Which of the following is listed as a second-line POAG treatment?

• A. MIGS
• B. SLT
• C. Shunt sx
• D. All of the above

Answer: (D)

When first-line medical therapy doesn’t achieve the target intraocular pressure, clinicians turn to second-line options that offer additional IOP reduction with varying levels of invasiveness. MIGS provides a minimally invasive way to lower pressure and is often considered after medications or alongside cataract surgery. SLT uses laser energy to improve outflow through the trabecular meshwork and can be chosen when meds aren’t sufficient, serving as an intermediate step between ongoing drug therapy and more invasive procedures. Shunt surgery represents a traditional filtration approach reserved for patients with inadequate control after medical and laser options or with more advanced disease. Since each of these modalities can be employed after initial therapy to reach the desired IOP, all of them are considered second-line treatment options.