From the Editor: The Change Constant in Glaucoma

The field is constantly evolving.

Heraclitus, a Greek philosopher, has been quoted as saying, “Change is the only constant in life.” When I began my career, some would argue that the field of glaucoma hadn’t significantly changed since Cairns first reported on modern trabeculectomy in 1968.1 I think it’s safe to say that our field has now fully embraced change. In the decade since my glaucoma fellowship, I have adopted at least 10 new glaucoma surgeries. I can’t thank YouTube enough for the surgical education (perhaps I should credit Ike Ahmed, MD, as well). Most of this expansion in surgical options was brought about by the advent of minimally invasive glaucoma surgery. But, although the last decade has seen much innovation, there is much more to come and our practice patterns may be even more significantly disrupted.

In July 2019, the FDA accepted Allergan’s new drug application for the bimatoprost sustained-release implant for primary open-angle glaucoma or ocular hypertension. The implications are significant, because more sustained-delivery options are forthcoming. This is a fantastic step toward the drop-free glaucoma practice, a topic about which I wrote in my first Glaucoma Physician article.2 Also, data presented at ASCRS by Robert Weinreb, MD, showed that patients receiving 3 bimatoprost sustained-release implants over 1 year could then be controlled without medications for the next year in 83% of cases. If these data are borne out in clinical practice, then many practices and many patients’ lives may very well be transformed.

In this issue of Glaucoma Physician, we continue to look at a number of arenas in the evolution of glaucoma care, starting with pharmacotherapy. We discuss how one might avoid incisional glaucoma surgery with selective laser trabeculoplasty or a trabecular microstent. We also examine how close we are to outflow imaging in the clinic, and we discuss glaucoma filtration surgery, from bleb management to the evolution of Xen gel stent implantation.

We hope you enjoy this issue and read on; however, don’t be surprised when in the future our state of the art changes yet again. GP


  1. Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol. 1968;66(4):673-679.
  2. Radcliffe NM. The drop-free practice: just a dream or a future reality? Ophthalmol Management. 2017;21(Glaucoma Physician March 2017):28,30,32,33.

On the cover: Intraoperative photograph of ab-externo implantation of the Xen gel stent (Allergan), from “The Continuing Evolution of Xen,” page 37.