When I sit back and look at the many articles printed over the years in Glaucoma Physician, I’ve always felt that we approach glaucoma from every possible angle—diagnostics, surgery, lasers, pharmacotherapy, and even practice management. That said, many of the innovations we have covered over the past decade have centered around minimally invasive glaucoma surgeries (MIGS) and interventional glaucoma. MIGS, and particularly trabecular MIGS, has enjoyed a period of meaningful iterative innovation.
But maybe it is time to step back and ask: What revolutions could come next for our field?
For inspiration, I often reflect on what my patients ask of me. By far, the most common request from patients is for a way to reverse glaucoma damage. Neuroprotection—and yes, you can classify IOP–lowering therapy within that broader category—would be enthusiastically welcomed by patients and physicians alike. I suspect patients are asking for pills that would provide neuroprotection, and would welcome any therapy (procedural or otherwise) that could provide neuroregeneration.
If you were to ask experienced glaucoma surgeons what would make their lives easier, a nontoxic antifibrotic agent would likely top the list. Such an innovation would enhance the success of so many of our procedures.
And while many eye doctors might lament that we don’t need “another drop,” it’s worth noting that there is emerging interest in topical agents capable of lowering episcleral venous pressure—a development that could meaningfully expand our therapeutic toolkit. Check out Dr. Douglas J. Rhee’s article on the topic in this issue.
All of this got me thinking about how a field transitions from incremental advances to paradigm-shifting breakthroughs. I believe serendipity often plays a pivotal role. Serendipity brought prostaglandin analogues, beta-blockers, pilocarpine, and even acetazolamide to glaucoma. Each originated outside glaucoma—even outside ophthalmology—before finding its home in our specialty.
So I’ve come to the conclusion that if we are to discover the next big leap in glaucoma treatment, we must once again make space for serendipity. I don’t suppose it’s something you can quite do on purpose, but maybe, without trying, we can all go out there and make some accidental discoveries? GP
