Glaucoma and ocular surface disease (OSD) are both chronic, progressive conditions that require long-term management, but that doesn’t mean everyone must be burdened with using topical medications for life. When I see patients who rely on medications to alleviate their symptoms, I often recommend interventional treatments that address the root cause of the problem and allow patients to reduce and potentially eliminate the use of eye drops. Selective trabeculoplasty (SLT) with Selecta Duet and intense pulsed light (IPL) treatments with Optima IPL are two effective minimally invasive procedures performed in the office setting that improve my patients’ ocular health and vision, and ultimately improve their quality of life.
SLT Minimizes Glaucoma Drops
According to the World Health Organization, glaucoma is the leading cause of irreversible blindness worldwide. Medications can control intraocular pressure and prevent vision loss, but as a glaucoma specialist for over 20 years, I can tell you that compliance with medication is a huge problem. When people are diagnosed with glaucoma, their entire quality of life changes dramatically. Patient schedules now revolve around putting in their eye drops at a certain time each day, every day, for life. It’s easy to understand why many of them forget or skip their eye drops and risk losing their vision.
Glaucoma drops also can be very difficult to take because they have a toxic effect on the ocular surface. Preservatives such as BAK are known to be a big part of the problem, but the drugs themselves are quite inflammatory as well. Yet patients need to keep using their drops, adding to that inflammation, discomfort, and redness, or risk losing their vision. It’s a bleak process.
To help get patients off topical glaucoma medications, I often recommend SLT with Selecta Duet as a first-line therapy. This highly effective in-office procedure allows most patients to reach their target pressure and maintain it more consistently than they did with eye drop medications. Without drops, the ocular surface becomes healthy again, improving vision while eliminating the redness, irritation, burning and foreign body sensation. Patients are so much happier. They feel and see better, they are not chained to that bottle of eye drops every day, and they can feel confident that their glaucoma is controlled, so they are not losing their vision.
Optima IPL Controls Inflammation*
Many glaucoma patients have concurrent ocular surface disease and must rely on eye drops not only to control their glaucoma, but also to keep their dry eye symptoms at bay. I’ve found Optima IPL treatment to be an outstanding way to treat peri-ocular inflammation, which in turn alleviates symptoms of ocular surface disease*. Patients have less need for topical anti-inflammatory drugs (cyclosporine, lifitegrast, steroids) and artificial tears.
For the many patients who have acne rosacea and telangectasias on the lid margin, Optima IPL greatly reduces the skin manifestations of ocular rosacea and often significantly enhances patient quality of vision. Patients love it. It is one of the most effective and powerful procedures that we use to treat peri-ocular inflammation. Optima IPL has been a huge win for our patients, who just love this procedure and happily return for maintenance treatments over time. It has become an integral part of our overall treatment strategy to reduce topical medications and enhance quality of life as much as possible for all of our patients.
* Lumenis M22 Optima IPL is authorized for use to treat Meibomian Gland Dysfunction, the leading type of dry eye disease, in: the European Union (CE), China, Australia, New Zealand, South Korea, Brazil, and Hong Kong.
In the US, the device is cleared for treatment of inflammatory skin conditions such as rosacea. Rosacea may lead to ocular surface conditions such as MGD, with 80% of rosacea patients suffering from MGD. Treatment of rosacea with the M22 has not been clinically proven to prevent or delay the development of MGD.
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