How can we best help our glaucoma patients manage this lifelong disease by lowering intraocular pressure (IOP) while preserving a good quality of life and maintaining the natural physiology to delay progression
and leave room for future treatments? This is a big ask. But these goals are now possible with the available range of interventional therapies.

Specifically, we are now looking at how traditional treatments that reduce aqueous volume or alter outflow can influence both clinical outcomes and the natural course of the disease. The production and outflow of aqueous humor serves many functions, such as maintaining IOP and the shape of the eye; nourishing avascular tissues such as the trabecular meshwork (TM), cornea, and crystalline lens; removing waste products;
and transporting vitamin C to the anterior segment for antioxidant protection.

About 90% of aqueous humor outflow occurs through the trabecular pathway, which includes the TM, Schlemm’s canal, collector channels, and the aqueous and episcleral veins, where it mixes with blood. The other 10% follows the secondary route through the ciliary muscle, supraciliary and suprachoroidal
spaces, and orbital vessels or vortex veins (uveoscleral pathway).

If we make it a goal of therapy to preserve physiologic aqueous outflow through the trabecular pathway, then we preserve the anatomy responsible for 90% of aqueous outflow. At the recent American Academy of Ophthalmology meeting in Orlando, I sat with two of my colleagues to discuss why this is important
and how we’re using current methods to maintain physiologic aqueous outflow.

By: I. Paul Singh, MD; Shivani Kamat, MD; Jessica Steen, OD, FAAO, Dipl ABO.