Early adoption of a novel initial treatment paradigm for open-angle glaucoma: an evidence-based model

ABSTRACT Introduction Glaucoma treatment is transitioning from a reflexive topical-medication-first approach to a proactive, procedure-based strategy of earlier laser, minimally invasive glaucoma surgery (MIGS), and/or sustained-release procedural pharmaceuticals with the aim of improving quality of life and minimizing the burden of daily compliance – this is interventional glaucoma (IG). After years of resistance, Selective Laser Trabeculoplasty (SLT) increasingly has emerged as appropriate evidence-based first-line therapy. The next phase of IG is earlier implementation of MIGS and/or procedural pharmaceuticals. Areas covered This article discusses the evidence for SLT, the barriers to its adoption, and procedural pharmaceuticals and MIGS as the next phase of the IG treatment paradigm. Historic transitions in ophthalmology, such as the adoption of phacoemulsification for cataract surgery, are discussed. Expert opinion Overcoming resistance to change will be driven by clinical evidence. Just as phacoemulsification changed cataract surgery, glaucoma care is undergoing a shift, with SLT increasingly adopted as first-line treatment instead of topical medications. The next logical step in this IG transition is the widespread adoption of MIGS and procedural pharmaceuticals. Using the breadth of evidence around lower-risk treatments now available, we can further evolve into an interventional subspecialty that provides better care for our glaucoma patients.

• Publication year

  2025

• Venue

  Expert Review of Ophthalmology

• Publication date

  2025-11-02

• Fields of study

  Not labeled

• Identifiers
  DOI 10.1080/17469899.2025.2594815
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

• Loss to follow-up and risk of incident blindness among patients with glaucoma in the IRIS® Registry (Intelligent Research in Sight).

  2025cited by this paper
• Reduction in Intraocular Pressure Fluctuation after Trabecular Micro-Bypass Implantation: Case Report

  2025cited by this paper
• Interventional glaucoma consensus treatment protocol

  2025cited by this paper
• Aqueous Humor Concentrations of Travoprost Free Acid and Residual Drug in Explanted Implants from Patients Administered a Travoprost Intracameral Implant

  2025cited by this paper
• Travoprost Intracameral Implant Demonstrates Superior IOP Lowering Versus Topical Prostaglandin Analog Monotherapy in Patients with Open-Angle Glaucoma or Ocular Hypertension

  2024influential reference
• Interventional glaucoma and the patient perspective

  2024cited by this paper
• An Emerging Multi-mechanism and Multi-modal Approach in Interventional Glaucoma Therapy

  2024cited by this paper
• Interventional Glaucoma: Improving the Patient-Provider Educational Exchange

  2024cited by this paper
• Rates of visual field change and functional progression in glaucoma following trabecular microbypass implantation of iStent technologies: a meta-analysis

  2024cited by this paper
• Early diagnostics and interventional glaucoma

  2024cited by this paper
• Adopting Interventional Glaucoma Via Sustained-Release Therapies: The Wide-Ranging Impact of Procedural Pharmaceuticals in Ophthalmology

  2024cited by this paper
• Long-Term Safety and Efficacy Evaluation of Travoprost Intracameral Implant Based on Pooled Analyses from Two Phase III Trials

  2024cited by this paper
• Standalone interventional glaucoma: evolution from the combination-cataract paradigm

  2024cited by this paper
• Alternatives to Topical Glaucoma Medication for Glaucoma Management

  2023cited by this paper
• Ophthalmology Workforce Projections in the United States, 2020-2035.

  2023cited by this paper
• Challenging the "Topical Medications-First” Approach to Glaucoma: A Treatment Paradigm in Evolution

  2023cited by this paper
• Efficacy and Safety of the Travoprost Intraocular Implant in Reducing Topical IOP-Lowering Medication Burden in Patients with Open-Angle Glaucoma or Ocular Hypertension

  2023cited by this paper
• Five-year visual field outcomes of the HORIZON trial.

  2023cited by this paper
• Surgical innovation in ophthalmology: challenges and opportunities

  2022cited by this paper
• LiGHT trial: 6-year results of primary selective laser trabeculoplasty versus eye drops for the treatment of glaucoma and ocular hypertension.

  2022cited by this paper
• Trends and Usage Patterns of Minimally Invasive Glaucoma Surgery (MIGS) in the US: IRIS Registry Analysis 2013-2018.

  2021cited by this paper
• Quality of Life in Primary Open-Angle Glaucoma and Cataract: An Analysis of VFQ-25 and OSDI from the iStent inject® Pivotal Trial.

  2021cited by this paper
• Primary trabeculectomy versus primary glaucoma eye drops for newly diagnosed advanced glaucoma: TAGS RCT.

  2021influential reference
• Suppression of Diurnal (9AM–4PM) IOP Fluctuations with Minimally Invasive Glaucoma Surgery: An Analysis of Data from the Prospective, Multicenter, Single-Arm GEMINI Study

  2021cited by this paper
• Usage Patterns of Minimally Invasive Glaucoma Surgery (MIGS) Differ by Glaucoma Type: IRIS Registry Analysis 2013–2018

  2021influential reference
• THE QUALITY OF MEDICAL EVIDENCE AND MEDICAL PRACTICE.

  2020cited by this paper
• Phase 3, Randomized, 20-Month Study of Bimatoprost Implant in Open-Angle Glaucoma and Ocular Hypertension (ARTEMIS 1).

  2020cited by this paper
• Cost-effectiveness analysis of standalone trabecular micro-bypass stents in patients with mild-to-moderate open-angle glaucoma in Canada

  2019cited by this paper
• Ocular Surface Disease and Glaucoma Medications: A Clinical Approach

  2019cited by this paper
• Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT.

  2019influential reference
• Barriers and Facilitators to Self-Directed Learning in Continuing Professional Development for Physicians in Canada: A Scoping Review

  2018cited by this paper
• Trabeculectomy bleb-associated infections.

  2017cited by this paper
• Current therapeutic options and treatments in development for the management of primary open-angle glaucoma.

  2017cited by this paper
• Repeatability of selective laser trabeculoplasty for open-angle glaucoma

  2016cited by this paper
• The effect of repeat 360-degree selective laser trabeculoplasty on intraocular pressure control in open-angle glaucoma.

  2016cited by this paper
• Cost-comparison of two trabecular micro-bypass stents versus selective laser trabeculoplasty or medications only for intraocular pressure control for patients with open-angle glaucoma

  2016cited by this paper
• On the barriers to significant innovation in and reform of healthcare

  2015cited by this paper
• Meta-analysis of selective laser trabeculoplasty versus topical medication in the treatment of open-angle glaucoma

  2015cited by this paper
• Glaucoma therapy and ocular surface disease: current literature and recommendations

  2013cited by this paper
• Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis.

  2013cited by this paper
• Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up.

  2012cited by this paper
• Outcomes and bleb-related complications of trabeculectomy.

  2012cited by this paper
• Intraocular pressure control and long-term visual field loss in the Collaborative Initial Glaucoma Treatment Study.

  2011cited by this paper
• Prevalence of Ocular Surface Complaints in Patients With Glaucoma Using Topical Intraocular Pressure-Lowering Medications

  2010cited by this paper
• Preservatives in eyedrops: the good, the bad and the ugly.

  2010cited by this paper
• Selective laser trabeculoplasty reduces mean IOP and IOP variation in normal tension glaucoma patients

  2010cited by this paper
• Intraocular pressure reduction in the untreated fellow eye after selective laser trabeculoplasty

  2009influential reference
• Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors.

  2009cited by this paper
• Dry Eye Syndrome-Related Quality of Life in Glaucoma Patients

  2009cited by this paper
• Effects of Timolol and Latanoprost on Respiratory and Cardiovascular Status in Elderly Patients With Glaucoma

  2009cited by this paper
• German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye

  2008cited by this paper
• Meta-analysis of 24-hour intraocular pressure studies evaluating the efficacy of glaucoma medicines.

  2008cited by this paper
• Prevalence of Ocular Surface Disease in Glaucoma Patients

  2008cited by this paper
• Selective Laser Trabeculoplasty: A Review

  2008cited by this paper
• Cardiovascular and Respiratory Considerations With Pharmacotherapy of Glaucoma and Ocular Hypertension

  2008cited by this paper
• Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial

  2006cited by this paper
• Selective Laser Trabeculoplasty as Initial and Adjunctive Treatment for Open-Angle Glaucoma

  2005influential reference
• Perioperative complications of trabeculectomy in the collaborative initial glaucoma treatment study (CIGTS).

  2005cited by this paper
• 24-Hour IOP control with once-daily bimatoprost, timolol gel-forming solution, or latanoprost: a 1-month, randomized, comparative clinical trial.

  2004cited by this paper
• Comparison of long-term outcomes of selective laser trabeculoplasty versus argon laser trabeculoplasty in open-angle glaucoma.

  2004cited by this paper
• What drives change? Barriers to and incentives for achieving evidence‐based practice

  2004cited by this paper
• Vision related quality of life and topical glaucoma treatment side effects

  2003cited by this paper
• Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study.

  2003cited by this paper
• Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication

  2002cited by this paper
• A call for innovative operations for glaucoma.

  2000cited by this paper
• Selective laser trabeculoplasty vargon laser trabeculoplasty: a prospective randomised clinical trial

  1999cited by this paper
• Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study.

  1998cited by this paper
• Side effects of antiglaucomatous drugs on the ocular surface.

  1996cited by this paper
• Topical antiglaucomatous therapy: adverse effects on the conjunctiva and implications for filtration surgery.

  1995cited by this paper
• The Glaucoma Laser Trial (GLT) and glaucoma laser trial follow-up study: 7. Results. Glaucoma Laser Trial Research Group.

  1995cited by this paper
• Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and CW laser interactions.

  1995cited by this paper
• Adverse effects of topical antiglaucoma medication. I. The conjunctival cell profile.

  1994cited by this paper
• Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery.

  1994cited by this paper
• The contralateral reduction of intraocular pressure by timolol.

  1994cited by this paper
• Adverse effects of topical antiglaucomatous medications on the conjunctiva.

  1993cited by this paper
• Hypotony maculopathy following trabeculectomy with mitomycin C.

  1992cited by this paper
• The Glaucoma Laser Trial: 4. Contralateral effects of timolol on the intraocular pressure of eyes treated with ALT. GLT Research Group.

  1991influential reference
• The laser step in early glaucoma therapy.

  1991cited by this paper
• Practice implications of the Glaucoma Laser Trial.

  1990cited by this paper
• The Glaucoma Laser Trial (GLT). 2. Results of argon laser trabeculoplasty versus topical medicines. The Glaucoma Laser Trial Research Group.

  1990cited by this paper
• The quality of medical evidence: implications for quality of care.

  1988cited by this paper
• Adverse respiratory and cardiovascular events attributed to timolol ophthalmic solution, 1978-1985.

  1986cited by this paper
• Argon laser therapy for open-angle glaucoma. A pilot study.

  1979cited by this paper
• Carbonic Anhydrase Inhibitors in Glaucoma Therapy

  1979cited by this paper
• Diseases of the lens and vitreous : glaucoma and hypotony

  1969cited by this paper

• No citing papers are available for this paper.