Honored Lecture: How glaucoma specialty continues to evolve

Boston-Glaucoma is now in a post-Renaissance period with far superior medications, better lasers, and the potential for individualized treatments for patients, according to Thomas W. Samuelson, MD.

Glaucoma is a relative new specialty, with the American Glaucoma Society only having been incorporated in 1985. Up until the mid-1990s with the introduction of different medications, the specialty was in its pre-Renaissance period, he said.

Dr. Samuelson-during his delivery of the Stephen A. Obstbaum, MD, Honored Lecture-recounted that the only anti-glaucoma drugs available were pilocarpine, timolol, and dipivefrin. Surgically, there was trabeculectomy and some ablative procedures.

“We now have options and we can individualize as never before,” said Dr. Samuelson, Minnesota Eye Consultants, Minneapolis.

Dr. Samuelson credits this evolution to a few factors. First, was the move from scleral incisions to clear corneal incisions and the willingness to perform phacoemulsification alone for patients with glaucoma. With that came the realization that phacoemulsification lowered IOP in most patients. This in turn decoupled trabeculectomy and cataract surgery.

The second factor was dissatisfaction with the status quo and the recognition of the need for something better than trabeculectomy with fewer complications, especially late complications.

The third factor was creative minds that thought outside the box and led to safer options for patients.

The fourth factor was industry taking an interest in glaucoma, which was responsible for many new innovations, such as the new glaucoma devices.

“Industry ignored glaucoma for many years, but when it took interest in the glaucoma surgical space this was hugely important,” he said. “Alcon purchased the ExPress device, which was hugely important. This collaboration between industry and clinicians is all important.”

Finally, innovations abroad have led to studies that could not be performed in the United States.

There is still much to learn, according to Dr. Samuelson, and may questions remain to be answered.

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