Tackling the Toughest: Navigating Complex Glaucoma Cases

Glaucoma management becomes most challenging when disease mechanisms are atypical, comorbidities coexist, and standard diagnostic or treatment algorithms fall short. In these situations—when intraocular pressure is difficult to control and visual function is at risk—clinicians must rely on mechanism-based decision-making supported by advanced imaging, functional testing, and clinical experience.

This expert-led, case-based webinar brings together internationally recognized glaucoma specialists to address real-world challenges across the full disease spectrum, from complex angle closure to advanced glaucoma and IOL selection in patients with progressive disease. The session highlights key clinical considerations across diagnosis, monitoring, and surgical decision-making, including differentiating mechanisms of angle closure, managing glaucoma in the presence of cataract, adapting monitoring strategies in advanced disease, and optimizing IOL selection while balancing visual expectations and long-term disease progression.

After watching this webinar, participants will be able to:

• Identify and differentiate mechanisms of complex angle closure glaucoma
• Avoid common diagnostic and surgical pitfalls in patients with coexisting glaucoma and cataract
• Adapt monitoring strategies when structural and functional tests reach a “floor effect”
• Use CIRRUS OCT and the Humphrey Field Analyzer appropriately across disease stages
• Make informed, patient entered decisions on IOL selection in glaucoma
  

Sahar Bedrood, MD - Decoding Complex Angle Closure Glaucoma

Dr. Bedrood opens the session with a practical exploration of complex angle closure mechanisms, demonstrating why accurate identification of the underlying cause is critical for successful treatment.

She discusses:

• Mechanism based differentiation of angle closure subtypes
• The role of gonioscopy alongside structural imaging
• Recognizing early glaucomatous damage despite apparently “normal” imaging outputs
• Selecting between laser, lens extraction, and filtering surgery based on pathophysiology
  

Matthew Schlenker, MD, MSc - Managing Glaucoma – Cataract as a Comorbidity

Dr. Schlenker focuses on patients with coexisting glaucoma and cataract, emphasizing the importance of diagnosing and staging glaucoma before cataract surgery.

Key topics include:

• Detecting subtle but clinically meaningful defects using CIRRUS OCT and the Humphrey Field Analyzer
• Understanding macular vulnerability and central visual field involvement
• Managing postoperative pressure spikes and surgical risk factors
• Practical considerations for combined cataract–glaucoma procedures
  

Marta Pazos, MD, PhD - Monitoring Progression in Advanced Glaucoma

Dr. Pazos addresses the challenge of monitoring progression in advanced glaucoma, where traditional structural and functional metrics may plateau.

She provides guidance on:

• Functional definitions of advanced disease
• Transitioning to central visual field strategies
  
• Using macular structural analysis when peripapillary measurements reach a floor effect
• Applying trend analysis to distinguish true progression from age-related change
  

Karsten Klabe, MD - Moderator | IOL Selection and Visual Expectations in Glaucoma

As moderator, Dr. Klabe integrates insights across the session and contributes a focused discussion on IOL selection in glaucoma patients, where optical performance must be balanced against long-term disease progression.

His perspective highlights:

• Why contrast sensitivity and central visual field integrity matter more than visual acuity alone
• Appropriate use of monofocal and enhanced monofocal IOLs in mild to moderate glaucoma
• Caution with advanced optics in patients with existing or potential central field loss· Managing patient expectations in a progressive disease

This webinar is designed for glaucoma specialists, comprehensive ophthalmologists and optometrists, cataract surgeons managing patients with glaucoma, and clinicians involved in advanced diagnostics and surgical decision-making.
 

• Introduction (0:00 – 6:12)
  • Karsten Klabe
• Decoding Complex Angle Closure Glaucoma (6:13-27:13)
  • Sahar Bedrood
• Managing Glaucoma – Cataracts as a Comorbidity (27:14-43:23)
  • Matthew Schlenker
• Monitoring Progression in Advanced Glaucoma (43:24-1:02:52)
  • Marta Pazos
    
• IOL Selection and Visual Expectations in Glaucoma and Closing Remarks (1:02:53-1:20:16)
  • Karsten Klabe