Tag: glaucoma treatment burden

Selected Work in Glaucoma | Dr Shibal Bhartiya

Glaucoma is not simply a disease of elevated eye pressure. It is a chronic optic neuropathy driven by structural vulnerability, mitochondrial dysfunction, metabolic and vascular factors, delayed diagnosis, treatment burden, and the silent accumulation of irreversible optic nerve damage over decades.

The published work of Dr Shibal Bhartiya addresses this broader understanding of glaucoma. Her peer-reviewed research — indexed on PubMed and spanning more than 25 years of clinical and academic practice — examines glaucoma as a long-arc disease requiring stewardship, longitudinal monitoring, individualized risk assessment, and patient-centred care.

This page summarises her key research themes with selected PubMed-indexed publications in each area.

View all indexed publications on PubMed | Google Scholar | ORCID 0000-0002-1947-5474

Research Themes

Glaucoma as a Neurodegenerative and Systemic Disease {#neuro}

Optic nerve damage in glaucoma can continue even when intraocular pressure is controlled. This has driven a significant shift in glaucoma thinking — from pressure reduction alone toward preservation of retinal ganglion cell health, mitochondrial function, and long-term neuronal survival. Published work by Dr Bhartiya in this area explores neuroprotective strategies, the biology of optic nerve aging, and the expanding connections between glaucoma and systemic metabolic disease.

Niacinamide and Neuroprotection: The Glaucoma Holy Grail Bhartiya S. Journal of Current Glaucoma Practice. 2022;16(3):141–143. PMID 36793265 | DOI: 10.5005/jp-journals-10078-1390

This editorial examines the emerging role of niacinamide (Vitamin B3) as a neuroprotective agent in glaucoma. It reviews the evidence linking mitochondrial NAD+ depletion to retinal ganglion cell death, and evaluates whether dietary niacinamide supplementation may slow optic nerve loss independently of intraocular pressure.

Reversing Aging and Improving Health Span in Glaucoma Patients: The Next Frontier? Dada T, Mahalingam K, Bhartiya S. Journal of Current Glaucoma Practice. 2024;18(3):87–93. View on PubMed

This paper positions glaucoma within the science of aging and healthspan. It reviews retinal ganglion cell degeneration as an age-related process and examines emerging strategies — including mitochondrial support, cellular senescence pathways, and anti-aging interventions — for preserving optic nerve health beyond IOP control.

GLP-1 Receptor Agonists, Allostatic Load, and Reframing the Glaucoma Paradigm Bhartiya S, Dorairaj SK. Journal of Current Glaucoma Practice. 2025;19(1):1–2. PMID 41523176 | DOI: 10.5005/jp-journals-10078-1471

Co-authored with Prof Syril Dorairaj (Mayo Clinic, Jacksonville), this editorial argues that GLP-1 receptor agonists — widely used in diabetes and obesity — may offer neuroprotective and IOP-lowering effects in glaucoma through mechanisms including reduced allostatic load, retinal ganglion cell rescue, and mitochondrial protection. It calls for a reframing of glaucoma management to incorporate emerging evidence on systemic metabolic pathways.

Intraocular Pressure, Progression, and Target IOP {#iop}

Lowering IOP remains the foundation of glaucoma management, but IOP is neither uniform across the day nor reliably predictive of individual progression risk. Published work in this area examines the concept of target IOP, the clinical significance of 24-hour pressure fluctuation, and the challenge of managing patients who progress despite apparently controlled pressures.

New Perspectives on Target Intraocular Pressure Clement CI, Bhartiya S, Shaarawy T. Survey of Ophthalmology. 2014. PMID 25081325

This paper critically evaluates existing frameworks for setting target IOP — percentage reduction, predetermined figures, and calculated ranges — and concludes that none have been adequately validated. It argues for individualized, patient-specific target-setting based on structural vulnerability and lifetime disease risk.

24-Hour Intraocular Pressure Monitoring: The Way Ahead Bhartiya S, Gangwani M, Kalra RB, Aggarwal A, Gagrani M, Sirish KN. Journal of Current Glaucoma Practice. 2020. PMID 31915728

Diurnal IOP fluctuation is an independent risk factor for glaucoma progression. This paper reviews the clinical evidence for 24-hour IOP monitoring and its implications for managing patients in whom single time-point clinic measurements may miss clinically significant pressure peaks — particularly those who progress despite apparently normal IOPs.

Minimally Invasive Glaucoma Surgery (MIGS) and Surgical Decision-Making {#migs}

The landscape of glaucoma surgery has changed significantly. MIGS has expanded options for patients and surgeons, but it has also introduced new questions around patient selection, long-term efficacy, and how conventional surgery should now be evaluated and positioned.

Revisiting Results of Conventional Surgery: Trabeculectomy, Glaucoma Drainage Devices, and Deep Sclerectomy in the Era of MIGS Bhartiya S, Dhingra D, Shaarawy T. Journal of Current Glaucoma Practice. 2019;13:45–49. PMID 31564792

This paper examines how trabeculectomy, glaucoma drainage devices, and deep sclerectomy should be assessed against MIGS alternatives — arguing that conventional surgery remains essential for advanced disease while MIGS expands the earlier surgical window for appropriate patients.

Evaluating Glaucoma Surgeries in the MIGS Context Dhingra D, Bhartiya S. Romanian Journal of Ophthalmology. 2020;64(2):85–95. PMID 32685772

A structured review of how glaucoma surgeries should be evaluated for real-world efficacy, highlighting the chronic, asymptomatic nature of glaucoma as a complicating factor in both patient decision-making and meaningful outcome measurement.

Surgical Management of Glaucoma: Evolving Paradigms Shaarawy T, Bhartiya S. Indian Journal of Ophthalmology. 2011;59(Suppl1):S123–130. PMID 21150024

An early and widely cited framework for glaucoma surgical decision-making, co-authored with Prof Tarek Shaarawy (University of Geneva). This paper outlines the core goals of surgical intervention — minimal complications, precise IOP titration, long-term pressure control — and surveys the therapeutic options available to the glaucoma surgeon.

Pars Plana Ahmed Glaucoma Valve Implantation with Triamcinolone-Assisted Vitrectomy in Refractory Glaucomas Dada T, Bhartiya S, Vanathi M, Panda A. Journal of Glaucoma. 2010. PMID 20689206

Original research reporting surgical outcomes of glaucoma drainage device implantation in refractory cases, demonstrating sustained IOP reduction at both 6 and 12 months post-operatively.

GATT: Gonioscopy-Assisted Transluminal Trabeculotomy {#gatt}

Gonioscopy-assisted transluminal trabeculotomy (GATT) is an ab interno angle surgery that removes the trabecular meshwork and inner wall of Schlemm’s canal circumferentially — targeting the primary site of outflow resistance in glaucoma. Published work by Dr Bhartiya examines the evidence base for GATT, its mechanisms, patient selection, and its place within the evolving surgical hierarchy for glaucoma.

Is GATT the Answer? Bhartiya S, Aktas Z, Ichhpujani P. Journal of Current Glaucoma Practice. 2023;17(4):167–168. PMID 38269261 | DOI: 10.5005/jp-journals-10078-1425

This editorial evaluates GATT’s mechanism — circumferential cleavage of the trabecular shelf to open the collector system — and asks whether the evidence supports its expanded use across glaucoma subtypes. It examines both the rationale for GATT’s efficacy and the critical considerations around irreversibility, patient selection, and the downstream consequences of destroying the entire trabecular meshwork.

MIGS, Health Economics, and the Equity Imperative {#migs-equity}

The adoption of minimally invasive glaucoma surgery is not only a clinical decision — it is an economic and ethical one. MIGS devices are expensive, their cost-effectiveness varies across healthcare systems, and access to newer surgical technologies is deeply unequal globally. Published work by Dr Bhartiya addresses this gap directly, arguing that surgical innovation must be evaluated not only for efficacy but for its distributional consequences.

Minimally Invasive Glaucoma Surgeries, Health Economics, and the Moral Imperative of Equity in Glaucoma Care Bhartiya S, Zhang X, Perera S. Journal of Current Glaucoma Practice. 2025;19(3):103–106. PMID 41113786 | DOI: 10.5005/jp-journals-10078-1489

Co-authored with Prof Xiulan Zhang (Zhongshan Ophthalmic Centre, Sun Yat-sen University) and Prof Shamira Perera (Singapore National Eye Centre, Duke-NUS), this editorial makes an explicit ethical argument: that the promise of MIGS cannot be realized if access is determined by economic geography rather than clinical need. It calls for health-economic evaluation frameworks that account for real-world affordability and equity — particularly in high-burden, resource-variable settings across Asia and beyond.

Quality of Life and the Lived Experience of Glaucoma {#qol}

Glaucoma affects far more than measurable visual field scores. Treatment fatigue, fear of progression, reduced mobility, loss of independence, and the psychological weight of a chronic invisible disease all shape how patients live with and manage their condition. Research in this area argues that glaucoma outcomes must be measured not only by optic nerve parameters but by functional independence and daily quality of life.

Weighted Quality of Life in Glaucoma Patients with Advanced Disease Bhartiya S, Ichhpujani P, Kapoor S, Parmar UPS, Singh D, Kumar S. Journal of Current Glaucoma Practice. 2025;19(2):85–89. PMID: 41113687

This observational pilot study (n=37 patients with moderate to severe glaucoma) compared standard GQL-15 quality of life scores with patient-weighted assessments capturing how much individuals actually value each visual domain. Patients prioritized recognizing faces and finding dropped objects — findings with direct implications for how clinicians communicate disability, set treatment goals, and evaluate success.

Patient Centricity and the Ethics of Glaucoma Care Bhartiya S. Journal of Current Glaucoma Practice. 2020;14(2):68–71. PMID 33304063

In a chronic asymptomatic disease with multiple acceptable treatment arms, patient-centred care is not a preference — it is a clinical requirement. This review examines shared decision-making, risk-benefit analysis, adherence, and the ethics of patient participation in glaucoma management.

Complementary Approaches and Evidence Appraisal {#cam}

Patients with glaucoma frequently explore complementary approaches alongside conventional treatment, particularly when progression continues despite controlled pressures. Published work in this area applies scientific scrutiny to alternative strategies without dismissing patient interest in them.

Complementary and Alternate Management of Glaucoma: The Verdict So Far Bhartiya S, Ichhpujani P. Journal of Current Glaucoma Practice. 2014;8(2):54–57. PMID 26997809

This review evaluates the evidence base for complementary approaches in glaucoma — including yoga, acupuncture, and nutritional supplements such as Ginkgo biloba. It argues that future research must evaluate these approaches not only for IOP effects, but for objective structural and functional outcomes including OCT and visual field parameters.

Genetics and Precision Medicine in Glaucoma {#genetics}

The future of glaucoma care includes identifying at-risk individuals before irreversible damage occurs. Published work in this area examines hereditary risk, family screening, and the practical and ethical challenges of translating genetic knowledge into clinical glaucoma counselling.

Bridging Genomics and Practice: Rethinking Genetic Counseling in Glaucoma Bhartiya S, Aggarwal A, Dada R. Journal of Current Glaucoma Practice. 2025;19(4):155–157. View on JCGP

This editorial argues that genetic counselling in glaucoma has not kept pace with the science. It examines hereditary risk patterns, the clinical implications of emerging genomic tools, and how glaucomatologists can integrate predictive medicine into practical, patient-centred counselling without oversimplifying polygenic risk.

Healthcare Systems, Drug Prescribing, and Continuity of Care {#systems}

Glaucoma outcomes are shaped not only by biology and surgery, but by the healthcare systems through which patients are diagnosed and treated. Disruptions in care continuity — from a pandemic, uneven prescribing patterns, or access constraints — translate directly into delayed diagnosis and preventable vision loss.

Glaucoma Drug Prescription Pattern in North India: Public vs Private Sector Hospitals Bhartiya S, Ichhpujani P, Parmar UPS et al. Journal of Current Glaucoma Practice. 2024;18(1):16–22. PMC10997958

The first comparative pharmacoepidemiological study of glaucoma prescribing across public and private hospitals in North India. Findings document significant variation in drug choice, fixed-dose combination use, and generic prescribing — with direct implications for treatment access, cost burden, and long-term adherence in resource-variable settings.

Generics versus Brand-Named Drugs for Glaucoma: The Debate Continues Bhartiya S et al. Romanian Journal of Ophthalmology. 2020;64(3):239–244. PMID 33367157

Glaucoma requires lifelong medication. The cost, efficacy, and side-effect profile of prescribed drugs directly determine whether patients take them consistently. This review examines the clinical implications of generic versus brand-name prescribing, with attention to treatment sustainability and adherence in the Indian context.

Current Glaucoma Practice: The Covid-19 Impact Bhartiya S. Journal of Current Glaucoma Practice. 2020;14(1):1–2. PMID 32581461

Published at the onset of the pandemic, this editorial documents the immediate and structural impact of Covid-19 on glaucoma care delivery — reduced clinic capacity, deferred surgery, and the urgent need to build more resilient systems for chronic disease monitoring and continuity.

Evolution of Glaucoma Research: A Scientometric Review Ichhpujani P, Kalra G, Kaur R, Bhartiya S. Journal of Current Glaucoma Practice. 2020;14(3):98–105. PMID 33867758

A bibliometric analysis mapping the global trajectory of glaucoma research — identifying dominant research themes, most productive institutions, and emerging areas of scientific inquiry across two decades of indexed publications.

Tackling Glaucoma Blindness: A Public Health Perspective {#blindness}

Glaucoma is responsible for a significant proportion of irreversible global blindness. Prevention requires not only clinical excellence but coordinated public health effort — early detection programs, community screening, equitable access to care, and the integration of telemedicine and AI into scalable glaucoma systems.

Current Perspectives in Tackling Glaucoma Blindness Bhartiya S, Ichhpujani P, Wadhwani M et al. Indian Journal of Ophthalmology. 2025;73(Suppl 2):S189–S196. PMID 41113687 | DOI: 10.4103/IJO.IJO_3280_23

This comprehensive narrative review, with Dr Bhartiya as corresponding author from Marengo Asia Hospitals, covers the full spectrum of measures required to address glaucoma blindness. It examines pharmacological innovation, novel drug delivery systems, MIGS, personalized medicine and genetic profiling, lifestyle modifications, telemedicine, and AI integration — alongside community-based detection programs and public health policy.

Editorial and Academic Leadership

Dr Bhartiya serves as Executive Editor of the Journal of Current Glaucoma Practice — the official, PubMed-indexed journal of the International Society of Glaucoma Surgery — and as Editor-in-Chief of Clinical and Experimental Vision and Eye Research (CLEVER).

In these roles she has shaped peer-reviewed discourse on glaucoma diagnostics, surgical outcomes, neuroprotection, chronic disease management, metabolic connections to glaucoma, and the ethics of long-term patient care. She has edited 28 textbooks across glaucoma, perimetry, and ophthalmic surgery, published with Jaypee Brothers, Springer, and other medical publishers.

Academic Profiles

Verified scholarly records are maintained across the following indexed profiles:

Clinical Philosophy

Glaucoma is rarely a single-moment diagnosis.

It is a disease of cumulative risk, silent structural damage, and long-term uncertainty. Most patients retain good central vision for years while progressive optic nerve loss occurs quietly in the periphery. By the time symptoms appear, significant irreversible damage has often already occurred.

The goal of glaucoma management is therefore not simply to lower a pressure number. It is to preserve vision, functional independence, mobility, and quality of life across the lifespan — through early recognition, individualized risk assessment, longitudinal monitoring, and consistent continuity of care.

This is long-arc stewardship. It is the governing principle across the clinical and academic work documented here.

About the Author

This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine. This article was updated in May 2026.

She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.

As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.

Access her work on Pubmed, Google Scholar, ResearchGate and ORCID.

Dr Shibal Bhartiya
Glaucoma • Second Opinion • Advanced Care

www.drshibalbhartiya.com
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Ethical Glaucoma Care

Posted on by Dr Shibal Bhartiya

Glaucoma is a chronic disease that often requires lifelong monitoring and treatment decisions that affect patients for decades. Ethical glaucoma…