50 Years in Ophthalmology: A look at glaucoma treatments

John Berdahl, MD, reflected on the notable innovations in glaucoma treatment over the past couple of decades. He highlighted the introduction of imaging OCT as a meaningful innovation that helped objectively assess the optic nerve. The speaker also noted that minimally invasive glaucoma surgeries (MIGS) were a significant advancement, filling the gap between eye drops and more invasive procedures like trabeculectomy. Berdahl predicted that the next wave of innovation would be focused on the potential of non-invasive, non-surgical methods to lower eye pressure, marking an entirely new category in glaucoma treatment. The first of these types of devices was approved by the FDA in the summer of 2024.

Inder Paul Singh, MD, shared that in the 20 years since his fellowship in ophthalmology, he remember the days when the treatment options were limited to eye drops, lasers, and then more invasive surgeries like trabeculectomy or tube surgery. He explained that the introduction of SLT (selective laser trabeculoplasty) and MIGS procedures represented a paradigm shift, allowing for earlier intervention and less aggressive treatment approaches. Singh emphasized that the earlier glaucoma is treated, the better the chances of the conventional methods, such as SLT or MIGS, being effective, as the patient's system may not be as scarred.

Shan Lin, MD, reflected on his 30-year experience in the glaucoma field, highlighting the introduction of prostaglandins as a tremendous change in glaucoma management, making it easier for patients with a single eye drop. Lin also noted the development of SLT, DSLT (dual selective laser trabeculoplasty), and new MIGS procedures as major advancements, which have helped delay glaucoma progression and reduce the need for more invasive surgeries, ultimately improving the overall management of glaucoma for patients.