ASCRS 2025: Deb Ristvedt, DO, on medications, lasers, and lifestyle in glaucoma management

Deb Ristvedt, DO, moderated a session titled Medications, Lasers, and Lifestyle, highlighting the rapid evolution of glaucoma treatment paradigms at the 2025 American Society of Cataract and Refractive Surgery annual meeting, held April 25 to 28 in Los Angeles, California.

“This space is so exciting because it's rapidly changing and our mindset is changing,” Ristvedt said. “We're going less drops. We're going earlier in the angle.”

The session emphasized a shift toward earlier intervention and longer-term control to minimize visual field loss. Drug delivery advancements were a central focus. Doug Rhee, MD, presented data on the sustained effects of medications at the trabecular meshwork, noting mechanisms that continue to act even beyond their expected duration. “We have medications in terms of drug delivery that now have more concentration in the eye and provide more stability of IOP 24 hours a day,” Ristvedt highlighted.

Laser therapy is also seeing transformative developments. The discussion revisited the LiGHT trial’s impact on positioning SLT as a first-line treatment. However, new attention was given to direct SLT—a next-generation modality delivering energy translimbally in just 2.6 seconds. “It works through the limbus targeting the trabecular meshwork… getting around the same results as manual SLT,” Ristvedt explained. A key advantage? It eliminates the need for a gonio lens, improving both patient experience and surgeon ergonomics. “It looks like less arching of our bodies. It looks like better setup and better ergonomics.”

Finally, the session examined lifestyle considerations—for both patients and providers. “Our lifestyle is so important when we think about holistically how we're affecting quality of life,” Ristvedt emphasized, underscoring the session’s broader call for sustainable, patient-centric glaucoma care.