Treating Glaucoma Has Evolved in Patients, Physicians Alike: Christine Funke, MD

Christine Funke, MD, glaucoma specialist at Barnet Dulaney Perkins Eye Center in Phoenix, Arizona, discusses how the treatment of glaucoma has evolved and will continue to evolve as minimally invasive glaucoma surgery (MIGS) becomes more popular as a standard of care.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

How has managing glaucoma changed and how can it continue to evolve?

Just for my own background, I have been doing this over a decade now, which sounds crazy to say. Glaucoma has really changed and evolved, since I started as a fellow. There [were] eye drops, and then there was major invasive, higher-risk procedure, and that was really all we learned. That's all that was available. And now over the course of my career, which has been really fun and exciting, is we've gotten to see a really large evolution in what options we have for treating glaucoma, and that evolution has really changed to what's called minimally invasive glaucoma surgery, or MIGS, is what we call it for short. Basically, what these are is an umbrella of different procedures that are low risk, high yield, to try and slow down the progression of disease. Glaucoma, also, just as a background, is a progressive chronic disease. Everything we have as a goal of surgeons and physicians is to try and slow down the disease. The issue we've had also with managing glaucoma in the past was that we relied on the patients in order to take a lot of eye drops, and that's a hard thing to do.

When we started to look at compliance rates, even with 1 single drop, the rate of compliance or the patients coming back in to refill those medications was very low. Compliance being a big issue, if somebody's not taking their medicine, they're going to progress [and] lose vision, which, of course, can ultimately lead to a lot of change in quality of life. The idea of what we're doing now, or this evolution into trying to do more early intervention and especially more surgically driven early intervention with low-risk surgery, is we're trying to slow down the disease and take the control out of the patient's hands. I think that it's very helpful for everyone. If I do surgery, I know that that treatment is being done, and it's there, and then we hope that then we can stabilize the disease that way. It's still an evolution going on now, which is what's been so exciting about the last decade.

Where I've been at with my practice is that, again, I see this evolution or change and this complete flip of dogma of this disease from when I learned, which was we kind of threatened people with surgery [compared] with now, I think, "Okay, this is first line what we want to do, because I'm taking control of this disease." But we still have a lot of work to do.

I think in terms of therapies and what we have available, we have a lot of great stuff on the table. We're getting close to a place where the things we have available, in terms of lasers and minimally invasive glaucoma, hopefully should keep most people at bay and keep the disease [at] what I consider to be young glaucoma. It's easier to treat and it's easier to manage when it's earlier in disease process. I think we have a really good way of going about it for the most part now. Diagnostically, I think we still have some work to do. But then also comes the change of all of the people in the field that are taking care of the disease. It's hard to change management. It's really hard to tell people this is how you've learned for the last decade, or 3 decades of how you've been treating people, and now suddenly we're telling you to do basically the exact opposite. I think that change, and that wave of change we've been seeing over the last several years, it's hopefully just continuing to evolve. But I think that's still a space where we just need to keep getting the word out and showing that patients do better long term by doing minimally invasive work instead.