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Top-Seven Optometric Glaucoma Society Annual Meeting

October 23, 2007, Tampa, Florida

Murray Fingeret, Brooklyn Vincent Michael Patella, Dublin

The Sixth Annual Scientific Meeting of the Optometric Glaucoma Society honored the many accomplishments of Paul Kaufman, MD. David Greenfield, MD delivered the President's lecture. The entire proceedings from the meeting will be available at the OGS website

1. In human primary open-angle glaucoma (POAG) as well as in animal models, significant amounts of tissue partially or completely obstruct openings between Schlemm's and the collector channel canals. (Thomas F. Freddo, Waterloo)
2. Inconsistencies in data presentation may have exaggerated differences between whether structural (optic nerve, retinal nerve fiber layer) or functional (visual field) changes are the initial signs of glaucomatous damage. (William M. Swanson, Bloomington)
3. There may be a relationship between loss of accommodation and the development of glaucoma. According to this theory, accommodative motion of the ciliary muscle constantly jiggles the TM, perhaps allowing for freer passage of aqueous fluid, pigmentary cells, extracellular materials, etc. (Paul Kaufman, Madison)
4. Some patients may have a greater ability than others to compensate for IOP-related bloodflow reductions. In most tissues of the body, autoregulatory dilation and contraction of blood vessels is confined to the pre-capillary arterioles or precapillary sphincters. Since these structures do not exist in the optic nerve head,, capillaries may play an active autoregulatory role. Studies of pericytes (the contractile cell that surrounds capillaries) show responsiveness to oxygen tension, carbon dioxide, and adenosine, which reflect the momentary metabolic need, and these responses show the potential for regulating capillary blood flow. Individual variation in the capacity for autoregulation (which can change with age, blood pressure, variations in vascular physiology, etc.) may account for varying susceptibility to the challenge of IOP to optic nerve head circulation. When it becomes possible to make individual assessments of autoregulatory capacity in the optic nerve head, it may help identify those most at risk of developing glaucomatous damage from elevated IOP. (Douglas R. Anderson, Miami, FL)
5. Despite many improvements, the popularity of trabeculectomy is in decline. Surgeons are increasingly opting to use drainage implants, and laser trabeculoplasty in the form of selective laser trabeculoplasty (SLT) is gaining ground. A recent multi-center randomized clinical trial comparing glaucoma implant surgery to trabeculectomy with mitomycin C reported its one-year results. Drainage implants were more likely to maintain intraocular pressure control and avoid hypotony and reoperation for glaucoma than trabeculectomy. Both procedures had similar rates of serious complications. A number of new glaucoma operations are now under development and evaluation, but no clear winners have yet emerged. (Steven J. Gedde, Miami, FL)
6. Many promising new drug therapies are under investigation, a number of which may be closer to clinical availability than might be imagined. Latrunculins, which are extracted from a species of sponge that lives in the Red Sea, inhibit the assembly of actin filaments. In monkey models actin filament inhibition causes a dramatic decline in intraocular pressure through enhanced TM outflow. In the area of neuroprotection, knowledge of the mechanisms of neuronal death is now sufficient to envision glaucoma therapy directed at preserving retinal ganglion cells and more. Finally, posterior segment drug delivery using nanoparticles, encapsulated cell technology (ECT) and other innovative strategies continue to evolve. (Paul K. Kaufman, Madison, WI)
7. Compliance: One goal of medical therapy is to reduce the number of dosages the patient is responsible for administering, while achieving a "target IOP". Research shows a direct relationship between number of required drug applications and likelihood of missing a dose. The perfect therapy is useless unless the patient takes it, and we all know compliance rates among patients suffering from glaucoma and other diseases can be poor. (Richard Parrish, Miami, FL)