April 20, 2018 Conference
Is it better to mitigate disease risk or surgical risk? It cuts both ways. Treating the disease aggressively, with hightly efficacious surgical management will mitigate disease risk as a low IOP is often achieved. Yet, in doing so, the patient is subjected to signficant surgical risk. Conversely, a much safer, less efficacious procedure lessens surgical risk, but may not adequately lower IOP, thus subjecting the patient to increase disease risk.
The traditional offerings for surgical management of glaucoma such as trabeculectomy and tube shunts have considerable risk, at times far exceeding disease risk. The era of perfoming trabeculectomy for those at lower risk for true function impairment from glaucoma are waning. The contemporary glaucoma surgeon offers a portofio of procedures, each with a unqiue risk benefit profile that may be matched to the disease risk faced by individual patients. Level of IOP control, target IOP, likelihood of progression, life expectancy, coagulation status, compliance and tolerance of medications, status of the native lens, availablility for postoperative care, status of the fellow eye, and prior surgical history are all variables that should be considered when selecting a procedure for each unique patient. This discussion will address decision making in glaucoma surgery.
“Surely intelligence wasn‘t enough; moral clarity was needed as well. Somehow, I had to believe, I would gain not only knowledge but wisdom, too.” Paul Kalanithi, M.D. “When Breath Becomes Air” (1)