Interventional Glaucoma

When customizing treatment plans for glaucoma patients, selective laser trabeculoplasty (SLT) can be as useful in diagnosis as it is in reducing IOP, explains Inder Paul Singh, MD, FEBOphth.

The 2017 Charles D. Kelman Lecture touched on three main areas-from the teaching of the phaco technique during the early years of phaco to use of phaco in glaucoma patients to the introduction of phaco to surgeons in developing countries.

A prospective, observational study found that eyes with mild POAG could be differentiated from pre-perimetric glaucomatous eyes, which also could be differentiated from normal eyes using OCTA-derived retinal vessel density measurements.

A new imaging technique can show the deaths of individual cells in people with glaucoma by labelling the cells with fluorescent dye, according to researchers. The approach might eventually be used to diagnosis the disease in its early stages or measure its progression.

Prostaglandin-based topical therapy has been the ‘go-to treatment’ for open-angle glaucoma for decades. In contrast, laser trabeculoplasty has conventionally remained reserved for patients unresponsive or unable to adhere to medication-based therapy.

For 20 years I have effectively employed endoscopic cyclophotocoagulation (ECP) as a primary or secondary line of glaucoma treatment. ECP is a minimally invasive glaucoma surgical (MIGS) option capable of reducing IOP in the majority of patients and can potentially eliminate the need for drainage surgery, including trabeculectomy (trab) and glaucoma drainage devices (GDDs).

Despite the legalization of marijuana by several state governments, physicians should not recommend smoking it as a treatment for glaucoma, said Sunita Radhakrishnan, MD. “It has been approved by public opinion rather than regulatory process,” said Sunita Radhakrishnan, MD. 

Reading speed is reduced in patients with glaucomatous visual field loss and normal visual acuity, and the reduction in performance is directly proportional to the extent of the visual field loss, said Aron Guimaraes, MD.

As more state legislatures are relaxing anti-marijuana laws, doctors are being put in the middle by patients requesting prescriptions or authorizations for its use for medical needs, said Marc F. Lieberman, MD.

Research in glaucoma that evaluates the molecular interactions between resident and systemic immune cells and neurons is progressing with the goal of providing translational applications for immunomodulation as a neuroprotective strategy in patients with glaucoma, said Gülgün Tezel, MD.

A glaucoma specialist explores endoscopic visualization for the diagnosis and treatment of uveitic-glaucoma-hyphema syndrome.

Although surgical intervention is not always necessary in eyes with choroidal detachment, drainage should be performed if spontaneous resolution does not occur in order to restore normal anatomy and prevent trabeculectomy failure.

Hydrogel punctal plugs may be a safe and viable method for delivery of anti-glaucoma drugs in the future.

An investigational glaucoma device that shunts aqueous from the anterior chamber to a sub-conjunctival/sub-Tenon’s pouch is being evaluated in a prospective study of 35 eyes operated on at two centers.

A nanophotonics-based device implanted in the eye may one day enable patients with glaucoma to monitor their IOP from home.

Advances in ultrasound biomicroscopy enable the capture of higher quality images to ophthalmic surgeons who seek accurate diagnoses or anatomic measurements.

The "Glaucoma 360 Annual Gala" raises money for GRF research and education. The gala includes a reception, silent and lives auctions, dinner, entertainment, and awards. For a glimpse of the evening's festivities, view the slide show.

The advent of 24-hour IOP monitoring will transform the care of patients with glaucoma and usher in a new era of personalizing IOP.24-hour IOP monitoring set to revolutionize glaucoma research and clinical care.

Increased patients and patient access, new payment models, and the rise of comparative effectiveness research top the list of challenges that ophthalmologists will face in the future, according to William L. Rich, III, MD, FACS.

The search for glaucoma biomarkers is in high gear. Funded by Catalyst for a Cure, the research program has already produced new biomarker candidates and novel techniques that promise to advance research in glaucoma. Research is focusing on ways to diagnose glaucoma early and detect the specific, minute changes that could allow researchers to reduce vision loss.

The availability of technologies for ambulatory IOP measurement will usher in a new era in glaucoma patient management. L. Jay Katz, MD, said the technologies will provide better understanding of IOP and patient adherence to topical medications and to make more timely adjustments in therapy while reducing the number of office visits.

New generation of surgical procedures for glaucoma are being performed with good facility and encouraging safety and efficacy results. Only time will tell whether these techniques will maintain their initial promise and how they impact the treatment for glaucoma.

Intraocular pressure (IOP) is only the starting point for glaucoma treatment. Successful treatment begins with establishing an IOP goal, but there are multiple considerations that affect treatment choices. Robert Stamper, MD, explored the considerations that go into drug selection. None of the factors that should influence drug selection are new, he said, but it is easy to forget that the patient with glaucoma likely has other medical problems and is taking other medications.

Future healthcare reform is not a luxury. Rather, it is a necessity, especially when the performance and costs of healthcare in the United States are considered.

For many years, researchers have suspected and tried to prove a link between glaucoma and dementia, said Yvonne Ou, MD. Definitive answers, however, have been hard to come by. Glaucoma and dementia have several factors in common: both are neurodegenerative, chronic, and progressive diseases that are age-related and cause irreversible neuronal cell loss. They are both becoming a major public health concern as the U.S. population ages.

Value-based medicine analyses have indicated that glaucoma therapy has great patient benefits because it preserves their vision-which positively impacts their quality-of-life (QOL)-and it is cost effective with a high return on investment, according to Gary Brown, MD.

Glaucoma specialists can be advocates for their patients on a number of levels. On a daily basis, ophthalmologists help overcome barriers to treatment and offer solutions to patients for instilling medications, involving family members in their care, organizing services for patients, and providing educational materials, said Cynthia Mattox, MD, New England Eye Center, Tufts University School of Medicine, Boston.

Glaucoma is now in a post-Renaissance period with far superior medications, better lasers, and the potential for individualized treatments for patients, according to Thomas W. Samuelson, MD.

Although generic medications approved by the FDA are identical to the innovator in their active and inactive ingredients, prescribers must be cognizant about sources of problems associated with the use of ophthalmic generic drugs.