Improving Glaucoma Outcomes With New Technologies and Patient-Centered Care

The future of glaucoma care will be driven by advancements in first-line therapies, technological innovations such as artificial intelligence (AI)–driven diagnostics and visual field testing, and surgical interventions like minimally invasive procedures, according to experts at a Southeastern Congress of Optometry (SECO) 2025 panel discussion.¹

Selective laser trabeculoplasty can reduce patients’ need for eye drops, with 74% of patients maintaining successful intraocular pressure control for at least 3 years after treatment. | Image credit: PIC4U - stock.adobe.com

The discussion explored the growing preference for selective laser trabeculoplasty (SLT) as a primary treatment over traditional eye drops, the challenges of patient adherence, and the potential of novel drug delivery systems. They also examined innovations in visual field testing, imaging technologies, and the use of AI for disease monitoring, all while stressing the importance of early intervention, patient education, and personalized approaches to care.

Replacing Eye Drops With SLT

Bobby Saenz, II, OD, MD, FAAO, a clinical assistant professor at the Rosenberg School of Optometry at the University of the Incarnate Ward, led the discussion on SLT as a first-line therapy, highlighting the increasing adoption of this approach.

SLT offers patients with glaucoma superior intraocular pressure (IOP) stability compared with traditional eye drops and at a lower cost, according to data from the LiGHT trial.² As a result, SLT can reduce patients’ need for eye drops, with 74% of patients maintaining successful IOP control for at least 3 years after treatment, making it a cost-effective alternative to traditional eye drop therapy. Additionally, data show that initial treatment with SLT for glaucoma and ocular hypertension led to slower visual field deterioration compared with medical therapy, supporting SLT as an effective first-line treatment option.³

Saenz emphasized the role of early surgical intervention, particularly with minimally invasive glaucoma surgery devices, such as the iStent inject and Xen Gel Stent, which help prevent disease progression. Unlike the iStent and Hydrus, which help drain fluid through the Schlemm canal, the Xen Gel Stent creates a new drainage route into the space under the conjunctiva, similar to traditional glaucoma surgeries but done internally.⁴

Optometric Referral Patterns and Prescribing Trends for SLT

Shifting gears, Jill C. Autry, OD, RPh, an optometrist at Eye Center of Texas, provided a different perspective, focusing on optometric referral patterns and prescribing trends. While SLT is gaining ground, Autry pointed out that many optometrists still prefer initiating treatment with prostaglandin analogs, largely due to accessibility and training limitations.

This sentiment echoes a 2020 study showing that providers' feelings about SLT are mixed, with many recognizing it as a safe and effective option for treating glaucoma.⁵ Although 85% of surveyed ophthalmologists reported offering SLT to newly diagnosed patients, only 28% said they preferred it over medications.

She stressed the need for enhanced optometric training on SLT and broader access to laser treatments. Autry also made a significant contribution to the discussion on visual field testing, highlighting advancements in binocular, wireless, and portable devices. These innovations improve patient comfort and enhance accessibility, particularly for those with neck issues or dexterity challenges. Autry introduced the idea of objective visual field testing, which measures pupil reactions to light, removing the need for patient participation—particularly beneficial for individuals with cognitive or physical impairments.

Overcoming Patient Adherence Challenges

Jessica Steen, OD, an associate professor at Nova Southeastern University College of Optometry, where she serves as Director of the Glaucoma Service and as an attending optometric physician at the College’s Eye Care Institute, dove into the challenges of patient adherence and the role of ocular surface disease in noncompliance with topical medications.

She explored how alternative drug delivery methods, such as sustained-release implants, could potentially improve patient outcomes by addressing these barriers. Steen also examined the growing importance of anterior segment OCT in glaucoma management, evaluating its potential benefits and limitations for disease monitoring. While she acknowledged that corneal hysteresis could be a promising biomarker for glaucoma progression, she emphasized that more research is needed to solidify its clinical role.

Following Steen’s insights, Justin Schweitzer, OD, vice president of the Optometric Glaucoma Society and a cataract, cornea, refractive, and glaucoma surgery specialist at Vance Thompson Vision, discussed the technological innovations that are reshaping glaucoma care. He reviewed data on low-energy SLT, which he positioned as an effective first-line therapy with promising long-term benefits. Schweitzer also highlighted the rapid advancements in visual field testing, focusing on the integration of portable, wireless, and AI-driven systems. He explored how these systems could enable early detection and improve disease monitoring by incorporating virtual and objective testing methods.

The discussion highlighted a paradigm shift in glaucoma management, with early intervention, the integration of new technologies, and a patient-centered approach taking center stage in the drive to improve care and outcomes.

References

1. Saenz R, Autry JC, Steen J, Schweltzer J. Hot topic breakfast - The future of glaucoma management: perspectives from leading experts. Presented at: SECO 2025; February 26-March 2, 2025; Atlanta, GA.

2. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505-1516. doi:10.1016/S0140-6736(18)32213-X

3. Wright DM, Konstantakopoulou E, Montesano G, et al. Visual field outcomes from the multicenter, randomized controlled laser in glaucoma and ocular hypertension trial (LiGHT). Ophthalmology. 2020;127(10):1313-1321. doi:10.1016/j.ophtha.2020.03.029

4. Garza PH, Shah MM. MIGS stent devices: what’s the evidence? cataract & refractive surgery today. October 2018. Accessed February 27, 2025. https://crstoday.com/articles/oct-2018/migs-stent-devices-whats-the-evidence

5. Bonafede L, Sanvicente CT, Hark LA, et al. Beliefs and attitudes of ophthalmologists regarding SLT as first line therapy for glaucoma. J Glaucoma. 2020;29(10):851-856. doi:10.1097/IJG.0000000000001615