Optimizing Treatment Strategies for Glaucoma Beyond First Line - Episode 14

How Will the Glaucoma Treatment Landscape Evolve in Coming Years?

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Shared insight on how the use and sequencing of therapies for glaucoma will evolve in coming years.


Neil Minkoff, MD: Where do we see glaucoma therapy going in the next 24 to 36 months, due to treatment paradigm changes, new medications, things like that?

Nathan Radcliffe, MD: We have most of the amazing technology here, and you’ll see doctors adopting it. Remember, it’s the comprehensive ophthalmologists who are treating most of the glaucoma. Only 15% of patients with cataracts who are eligible for MIGS [minimally invasive glaucoma surgery] are getting MIGS right now. That should grow, it should grow significantly, and that will be a big impact. It will be a big benefit to patients; it will be a big cost to payers. Those things will happen together. We did see a big price cut on stents from Medicare, about a 66% reduction in payment. That will shift things away from stents, I’m guessing, toward other procedures—goniotomy and canaloplasty. But still the utilization will grow. Laser is going to be growing. Sustained delivery’s day may be a few more years away. That may be the next wave after 2 or 3 years of robust growth, and pending even better technological improvements in that space.

Terri-Diann Pickering, MD: The MIGS adoption needs to grow and will spread. The SLT [selective laser trabeculoplasty] as initial therapy is also going to be more widely adopted over the next couple of years, especially with the LiGHT trial data.

Neil Minkoff, MD: Payers, are we going to change the way we manage this, or how do we incorporate the medical and the pharmacy?

Kevin Stephens, Sr., MD: What we do, we have our expert panels, and then we have a P&T [pharmacy and therapeutics] review committee, and policy review. Every quarter we have a meeting with our providers to try to figure out how do we update and stay abreast with the medical science. And I have to say, that’s the big question here, a lot of times we use the FDA approval as a yardstick, but we also have our expert panels in the field, so we try to go along with the standard of care. I see this effort. Medicine is constantly evolving, and we can’t be like dinosaurs because we’ll become extinct. We have to look at the data. That’s the key issue, do the data show efficacy and utility? Many times we don’t have the data to support it, and we will then classify it as experimental, investigational, and we wouldn’t cover it. The key is to let the data guide the authorization and utilization.

Maria Lopes, MD, MS: Often in the real world, we simply lack comparative data. Over time, having that would be good, so that even if something is higher cost, it justifies why payers perhaps should have a less onerous process, or maybe fewer steps, if we understand the cost of failure and what we’d otherwise be paying for. It’s also a great opportunity for best practices. We think about treatment pathways and other areas, including oncology. It’s a great opportunity as we learn more about not just new treatment options, but a lot of the things you brought up, which is how should they be sequenced in a best practice approach.

Transcript edited for clarity.