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Top-ten Optometric Glaucoma Society Annual Meeting
Boston, MA, USA, October 11, 2011
Murray Fingeret, John Flanagan and V. Michael Patella
- Glaucoma as a disease entity may be in the midst of a changing profile. This is related to the general aging of the population with the emergence of a large number of 'very old' individuals and the aggressive treatment of medical diseases that may adversely affect the health of the optic nerve. We currently have no satisfactory treatment options for patients with 'well-controlled' IOPs, particularly for those for whom IOP-independent mechanisms play a major role in disease progression, further IOP lowering is impractical, or may be adverse to the surgical intervention. (Jeffrey Liebmann, New York, NY, USA)
- In order to cure glaucoma completely, stem cell therapy would necessarily replace degenerated retinal neurons and re-establish the visual pathway. Such complete RGC replacement remains a formidable challenge, although there has been progress in integrating transplanted cells into the glaucomatous retina. How-ever, it is also possible that the survival and partial integration of transplanted cells within the retina may provide alternative benefits by enhancing the survival and function of host RGCs. The mechanism of the protective effect is incompletely under-stood but appears to involve release of neurotrophic factors by transplanted cells. (Keith Martin, Cambridge, UK)
- Exfoliation syndrome (ES) has significant ocular consequences including secondary glaucoma and cataract formation. Currently there is no treatment to prevent the build up of exfoliation material in the eye. While there is a genetic component, varying prevalence around the world suggests environmental factors may also play a role. Evaluating three separate cohorts, we found a positive association between latitude and ES risk. The risk appears to relate to exposure to cold and sunlight. (Louis R. Pasquale, Boston, MA, USA)
- Almost all disc hemorrhages occur adjacent to regions of prior structural damage or in areas of progressive structure damage. They appear as linear, splinter-like or flame-shaped areas of bleeding within the retinal nerve fiber layer (RNFL) or optic disc neuroretinal rim. Evidence suggests that they are not just predictive of future progression but also represent ongoing, localized damage to the optic nerve head. (Jeffrey Liebmann, New York, NY, USA)
- The value of the one eye trial, used to initiate or advance medical therapy has recently been questioned. Most of the assumptions on which the one eye trial is based have been found to be incorrect. This includes that IOP fluctuates differently between the eyes and that the diurnal pattern is not consistent day to day. (Robert D. Fechtner, Newark, NJ, USA)
- Keeping retinal ganglion cells alive in glaucoma is necessary but not sufficient to maintain visual function; it is crucial that axons remain healthy and connected to their target neurons. It seems likely that effective neuroprotection of the optic nerve will require a combination of strategies targeting different components of the neuron including the axon and the cell body. Retinal ganglion cells have the capacity to regenerate axons after axonal injury and this can be increased by factors derived from macrophages and glial cells. However, promoting sufficient regeneration to restore visual function remains an enormous challenge. (Keith Martin, Cambridge, UK)
- Although there have been many changes in perimetry through the years, the most common procedure of detecting a small target on a uniform background has remained essentially unchanged for hundreds of years. New innovations and a unique approach for future developments would be useful. (Chris A. Johnson, Iowa City, IA, USA)
- Prospective analysis of lifetime residential history suggests exposure during teenage years is critical to the development of Exfoliation Syndrome (ES). Working over sun or water is also associated with an increased risk of ES and that sunglasses but not hats reduce the risk. These results point to some primary preventative measures, but they must be put in place during the individual's teenage years. (Louis R. Pasquale, Boston, MA, USA)
- Almost every aspect of how we view and manage glaucoma has evolved over the past fifty years. Thus, we all must be both alert to emerging improvements and at the same time observant of ways in which accepted management strategies can and should further evolve. The improvements of the past have come from careful, innovative, and independent thought that challenged - or in some cases validated - accepted dogma. The improvements of the future will likely be achieved in a similar fashion. (Douglas R. Anderson, Miami, FL, USA)
- We especially look forward to further refinements in our ability to identify patients most at risk of developing glaucoma-related visual disability, so that healthcare resources can be better focused upon those most in need. Refinements may come through improved progression analyses, but the really significant changes will likely be driven by improvements in our ability to observe and regulate more basic glaucomatous processes - rather than simply quantifying the damage that those processes have caused. (Douglas R. Anderson, Miami, FL, USA)
