ADVANCING THE STANDARD OF GLAUCOMA CARE

Interventional Glaucoma

For decades, glaucoma management has been centered around two treatment approaches—topical medications and incisional surgery. Discover how interventional glaucoma is reshaping the treatment landscape for patients with this sight threatening disease.1

Re-examining The Conventional Glaucoma Patient Journey

Reactive glaucoma management follows a stepwise approach, escalating treatment only after disease progression.1,2

The current “medication-first and always” mindset is being challenged

Limitations of Glaucoma Drop Therapy

Patients treated with glaucoma drop therapy regimens can suffer significant disease progression2

Probability of Primary Open Angle Glaucoma-related Blindness by Visual Field or Visual Acuity

13.5% of patients progressed to blindness

13.5% of patients progressed to blindness

Data collected from 1981-2000

In a 20-year study sponsored by the NIH in Olmsted County, Minnesota2:

Despite being diagnosed and treated with glaucoma drop therapy, the probability of disease progression leading to blindness in at least one eye shown to be 13.5%, and 4.3% bilaterally

Average time to blindness in these patients was 5.8 years

Drops-first management has compounding limitations:

Self-Application of Topical Medication Leads to Adherence Challenges:

of glaucoma patients are non-compliant with glaucoma drop therapy3

of glaucoma patients purposely discontinue glaucoma drop therapy within 6 months

Stepwise Introduction of Additional Topical Therapy has Diminishing Return on IOP Reduction

Additional topical medications provide only 8-11% further reduction in intraocular pressure (IOP) following treatment with the first drop.4

Long-term Glaucoma Drop Therapy Leads to Ocular Side Effects

Blurred Vision
Periorbitopathy
Ocular Surface Disease

Advancements in Glaucoma Treatment

Advancements in therapeutic options have addressed the limitations of drop-based therapy by effectively lowering IOP without relying on patient self-application of topical pharmaceuticals.1*

Interventional Glaucoma: A Proactive Approach

Moving towards a new standard

Incorporating early procedural interventions can slow disease progression more effectively than topical glaucoma drop therapy7

  • Illustration of an eye treated with glaucoma drop therapy
  • Illustration of an eye with reduced glaucoma drop therapy

An Interventional Approach that is Advancing Patient Care

Personalize

Personalize glaucoma management by early predictive diagnostics and active monitoring.

Proactive

Proactively manage glaucoma rather than waiting for significant progression or patient non-compliance and adherence.

Effective, low-risk

Effective, low-risk early procedural interventions allows the HCP to re-gain control of glaucoma treatment.

Integrating Interventional Glaucoma Into Your Practice

A consensus protocol was developed by eleven leading ophthalmologists. The Interventional Glaucoma working group reviewed individual treatment strategies and established a consensus-based framework tailored to each stage of disease progression8.

  • Ocular Hypertension

    • Lasers
    • Procedural Pharmaceuticals
    • Tissue-sparing MIGS
    • MTMT

  • Mild Glaucoma

    • Lasers
    • Procedural Pharmaceuticals
    • Tissue-sparing MIGS
    • Non-tissue-sparing MIGS Procedures
    • MTMT

  • Moderate Glaucoma

    • Lasers
    • Procedural Pharmaceuticals
    • Tissue-sparing MIGS
    • Non-tissue-sparing MIGS Procedure
    • MTMT
    • Filtering Surgery

  • Severe Glaucoma:

    Favoring a more aggressive intervention, skipping laser to focus on a combined protocol of procedural pharmaceuticals and tissue-sparing MIGS followed by non-tissue-sparing MIGS if IOP is not controlled. Filtering surgery is still the last resort but may be considered when prompt and substantial reduction of IOP is imperative to prevent irreversible optic nerve damage.

    • Procedural Pharmaceuticals
    • Tissue-sparing MIGS
    • Non-tissue-sparing MIGS Procedures
    • MTMT and/or Lasers
    • Filtering Surgery

  • Bridge therapy: Drops used as a temporary treatment while patient awaits procedural intervention | Supplemental: Drops used in addition to a procedural intervention MTMT: Maximum tolerated medical rherapy | Tissue-sparing MIGS: Either trabecular bypass or canaloplasty

Discover the Future of Glaucoma Care

Watch how Glaukos is advancing patient outcomes and supporting practices on their interventional glaucoma journey.

Applying Interventional Glaucoma in Practice

As awareness of interventional glaucoma continues to grow, translating this understanding into clinical practice is essential to advancing patient care.
Clinicians should assess their current treatment protocols and consider where opportunities exist to integrate interventional options earlier in the care continuum.

Discover how Glaukos' products meet the needs of Interventional Glaucoma

iDose® TR (travoprost intracameral implant) 75 mcgiStent Infinite®* Glaukos provided reimbursement for the Interventional Glaucoma Working Group’s time and travel expenses to allow them to participate in consensus-building discussions.

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References

  1. 1. Bedrood S et al. Clin Ophthalmol. 2023;17:3899-3913.
  2. 2. Malihi M et al. Ophthalmology. 2014;121(1):134-41.
  3. 3. Nordstrom BL et al. Am J Ophthalmol. 2005;140(4): 598-606.
  4. 4. Johnson T , Jampel HD. Am J Ophthalmol. 2020;216:110-20.
  5. 5. Kolko et al. Ocular Surface. 2023;29:456-68.
  6. 6. O’Hare et al. Clin Exp Ophthalmol. 2012;40(7):675-81.
  7. 7. Litcher PR et al. Ophthalmol. 2001;108(11):1943-53.
  8. 8. Funke C et al. Exp Rev Ophthamol. 2025; 20:79-87.

iStent inject® W Important Safety Information

Indication for Use

The iStent inject® W Trabecular Micro-Bypass System Model G2-W is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate primary open-angle glaucoma.

Contraindications

The iStent inject® W is contraindicated in eyes with angle-closure glaucoma, traumatic, malignant, uveitic, or neovascular glaucoma, discernible congenital anomalies of the anterior chamber (AC) angle, retrobulbar tumor, thyroid eye disease, or Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure.

Warnings

Gonioscopy should be performed prior to surgery to exclude congenital anomalies of the angle, PAS, rubeosis, or conditions that would prohibit adequate visualization of the angle that could lead to improper placement of the stent and pose a hazard.

MRI Information

The iStent inject® W is MR-Conditional, i.e., the device is safe for use in a specified MR environment under specified conditions; please see Directions for Use (DFU) label for details.

Precautions

The surgeon should monitor the patient postoperatively for proper maintenance of IOP. The safety and effectiveness of the iStent inject® W have not been established as an alternative to the primary treatment of glaucoma with medications, in children, in eyes with significant prior trauma, abnormal anterior segment, chronic inflammation, prior glaucoma surgery (except SLT performed > 90 days preoperative), glaucoma associated with vascular disorders, pseudoexfoliative, pigmentary or other secondary open-angle glaucomas, pseudophakic eyes, phakic eyes without concomitant cataract surgery or with complicated cataract surgery, eyes with medicated IOP > 24 mmHg or unmedicated IOP < 21 mmHg or > 36 mmHg, or for implantation of more or less than two stents.

Adverse Events

Common postoperative adverse events reported in the iStent inject® randomized pivotal trial included stent obstruction (6.2%), intraocular inflammation (5.7% for iStent inject® vs. 4.2% for cataract surgery only), secondary surgical intervention (5.4% vs. 5.0%) and BCVA loss ≥ 2 lines ≥ 3 months (2.6% vs. 4.2%).

Caution

Federal law restricts this device to sale by, or on the order of, a physician. Please see DFU for a complete list of contraindications, warnings, precautions, and adverse events.

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