Recent advances in glaucoma management provide hope to thousands of sufferers

Glaucoma is the most common cause of irreversible blindness worldwide. Open-angle glaucoma (OAG) is the most frequent phenotype, with a prevalence of 2% in people over the age of 40 years. The Irish College of Ophthalmologists have also identified glaucoma as the leading cause of blindness in Ireland, with the incidence expected to rise by 33% over the next 10 years. Almost half of all cases remain undiagnosed, as patients are often asymptomatic until much later in the disease course. This makes early detection and treatment imperative to a good visual prognosis. Glaucoma is characterised by progressive loss of retinal ganglion cell (RGCs) and optic nerve damage, often associated with elevated intraocular pressure (IOP). As a result, patients begin to lose their peripheral vision, and as the disease progresses their central vision can begin to be impacted; eventually leading to total loss of sight.

Over the past two decades there has been a proliferation of glaucoma treatments, with laser and minimally-invasive options bridging the gap between medical therapies and more traditional surgical interventions including trabeculectomy and aqueousshunt surgery. As a result, there has been a monumental shift in the glaucoma treatment paradigm from ‘drops for life and surgery as a last resort’ to ‘earlier intervention in order to preserve vision.’ Whilst trabeculectomy and aqueous-shunt surgery remain highly effective at lowering IOP, they come with higher complication risks including bleb infection, post-operative manipulation, revision surgery and hypotony. On the other hand, topical medications may not be effective enough at lowering the IOP, and their chronic use may give arise to non-compliance as well as aggravate ocular surface disease, thus exacerbating the very problem they were designed to address. The advent of laserbased glaucoma interventions as well as minimally invasive glaucoma surgery (MIGS) enables glaucoma specialists to narrow the gap between traditional treatment techniques.