospect of losing vision causes anxiety. Thus, it is important to instill confidence that when glaucoma fights back, we will work alongside the referring doctor to work on this problem together. Building a relationship with a patient really starts with engaging to understand not only what options have been tried, but also what their experience was with each one. Asking the right questions will lead you down the pathway to talk more about the right options for each patient. Every encounter is an opportunity to build that relationship, and that notion extends to working with the referral network, as well.

1. Glaucoma Research Foundation. January is Glaucoma Awareness Month. Available at: https://www.glaucoma.org/news/glaucoma-awareness-month.php. Accessed: February 1, 2022.

2. Grant WM. Experimental aqueous perfusion in enucleated human eyes. Arch Ophthalmol. 1963;69:783-801.

3. Rosenquist R, Epstein D, Melamed S, et al. Outflow resistance of enucleated human eyes at two different perfusion pressures and different extents of trabeculotomy. Curr Eye Res. 1989;8(12):1233-1240.

4. Battista SA, Lu Z, Hofmann S, et al. Reduction of the available area for aqueous humor outflow and increase in meshwork herniations into collector channels following acute IOP elevation in bovine eyes. Invest Ophthalmol Vis Sci. 2008;49(12):5346-5352.

5. Brown RH, Tsegaw S, Dhamdhere K, Lynch MG. Viscodilation of Schlemm canal and trabeculotomy combined with cataract surgery for reducing intraocular pressure in open-angle glaucoma. J Cataract Refract Surg. 2020;46(4):644-645.

6. Vold SD, Williamson BK, Hirsch L, et al. Canaloplasty and trabeculotomy with the OMNI System in pseudophakic patients with open-angle glaucoma: the ROMEO Study. Ophthalmol Glaucoma. 2021;4(2):173-181.