PUBLICATION EXCLUSIVE: Comprehensive ophthalmologists take combination approach to treating glaucoma

I am primarily a corneal, cataract and refractive surgeon with an interest in glaucoma associated with cataract and corneal pathology. In our group at Minnesota Eye Consultants, we have four fellowship-trained glaucoma specialists. It is my strong impression that the patients I treat in my clinic are different from those my glaucoma specialist partners treat. In my opinion, there is “comprehensive ophthalmologist glaucoma” and “glaucoma specialist glaucoma,” and they are a different disease. The patients I see are losing vision from cataract or corneal disease and happen to have ocular hypertension or mild to moderate glaucoma, usually well controlled with topical medications. The patients my glaucoma specialist colleagues see are going blind from glaucoma despite maximally tolerated medical therapy and might or might not happen to have an associated cataract or corneal problem. I believe this difference in patient population explains the different perception comprehensive ophthalmologists and glaucoma specialists have regarding microinvasive glaucoma surgery. My comments will be for the surgeon treating “comprehensive ophthalmologist glaucoma.”First, my favorite and most effective operation for the patient with glaucoma that I treat is clear corneal cataract surgery with implantation of a posterior chamber IOL. The typical patient enrolled in the MIGS studies all had a washout off-medications IOP of 25 mm Hg to 26 mm Hg. With cataract surgery alone, IOP reduction in such a patient is 5 mm Hg to 10 mm Hg. And almost too good to be true, the higher the pre-cataract surgery IOP, the greater the pressure reduction with cataract surgery. Cataract surgery alone is a powerful glaucoma operation and also helps patients see better, generating high patient satisfaction.