advertisement
Highlights from the World Glaucoma Congress
Paris, France, June 29-July 2, 2011
Choka Melamed, Tel Hashomer, Israel
The 4th World glaucoma Congress in Paris was a huge success. It was the best attended international Glaucoma meeting with a record of 3295 participants from 104 countries.
The program contained a variety of educational events with active participation of 300 faculty speakers in didactic lectures, free paper sessions, Courses, Grand Rounds, Surgical video sessions and Industry-sponsored symposia. More than 800 posters, a record number for WGC, were displayed throughout the three days of the meeting.
There was a very special atmosphere of friendship and camaraderie during the meeting. The key-note lecture of our French colleague A. Bron on 'Wine, Glaucoma and Life' fit this wonderful atmosphere very well, adding the special flavor of France and Paris.
On Wednesday morning we had the Glaucoma Societies Symposia, representing colleagues from various countries and regions, which attracted a lot of speakers and participants from all over the globe.
For the first time in WGC history, we had the Glaucoma Surgery Day throughout Thursday in the main Amphitheatre, with excellent talks on a variety of issues related to Glaucoma surgery: When and how to perform Laser Trabeculoplasty and Trabeculectomy, the role of Aqueous Drainage Devices, Novel approaches to Glaucoma Surgery in attempt to be 'less invasive', Cataract and Glaucoma, Angle Closure and Pediatric Glaucoma. This unique event, organized by F. Grehn and R.N. Weinreb, was very well accepted by the audience.
Another first was the session devoted to 'the five best contributions in the last ten years'. The five topics chosen representing Diagnosis, Treatment and Basic Research in Glaucoma were: High Resolution Imaging, Involvement of Brain damage, Animal models of Glaucoma, Drainage devices, and In-vivo visualization of retinal ganglion cells.
The Grand Rounds session was very educative, with five interesting cases chosen by the scientific committee to be presented by young ophthalmologists from Spain, India, Hong Kong and Brazil. A vivid discussion of each case was moderated by C. Baudouin and D. Epstein, with A. Bron, I. Goldberg and R. Susanna as panelists.
There were so many topics presented and discussed which were novel, some of them somewhat provocative, and all triggered a lot of discussion and interest.
In Diagnostics, topics like IOP measurements as an alternative to Applanation Tonometry, improved Imaging techniques, Apoptotic RGC Imaging, etc. were discussed. Reassessment of decision making regarding diagnosis and treatment was debated in quite a few sessions: When to start therapy, How to evaluate glaucoma progression, How to combine structural and functional measurements to improve detection of progression, Risk calculations for progression, etc.
Issues related to Neuroprotection and especially the role of drugs such as brimonidine in the clinical setting were debated. The use of preservative-free drugs also was a hot topic in this meeting, and it was debated whether they should be preferred for long-term use in our glaucoma patients.
Tips and pearls for safer and more effective glaucoma surgery were offered by key opinion leaders with vast experience in the field. Novel approaches, such as High Intensity focused Ultrasound to replace Laser Cyclophtocoagulation, CO2 Laser Sclerectomy, Canaloplasty, Trabectome, I-Stent, Supraciliary Shunts and other 'less penetrating' procedures, were described.
A film festival of fascinating surgical videos, organized by Dennis Lam, was another educational tool with a very high added value.
In summary, the 4th WGC provided a lot of new and exciting information on all issues related to Glaucoma management today. Our hosts, the French Glaucoma Society, organized high-quality sessions in French, allowing many colleagues from French-speaking countries to enjoy the scientific excellence of the meeting as well. It was very encouraging to see the full attendance in all rooms and halls, despite the attractions outside of wonderful Paris in early summer. We are all very grateful to all speakers and participants and we look forward to the 5th WGC in 2013!
American Glaucoma Society Symposium
Arthur Sit, Rochester, MN, USA
IOP Telemetry in Non-human Primates: Initial Characterization of Continuous
IOP at Multiple Time Scales (J. Crawford Downs, Portland, OR)
Intraocular
pressure (IOP) was measured continuously in non-human primates using an
implantable telemetric pressure sensor system adapted to the eye. IOP was
found to fluctuate tremendously, as much as 10 mmHg day-to-day and hour-to-hour,
and up to 45 mmHg second-to-second. This indicates that snapshot IOP measurements
may be inadequate to capture the true dynamic character of IOP in humans.
IOP fluctuations of this magnitude also need to be considered as possible
contributors to glaucoma pathophysiology.
Day and Night Differences in Aqueous Humor Dynamics in Patients with
Ocular Hypertension (OHT) Treated with Latanoprost, Dorzolamide and Timolol
(Carol Toris, Omaha, NE)
Twenty-four hour variations in aqueous humor
dynamics provide important information concerning the mechanisms of action
and the circadian efficacy of glaucoma medications. Day and night aqueous
humor dynamics were measured in ocular hypertensive patients at baseline
and after treatment with latanoprost, timolol and dorzolamide. Neither timolol
nor dorzolamide have significant IOP lowering effect at night, likely due
to the inability to further suppress an already decreased aqueous humor
flow rate. Latanoprost has decreased efficacy at night, likely due to a
physiologic nocturnal decrease in uveoscleral outflow.
Baseline Optic Nerve Topography and Retinal Nerve Fiber Layer Thickness
Predict Visual Field Progression in Glaucoma Suspect and Glaucomatous Eyes
(Mitra Sehi, Palm Beach Gardens, FL)
Baseline optic nerve head (ONH)
topography and retinal nerve fiber layer thickness (RNFLT) were evaluated
as predictors of visual field progression in glaucoma suspect and glaucomatous
eyes. Using multivariate models, confocal scanning laser ophthalmoscopy,
time-domain optical coherence tomography and scanning laser polarimetry
were all predictive of standard automated perimetry (SAP) progression. ONH
and RNFLT abnormalities are useful adjuncts for prediction of subsequent
SAP progression.
Prediction of Risk and Rates of Visual Field Progression in Patients
with Established, Treated Glaucoma (Gustavo De Moraes, New York, NY)
A glaucoma visual field (VF) progression risk model to predict the global
rate of change (dB/yr) and risk of progression (%) was developed and tested.
Multiple regression coefficients were used to deter-mine the role of baseline
(age, central corneal thickness, baseline mean deviation, exfoliation syndrome,
β-parapapillary atrophy) and intercurrent risk factors (disc hemorrhage,
mean and peak IOP, follow-up time) on VF outcomes. These models were effective
in estimating the risk of future visual field progression and may be useful
clinical tools.
Four Year Incidence of Open-angle Glaucoma (OAG) and Ocu-lar Hypertension
(OHT) in Latinos: The Los Angeles Latino Eye Study (LALES) (Rohit Varma,
Los Angeles, CA)
The LALES is a population-based study of primarily
Mexican Americans in Los Angeles. Participants underwent baseline and four-year
follow-up examination and visual field testing. The four-year incidence
of OAG was 2.43%, and for ocular hypertension was 3.53%. The incidence rates
in Latinos are significantly higher than those observed in non-Hispanic
Whites in the first eye.
A Comparison of Visual Function in Patients with Progressive Stages
of Glaucoma Assessed in the Home and Clinic (Anajali Bhorade, St Louis,
MO)
Glaucoma patients often state they have visual difficulties despite
good performance on vision tests in the clinic. Differences in visual function
at different glaucoma stages were tested in the home vs. clinic. There is
progressive decrease in visual function with more advanced glaucoma on all
vision tests and worse visual function in the home vs. clinic for most vision
tests. The decrease in visual function at home may be partially related
to poor lighting conditions.
Treatment Outcomes in the Tube vs. Trabeculectomy (TVT) Study After
Five Years of Follow-up (Steven Gedde, Miami, FL)
The TVT Study is
a multicenter randomized trial comparing Baer-veldt tube implant with trabeculectomy
for glaucoma patients with previous trabeculectomy and/or cataract extraction.
After five years of follow up, tube shunt surgery had a higher success rate
compared with trabeculectomy with MMC, but had similar IOP reduction and
use of glaucoma medical therapy. Tube shunt surgery and trabeculectomy with
MMC are both good options for managing glaucoma in patients with prior cataract
and/or glaucoma surgery.
Change in Intraocular Pressure After Cataract Extraction in the Observation
Group of the Ocular Hypertension Treatment Study (OHTS)(Steven Mansberger,
Portland, OR)
Subjects in the observation group of the OHTS who underwent
uncomplicated cataract extraction were evaluated to determine the change
in IOP after surgery. There was an immediate mean reduction in IOP of 4
mmHg which appeared sustained for about 30 months. Cataract surgery in ocular
hypertension patients appears to effectively reduce IOP.
A Randomized Trial of Brimonidine vs. Timolol in Preserving Visual
Function: Results from the Low-pressure Glaucoma Treatment Study (Theodore
Krupin, Chicago, IL)
The Low-pressure Glaucoma Treatment Study (LoGTS),
a randomized, double-masked, multicenter clinical trial, compared alpha-2-adrenergic
agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol
maleate 0.5% for preserving visual function in low pressure glaucoma. Mean
treated IOP was similar for both medications. However, significantly fewer
brimonidine treated patients had visual field progression by pointwise linear
regression than timolol-treated patients. This suggests that additional
research to investigate IOP-independent disease mechanisms and treatment
possibilities for glaucoma is needed.
European Glaucoma Society Symposium - Regional initiatives in glaucoma
John Thygesen, Copenhagen,Denmark
Development of cooperation with patients associations (John Thygesen,
Denmark)
The World Glaucoma Association (WGA:
www.worldglaucoma.org) has 15
Regional societies (EGS is one of them) and 59 national glaucoma societies
as members around the world. In Europe 30 national glaucoma societies are
members of WGA. The World Glaucoma Patient Association (WGPA:
www.worldgpa.org) is designed to assist
glaucoma patients in managing the disease that is silently stealing the
eyesight of so many patients. Its mandate is to act as an umbrella or framework
to dispense useful information to individuals, health care providers and
support-type bodies that are devoting their efforts to the fight against
glaucoma. Fourteen out of 32 countries in Europe have a National Glaucoma
Patient Organisation (44%).
The next world glaucoma week will be March
11-17, 2012. (www.wgweek.net).
Where glaucoma sits within other health issues in Europe (Augusto
Azuara-Blanco, UK)
There are substantial political, socio-economic
and cultural differences among the different European countries. The western
countries overall have high standards but still have pockets of underprivileged
populations. The central European region has shown a more successful economic
transition than Eastern countries and the standard of health care is often
associated with the level of investment. Although there are a large number
of ophthalmologists they are not evenly distributed. Both state and private
healthcare services are available. To inform this topic, we conducted a
survey among Presidents of National Glaucoma Societies (n = 30) from Europe.
Questions were asked about (1) difficulties for proving care for those with
diagnosed glaucoma; (2) how does glaucoma care compares with other eye diseases
and other chronic conditions; (3) waiting times to see a family doctor/ophthalmologist
and to have surgery, e.g., glaucoma/cataract/hip replacement; (4) whether
asymptomatic people have regular free eye examinations in the community,
and if eye examinations in the community include glaucoma tests; (5) payment
for health care and, specifically, eye care; (6) whether there is social
support (disability benefits, tax relief) for people with visual impairment;
and (7) about public awareness of glaucoma.
From the 23 (76.6%) replies
it was suggested that glaucoma sits equally or favorably within other health
issues in Europe. Policy makers probably recognise the value of investing
for preventing glaucoma blindness.
A regional perspective on genetic studies and biobanks-EGS GlaucoGene
(Ananth Viswanathan, UK)
EGS GlaucoGENE is a Special Interest Group
of the European Glaucoma Society, formed by a consortium of experts across
Europe on glaucoma phenotyping, complex genetics and basic ophthalmic biology.
The aim of EGS GlaucoGENE is to enhance research studies and promote knowledge
concerning multifactorial genetics in glaucoma, which holds great promise
for future advances in glaucoma risk stratification and management.
The
main activity of EGS GlaucoGENE is the development of the European Glaucoma
Society (EGS) Glau-coGENE Project, which is a large scale pan-European genetic
epidemiology research network. Its objective is to create a central database
consisting of genetic and standardised phenotypic information from people
throughout Europe. With the additional com-ponent of proteomics, the database
is expected to become a major resource for future studies on glaucoma genetics.
The EGS Glauco-GENE project is currently the only large multicentre glaucoma-specific
biobank. Unlike previous biobanks, the EGS GlaucoGENE Project focuses on
both detailed and standardised phenotyping and there-fore may be regarded
as an innovative effort in genetic epidemiology.
A feasibility study
for the EGS GlaucoGENE project began in May 2007 and recruitment was completed
at the end of 2008, with the participation of four centres: Moorfields Eye
Hospital, London, UK, Aristotle University of Thessaloniki, Greece, University
of Genoa, Italy and University of Mainz, Germany. The Institute of Ophthalmology,
University College London (UCL), UK, and the University of Mainz are responsible
for handling and storage of biological samples. The University of Copenhagen
will be responsible for the storage of biological data.
EGS Glaucocard project: an online system for patients' data collection
(Marc Schargus, Germany)
The purpose of the European Glaucoma Society
(EGS) Project 'Glaucocard' is to develop an integrated and interconnected
electronic European glaucoma data record.
Although some national glaucoma
related data sets are available, presently no structured cross-national
datasets for documentation and exchange of medical data and disease history
of glaucoma patients exist. Up to now, ophthalmologists and patients have
no possibility to transfer disease history, image or visual field data from
one ophthalmologist to another in a simple, digitalized manner. The team
of Project Glaucocard defined a new standardized digital datasets for glaucoma
patients based on existing standards at a consensus meeting, the finalized
dataset shows now 130 different field variables. The digital data from the
EGS Glaucocard can be used for referrals and to store or forward data for
teleconsultation of glaucoma specialists to optimize glaucoma treatment.
This will hopefully result in an increase of quality in glaucoma care and
will save expenses in health care by unnecessary re-examinations.
Use of IOP-lowering medications: Past, present and future (Hannu Uusitalo,
Finland)
Prostaglandins are now considered first-line, gold standard
therapy for glaucoma in Europe. Fixed combination drugs have been widely
accepted. So far they all contain betablockers. During 2011-2012, several
of the prostaglandins will have generic competition. Compliance continues
to be a primary concern. Despite promising drug delivery options (drug eluting
lenses, subconjunctival injections), safety is primary concern.
Among
novel therapeutics in development: cannabinoids, seratonergics, Rho kinase
inhibitors were mentioned.
Report from the EGS 2010 Madrid Congress (Franz Grehn, Germany)
More than 2000 delegates participated in the EGS 2010 Madrid Congress.
The next EGS Congress will be in Copenhagen June 17-22, 2012 (www.eugs.org).
French Glaucoma SocietySymposium
Eric Sellem, Paris, France
The Ocular Surface in Glaucoma (Ch. Baudouin, Paris)
There
is considerable evidence from experimental and clinical studies that the
long-term use of topical drugs may induce ocular surface changes, causing
ocular discomfort, tear film instability, conjunctival inflammation, epithelial
disruption, corneal surface impairment, subconjunctival fibrosis, and the
potential risk of failure for further glaucoma surgery. Subclinical inflammation
has also been widely described in patients receiving antiglaucoma treatments
for long periods of time. The most frequently used preservative, benzalkonium
chloride (BAK), has consistently demonstrated its toxic effects in laboratory,
experimental, and clinical studies. As a quaternary ammonium, this compound
causes tear film instability, loss of goblet cells, conjunctival squamous
metaplasia and apoptosis, disruption of the corneal epithelium barrier,
corneal nerve impairment and potential damage to deeper ocular tissues.
Indeed, mild symptoms should not be underestimated, neglected, or denied,
because they may very well be the apparent manifestations of more severe,
potentially threatening inflammatory reactions that may later cause major
concerns.
Glaucoma Economics (J.-F. Rouland, Lille)
Direct patient costs
were estimated before and after introduction of prostaglandin analogs. Between
1990 and 1998, direct ophthalmology costs were estimated at € 434 per person
year and between 1998 and 2000 annual direct costs were estimated at € 264
per person. Two main reasons were proposed: fewer surgical procedures and
better persistency with prostaglandin analog drugs.
Risks Factors in OHT and Glaucoma: an exploratory Case Control Study
(J.-P. Renard, Paris)
A nationwide French recruitment has retained
and compared 339 pairs of POAG cases and age-matched controls with OHT.
Cases and controls were matched on IOP levels and differed only with regard
to structural and functional damage of retinal nerve fiber layer and optic
nerve head. In the final multivariate analysis, after adjustment for age,
gender and duration of disease, by comparison with OHT, high-tension POAG
was significantly associated with: thin corneal central thickness (< 510
μm), IOP at diagnosis > 24 mmHg, β-zone peripapillary atrophy, hypercholesterolemia,
more frequent use of pesticides during professional life and with low consumption
of fatty fish and walnuts. These observations report ocular and new environmental
factors and suggest a protective effect of omega-3 fatty acids and a deleterious
effect of professional exposure to pesticides in POAG. They need to be confirmed
with more detailed assessment of dietary intake and professional exposure.
Therapeutic Alliance in Glaucoma: are patients and ophthalmologists
on the same wavelength? (J.-Ph. Nordmann, Paris)
Therapeutic success
in glaucoma depends on adherence which is influenced by the quality of the
physician-patient relationship. The concept of Therapeutic Alliance analyses
the three dimensions of this relation, i.e. 'Goal', 'Task' and 'Bound'.
The assessment of Therapeutic Alliance has been studied for 178 ophthalmologists
and 491 of their glaucoma patients with a self-administrated 'Working Alliance
Inventory' questionnaire composed of 36 items and scored from 1 (low) to
7 (high) according to the degree of agreement. It showed a very high score
both for physicians (217,4) and patients (224), the upper limit being 252.
This means that patients and doctors have a similar view of the goal of
treatment, the task to achieved it and have a relationship of high quality.
Despite this good relation, analysis of the answers concerning adherence
showed that ophthalmologists were not able to determine which of their patients
were adherent or not to the treatment.
Current Data on Ultrasound Glaucoma Treatment (Ph. Denis, Lyon)
Ultrasonic coagulation of the ciliary body using high-intensity focused
ultrasound delivered by a circular miniaturized transducer seems to be a
promising and well-tolerated method to reduce intraocular pres-sure in patients
with refractory glaucoma. A prospective non-comparative interventional clinical
study in 12 eyes of 12 patients with refractory glaucoma and uncontrolled
intraocular pressure (IOP) was undertaken. The duration of each shot was
3 s (group 1: patients 1 to 4), or 4 s (group 2: patients 5 to 12). The
single-step procedure was short (less than two minutes), easy and accurate.
IOP was reduced from a mean preoperative value of 35.6 ± 2.5 mmHg (n = 2.5
glaucoma medications) to a mean postoperative value of 27.9 ± 5.7 (n = 1.8),
27.3 ± 3.2 (n = 3.0) and 27.0 ± 4.9 (n = 2.3) at 1 day, one and six months
respectively in group 1; and from a mean preoperative value of 40.5 ± 13.6
(n = 3.3) to a mean postoperative value of 27.1 ± 16.3 (n = 2.9), 23.9 ±
9.9 (n = 3.3), 23.4 ± 7.0 (n = 3.5) in group 2. No major intra- or post-operative
complications occurred. UBM showed localized and reproducible cystic involution
of the ciliary body and no damages of the adjacent ocular structures.
Glaucoma Society of India Symposium - Glaucoma in the Developing World and Innovative strategies
Harsh Kumar, New Delhi, India
The symposium of The Glaucoma society of India enjoyed a sizable attendance
from both the Indian and foreign delegates. The idea was to discuss the
problems of the developing world and the innovative approaches to the same.
Ronnie George from Sankara Netralaya compared the costs involved in medical
versus surgical treatment for glaucoma in India. He estimated the cost of
surgery to be three times more than medical therapy over a three-year period.
This excluded the costs of cataract which was an inherent problem after
glaucoma surgery. He used average number of medications used per patient
per year to calculate the costs of medical therapy. For surgery, he included
the costs of personnel, equipment, operation theatre costs and those required
for training. During the discussion it was emphasized that we also need
to know the cost efficacy of either treatment modality. Prof Sihota pointed
out that with the Indian Government subsidizing glaucoma surgeries like
it did for cataract surgery in the past, the costs of glaucoma surgery in
public hospitals would reduce further. Dr Harsh discussed that for patients
coming from rural peripheral areas where availability of medications was
negligible, surgery may be the only option irrespective of the cost to the
Govt.
Next Murali Ariga emphasized that in India the non compliance rates
at certain pockets may be as high as 90%. Barriers to adherence and various
factors that influence adherence such as cost, literacy and poor understanding
of the disease were discussed. Unfortunately, there are very few studies
on compliance issues among Indian patients. He pointed to the studies in
the West where different techniques for measuring compliance among glaucoma
patients have been used that have shown poor compliance in as many as 50%
of their patients.
Viney Gupta from the RP Centre stressed that patient
drop outs in developing countries were also higher, especially for chronic
diseases, compared to developed countries. He presented a study from the
RP Centre, AIIMS which showed that patient drop out after trabeculectomy
at three years was as high as 75%. The reason given by the majority of patients
was that they thought surgery was the ultimate cure for glaucoma. Poor socioeconomic
conditions, especially the long travel distances, were major hindrances
for follow up. He pointed out the need for taking into account the socio
economic conditions of the patients apart from others in ensuring proper
follow up and care.
Ramanjit Sihota from the RP Centre showed the prevalence
of different types of glaucoma. She highlighted the growing incidence of
secondary glaucoma especially iatrogenic steroid induced glaucomas in India.
She gave an overview of how technology like internet, mobile phones and
tele-ophthalmology can revolutionize the awareness and management of glaucoma
in India as there is a tremendous growth in these fields.
Manju Pilai
from the Aravind Eye hospital talked on the quality of life issues among
glaucoma patients in the developing world. There are few studies on QOL
among patients with glaucoma in India. One study using utility values showed
substantially low QOL among Indian glaucoma patients compared to the West.
Dr Kymes later alluded to the same study in explaining that Indian patient's
feared blindness more than death. Dr Manju also explained other instruments
that have been used to measure QOL which take into account the disability
the patients face. These instruments are directly related to the severity
of the disease.
Prateep Vyas gave an insight into the costs of blindness
in India. He explained that the lifetime costs of blindness in India could
be amounting to more than a billion dollars. This could have a substantial
effect on the economy especially since there was an increase in the aging
population.
Gowri Murthy described the 'Nayana' Project that they had
under-taken in collaboration with the World diabetes foundation. This was
a mobile van which had equipment for diagnosis and treatment of diabetic
retinopathy and glaucoma. Combining both diseases was found to be cost effective.
She explained in detail how the equipment was loaded and maintained to prevent
wear and tear during long distances of travel around regional India. This
innovative project not only provided diagnosis and treatment to patients
at their doorstep, but also helped train ophthalmologists and update their
skills especially those practicing in remote areas. Sathyan Parthsart from
Aravind Eye Hospital talked of their tele-ophthalmology project which had
been functioning successfully for many years. This project had greatly helped
in training of ophthalmologists and paramedical workers, apart from its
use in diagnostics of glaucoma.
Finally, Steven Kymes from the USA, who
has done some pioneering work in the economics of glaucoma, talked about
the ways economic issues in glaucoma could be dealt with in a developing
economy like India. He stressed the need of making aware the costs and the
issues that affect the blind among the health policy makers. He also emphasized
the need of cost efficacy studies in India, which although are difficult
to model, but would go a long way for assessment of glaucoma scenario for
the health policy makers.
Harsh Kumar, the president of Glaucoma society
of India, and L. Vijaya summarized the lectures. They concluded that a lot
needs to be done in increasing awareness of glaucoma in India, but as India
emerges as a stronger economy, this is the right time to approach the Government
for greater inputs into programs for prevention of blindness rather than
their cure.
The Korean Glaucoma Symposium -New Findings in Glaucoma
Tae Woo Kim, Seonghnam, South Korea
The Korean glaucoma symposium addressed new developments in the diagnostic imaging including the evaluation of ganglion cell complex, retinal nerve fiber layer and anterior segment structures, and three-dimensional visualization of the lamina cribrosa. New candidates for neuroprotective therapy were also discussed.
Perimacular inner retinal layer thickness in glaucoma (Chan Yun Kim)
Studies have reported similar diagnostic power of macular ganglion cell
complex measurement with peripapillary NFL evaluation. GCC measurement may
be useful to detect glaucoma, especially in myopia where proper RNFL thickness
measurement is challenging. Perimacular GCC thickness in normal participants
significantly correlated with old age and long axial length. Analysis of
inner retinal thickness should be interpreted in the context of these findings.
Structure-Function Relationship in central vision in glaucoma (Michael
S. Kook)
We found a significant correlation between the macular ganglion
cell complex thickness (GCCT) and the macular visual field (VF) mean sensitivity
(MS) in glaucomatous eyes. In addition, macular peripapillary retinal nerve
fiber layer also had a significant correlation with macular VF MS with similar
structure-function relationship compared to that of GCCT.
Retinal nerve fiber layer (RNFL) imaging in glaucoma management: Premises,
promises and challenges (Christopher Leung)
With the advent of various
digital imaging technologies, measurement of RNFL thickness has been shown
reliable for early detection of glaucoma and monitoring of disease progression.
There are challenges, however, to interpret RNFL measurements in eyes with
advanced glaucoma, high myopia and age-related RNFL progression. Investigations
on RNFL segmentation failure, variations of RNFL topology, and physiological
changes in normal eyes are eminently needed to address these challenges.
Disc hemorrhage: The incidence and significance (Ki Ho Park)
Disc hemorrhage (DH) is a well-known risk factor for glaucoma progression.
Our recent study including 387 NTG patients and 205 POAG patients has found
that the period prevalence and incidence rates of glaucomatous DHs were
33.3 % and 0.46 ± 0.18 times/year in NTG, and 17.6 % and 0.34 ± 0.23 times/year
in POAG, respectively. This reflects the existence of IOP independent risk
factors in the pathogenesis of DH.
New targets for SD-OCT imaging in glaucoma (Nick Strouthidis)
The application of SD-OCT optic nerve imaging to capture longitudinal
changes in the lamina cribrosa in a monkey model of glaucoma was demonstrated.
This has implications for the early detection of glaucomatous progression
in human subjects. Furthermore, the use of SD-OCT to capture lamina deformation
following acute elevation of IOP in the monkey eye introduces the possibility
of testing ocular biomechanics in vivo.
New algorithm to image the lamina cribrosa (Tae-Woo Kim)
With
the emergence of spectral domain OCT, it became possible to image the lamina
cribrosa in human patients. We reconstructed three-dimensional image of
the optic nerve from the images obtained with enhanced depth imaging using
two algorithms - maximum intensity projection and texture based volume rendering.
These algorithms enable the evaluation of the true 3D configuration of the
lamina cribrosa.
Dynamic changes of anterior segment (AS) parameters in eyes with primary
angle closure (PAC) and open angle assessed by AS OCT (Kyung Rim Sung)
PAC eyes had different characteristics of AS parameters from those of
age-matched open angle eyes but similar response of those AS parameters
according to pupil change. Older eyes had substantially different dynamic
responses compared with young eyes. Change of dynamic behavior of AS parameters
according to aging may be an additional contributor to PAC mechanism on
top of predisposing anatomical condition.
Thinner RNFL thickness in normal tension glaucoma (NTG)(Changwon Kee)
This study verified that patients with NTG may have innately thin RNFL
thickness. This may contribute to the pathogenesis of NTG.
New candidates for neuroprotective therapy in glaucoma (Makoto Aihara)
Among commercially available drugs, alpha-2 agonists and calcium channel
blockers have been found in in-vitro and in-vivo animal studies to have
a strong potential for neuroprotection. Also, anti-oxidative agents, such
as flavonoids may be promising candidates. Still there is no evidence based
on randomized controlled studies, but this is expected to be done in future.
Latin American Glaucoma Society Symposium
Jorge F. Lynch, Beunos Aires, Argentina
Jorge Acosta from Argentina presented a summary of available glaucoma
surgical techniques with its pros and cons.
Ivan Maynard Taveres from Brasiland
Juan Camilo Parra from Colombia showed situations where to implant an Ahmed
valve, how to solve some severe complications following its use and gave
us their recommendation what to do in every case.
Juan José Mura from Chile
explained the different approaches to solve hyperfiltration after filtration
surgery and projected a prognosis of this frequent complication.
Remo
Susanna, representing PAGS, showed his technique of temporary ligation of the GDD
tube by a rip-cord like system with a 6-0 nylon suture and tied strongly
with a 7-0 Vycril, how to flush a previous inserted tube and to use - as
a guide for insertion - an insulin needle into the tube in difficult cases.
Sandra
Saramina from Mexico showed the Dr Félix Gil technique of the Ahmed Implant
with a long, tunnelized insertion of the tube and a fixable plate of only
one stitch, which shows excellent results and very few complications.
Curt
Hartleben from Mexico described the principal features of how to unroof
a Cystic Ahmed Implant bleb and explained why this is so frequently needed.
Guillermo
Barreto Fong from Perú described a two-steps sequential sliding conjuctival
technique to repair a leaking bleb after filtration surgery. It took four
weeks to displace the conjunctiva to the desired position and covert the
leakage.
Juan Carlos Viera dealt with surgical options in the treatment of
chronic angle-closure glaucoma.
