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Top-Ten Australia and New Zealand Glaucoma Interest Group Scientific Meeting
Melbourne, Australia, March 2008

Anne Brooks

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1. The Gillies Lecture: The Glaucoma Inheritance Study in Tasmania (GIST) has identified: that a family history is present in 60% of glaucoma cases; that 27% of members of large glaucoma families were unaware of their family history of glaucoma; and that familial glaucoma is more severe than sporadic glaucoma. Myocilin mutations account for 3% of Primary Open-Angle Glaucoma, with genotype-phenotype correlations. The Gln368Stop is mild, Thr377Met & Gly252Arg intermediate and Pro370Leu severe in relation to age of onset, maximum recorded intra-ocular pressure (IOP) and need for surgery. To identify the other genes associated with glaucoma, normal twins were examined in the Twins Eye Study. A high heritability of IOP and Cup to Disc ratio and confounding factors such as Central Corneal Thickness, Disc area, refraction and AL was identified. A gene locus associated with AL on chromosome 5 was also identified. Recently, the LOXL1 gene was associated with XFS. Identification of further genes will improve our understanding of glaucoma and allow cascade genetic screening. (David Mackey, Hobart, Australia)
2. While several studies have shown that existing diagnositic techniques particularly imaging technologies can provide additive information to the current clinical assessment in suspect cases, the results of testing require interpretation within the context of the clinical exam. While studies have indicated promise in the prediction of the development and progression of glaucoma, defining the optimal algorithms that can best define progression remains elusive. (Christopher Girkin, Birmingham, AL, US)
3. Avastin has a direct effect on cultured Tenon's fibroblasts. Addition of avastin to culture media led to a significant reduction in cell proliferation and fibroblast mediated collagen gel contraction and induced fibroblast death through non-apoptotic mechanisms. (Queena Qin, Melbourne, Australia)
4. The sensitivity of the mfVEP in glaucomatous eyes can be improved by modifying the test stimulus to target specific visual pathways of low redundancy (slow blue on yellow for parvo, and fast low luminance achromatic for magno), and by using binocular simultaneous recording to improve inter-eye asymmetry measures. (Stuart Graham, Sydney, Australia)
5. Creatine is a bioenergetic compound which can attenuate neuronal loss in experimental neurodegenerations. The effect of creatine as a neuroprotectant against in vivo excitotoxicity-induced retinal ganglion cell (RGC) injury was assessed using immunohistochemistry. Creatine provided marked structural protection of the RGCs and warrants further investigation. (Robert Casson, Adelaide, Australia)
6. In glaucoma subjects after beginning IOP-lowering therapy, the force required to induce vein pulsation fell from mean 55 g to 26 g and IOP fell from mean 25 mmHg to 17 mmHg over 11 months. This suggests that IOP lowering may alter retinal vein flow properties. (Bill Morgan, Perth, Austalia)
7. Following standard Mitomycin Trabeculectomy, deep scleral tissue was obtained from five eyes and assayed for MMC by high performance liquid chromatography and mass spectrometry. All specimens contained MMC in amounts 0.67 to 6.0 ng with some correlation to concentration of solution. It is proposed that MMC retained in scleral tissues continues to be released over a prolonged period, accounting for prolonged effect of MMC Trabeculectomy. The wide variations in concentrations indicate a need for more precise techniques of application. (Robert West, Melbourne, Australia)
8. In the longitudinal multicenter African Descent and Glaucoma Evaluation Study (ADAGES) structural and functional differences in the optic nerve in individuals of West African and European ancestry and the effect on the detection of glaucoma and progressive glaucomatous disease were evaluated. Initial findings have confirmed the larger neural canal in individuals of African descent and also found significant differences in RNFL thickness and a deeper cup in these individuals. The impact of these differences on glaucoma detection strategies was discussed along with their potential impact on the biomechanical behavior of the optic nerve. (Christopher Girkin, Birmingham, AL, US)
9. The role of the LOXL1 gene in a population-based cohort had been investigated and two variants were found to be strongly associated with pseudoexfoliation. Other as yet unidentified factors are likely to also influence the phenotypic expression. (Alex Hewitt, Melbourne, Australia)
10. While in general the newer surgical techniques (trabectome, SOLX shunt, trabecular bypass shunts, standard shunts, express shunt, viscocanalosomy, endoscopic laser, and canaloplastly) may have fewer complications, they appear to have a lower efficacy than conventional trabeculectomy. However, more comparative trials are needed. Techniques that preserve superior conjunctival are preferred as they conserve this region for future trabeculectomy. Additionally, several recent advances in trabeculectomy technique have increased the safety of this procedure. (Christopher Girkin, Birmingham, AL, US)