Glaucoma Beyond the Drops: A Less-Drops Future
Our own founder and medical director, Dr. Zarmeena Vendal, was recently featured in Ophthalmology Management’s 30th anniversary article on three decades of innovation in eye care — invited as one of just five leaders asked to share where the field is headed next.
Her focus? A more hopeful future for glaucoma patients. If you’ve been managing glaucoma, chances are your day includes at least one bottle of eye drops. For a long time, that was the whole story. But as Dr. Vendal explains, glaucoma care has changed dramatically, and today there are gentle, proactive options that can lower your eye pressure while easing your reliance on those daily drops. Below, we’ve translated her insights into plain language for the patients we care for every day here in Central Texas.
The Future of Vision… Today!
Why drops alone can be a challenge
Eye drops work, and for many people they remain an important part of glaucoma care. But drops ask a lot of you. They have to be taken every single day, often on a strict schedule, sometimes several times a day, for years. Life gets busy. Bottles run out. A missed dose here and there is completely human, but with glaucoma, consistency matters.
There’s another wrinkle that patients rarely hear about: your eye pressure isn’t a single fixed number. It naturally rises and falls throughout the day and night. Doctors call this diurnal variation. A drop taken in the morning may not hold your pressure steady around the clock, which means the disease can quietly make progress in the hours between doses.
As Dr. Vendal describes it, staying on top of daily drops, and the swings in pressure they can leave behind, is one of the biggest ongoing struggles of the glaucoma journey. Modern treatment aims to take some of that weight off your shoulders.
A more proactive approach: “interventional” glaucoma
For decades, glaucoma care often meant waiting, watching, and adding another drop when pressure crept up, saving surgery for later when the disease was more advanced. Dr. Vendal points to a meaningful change in that mindset. Today’s tools are safe and gentle enough that physicians can step in earlier and more proactively, rather than waiting for drops to fall short.
This proactive philosophy is called interventional glaucoma, and it’s the foundation of how we approach care at Westlake. The goal is simple and patient-centered: better, steadier pressure control with less day-to-day burden on you. Here are three of the advances Dr. Vendal highlights.
Three ways glaucoma care is moving forward
1. MIGS — minimally invasive glaucoma surgery
MIGS refers to a family of gentle procedures that help your eye drain fluid more effectively, which lowers pressure. Because they’re minimally invasive, they’re designed to be safer and easier to recover from than traditional glaucoma surgery. Many can be performed on their own or combined with cataract surgery.
Dr. Vendal describes MIGS as a turning point: it brought the safety of glaucoma surgery in line with its effectiveness. That combination gives physicians the confidence to intervene sooner, easing pressure swings and reducing how much a patient has to depend on drops. Dr. Vendal was the first physician in the Austin area to introduce the OMNI® canaloplasty system, and today our team offers the full range of MIGS options.
2. SLT — a quick, in-office laser
Selective laser trabeculoplasty, or SLT, is a brief laser treatment done right in the office. It gently encourages your eye’s own natural drainage system to work more efficiently. There’s no incision, it takes only a few minutes, and it’s well tolerated by most patients.
What makes SLT so appealing, in Dr. Vendal’s view, is that it lifts the burden of treatment off the patient. It directly addresses the challenge of remembering daily drops, and it helps smooth out those around-the-clock pressure swings, which she describes as a win-win.
3. Sustained drug delivery — medicine that works around the clock
One of the newest advances is sustained drug delivery: a tiny implant placed by your physician that releases glaucoma medication steadily over an extended period. Instead of depending on a drop you have to remember, the medicine works consistently in the background. At Westlake, this includes the iDose® TR implant, which can deliver continuous therapy around the clock, and the Durysta® implant, which maintains lower pressure for months from a single in-office treatment.
Dr. Vendal considers this a powerful next step for keeping pressure steady and reducing the daily load on patients. She notes it’s among the safest ways to deliver glaucoma therapy, and one that a wide range of eye surgeons can offer, so more patients in more communities can benefit. Fittingly, she was the first physician in the Austin area to introduce the iDose TR implant.
Where we heard this: Dr. Vendal shared these perspectives as one of five ophthalmology leaders featured in Ophthalmology Management’s 30th anniversary article, “Thirty Years of Innovation and the Future of Ophthalmology.” We’ve paraphrased her clinical insights here for our patients.
The goal: “as dropless as possible”
Tying it all together, Dr. Vendal describes a future where glaucoma practices aim to be, in her words, as dropless as possible. That doesn’t mean drops disappear overnight, or that they’re right to stop for everyone. It means that when it’s appropriate for you, these gentler, more proactive options can reduce how much your vision depends on remembering a bottle every day.
Her larger point is an encouraging one for patients: better, steadier control, achieved earlier, can actually change the long-term path of the disease. A toolbox that’s safe, effective, and easier to adopt gives your care team more ways to protect the vision you have.
Every eye is different
It’s important to know that none of these options is one-size-fits-all. The right path depends on your type and stage of glaucoma, your current pressures, the treatments you’re already using, and your own goals and preferences. Drops still have an important place for many patients, and any change to your treatment is a decision you and your physician make together.
If you’re curious whether a less-drops approach could be part of your care, that conversation starts with a personalized glaucoma evaluation, right here with the team you already know and trust.
Frequently asked questions
Is there a way to treat glaucoma without daily eye drops?
For many patients, yes. In-office laser (SLT), minimally invasive glaucoma surgery (MIGS), and sustained drug-delivery implants can lower eye pressure and reduce, or in some cases replace, the need for daily drops. The right approach depends on your type and stage of glaucoma, and is decided with your physician at Westlake Eye Specialists.
What is MIGS (minimally invasive glaucoma surgery)?
MIGS is a group of minimally invasive procedures that help the eye drain fluid more effectively to lower pressure. They are designed to be safer and gentler than traditional glaucoma surgery, often with a quicker recovery, which allows physicians to treat glaucoma earlier and more proactively.
What is SLT and does it hurt?
Selective laser trabeculoplasty (SLT) is a quick, in-office laser treatment that helps the eye’s natural drainage system work better. It is well tolerated, takes only a few minutes, and can reduce or delay the need for glaucoma drops for many patients.
How do I know which glaucoma option is right for me?
Every eye and every stage of glaucoma is different. The best way to find out which options fit your situation is a personalized evaluation with a Westlake Eye Specialists physician, who can review your pressures, your current treatment, and your goals with you.
Ready to explore a less-drops future?
The Future of Vision… Today!
Schedule a personalized glaucoma evaluation with the Westlake Eye Specialists team and find out which of today’s gentler, more proactive options may be right for you.