AGS 2025: Telemedicine and genetics for resource-efficient care with Louis R. Pasquale, MD

Louis R. Pasquale, MD, highlighted two patient case studies during a Friday morning symposium at the 2025 American Glaucoma Society Annual Meeting, held from February 26 to March 2 in Washington, DC, emphasizing new approaches to managing glaucoma and advancing clinicians’ understanding of genetic risk factors.

In the first case, Pasquale discussed a patient who developed rapidly progressive primary open-angle glaucoma (POAG) and lost vision in one eye while under the care of another specialist. Despite IOP in the high teens, he initially believed that lowering the IOP to the low teens would halt further progression in the remaining eye. However, progression continued, even with normal clinic measurements. This led to the use of remote tonometry, specifically the iCare HOME device, which allows patients to measure their own IOP at home. Pasquale highlighted that pressures often peak in the early morning hours, revealing unexpectedly high IOP readings of 24 mm Hg in the right eye and 22 mm Hg in the left, which were not observed in the clinic. This finding prompted surgical intervention, illustrating the utility of remote tonometry in detecting pressures that may otherwise go unnoticed during office visits.

In the second case, Pasquale discussed a patient with borderline glaucoma changes, normal IOP, and a family history of glaucoma. He introduced the concept of genetic risk scores for glaucoma, which have proven to be a better predictor than family history. In this case, the patient’s genetic risk score indicated a high likelihood of developing glaucoma, prompting more frequent follow-up. Over time, the patient developed a disc hemorrhage, confirming the need for treatment. Pasquale emphasized research showing that individuals in the highest 10th percentile of genetic risk have a significantly higher chance of developing glaucoma. Genetic risk scoring, currently being refined, could revolutionize early glaucoma detection and management, providing a critical tool for identifying patients who may require surgical intervention.

Pasquale also highlighted that new research on genetic risk scores for glaucoma will be further discussed at the upcoming 2025 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, May 4 to 8, 2025 in Salt Lake City, Utah.