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Top-nine of the Australian and New Zealand Glaucoma Interest Group Annual Meeting
February 1-2, 2013, Hobart, Tasmania, Australia
Anne Brooks
- The availability of sophisticated anterior segment imaging modalities, including the anterior segment optical coherence tomography, has enabled the identification and quantification of the various angle closure mechanisms by semi-automated software. Novel risk factors for angle closure have also been identified, including smaller anterior- chamber width, anterior-chamber area and volume; larger iris area, iris thickness and lens vault; and slower speed of pupil constriction. Laser peripheral iridotomy remains the definitive procedure for eliminating pupil block in primary angle closure, but argon laser peripheral iridoplasty has a role in the treatment of acute primary angle closure and in eyes with persistent iridocorneal apposition after laser peripheral iridotomy. Recent genomewide association studies have identified novel genes associated with primary angle closure glaucoma, which code for structural proteins such as collagen and a protein involved in maintaining adherent cell junction stability. (Paul Chew, Singapore)
- If we are to reduce its contribution to global blindness, we need to create efficient, patient-centered models of care with an emphasis on collaboration within well-trained teams of eye care professionals. There needs to be a focus on education, with a progression from traditional education models to the incorporation of competency based education and team training. When establishing eye care programs in developing countries, where there has been little emphasis on detection and treatment of glaucoma, lessons can be learned from the experience in the developed world. The emphasis should be on sustainability, education and quality assurance. (Cathy Green, Australia)
- The advent of genetic testing enables a truly patient-centered, individualized model of medical care focused on disease prediction and prevention. Maria Franchina and colleagues have developed iDG profiler, a tool that allows users to upload their own genetic data to determine their inherited risk of developing glaucoma. This glaucoma-gene risk profiling tool will be available at www.geneyerisk.com. (Maria Franchina, Australia)
- This group had previously presented a rabbit model of glaucoma surgery where the primary endpoint is saline outflow into drainage device capsules at a constant pressure. Extending this model, it was shown that in four-week-old capsules without previous aqueous drainage, the process of measuring outflow resulted in greatly reduced outflow when measured again three days later. The authors concluded that in established rabbit GDD capsules, the mechanical and hydraulic forces involved in outflow measurement induced a tissue response, and that these forces deserve further attention in elucidating their role in wound healing after filtration surgery. (Craig Ross, Australia)
- The ANZGIG meeting was held in Hobart, where the Glaucoma Inheritance Study in Tasmania (GIST) began 19 years ago. With over 75 publications from the GIST, David Mackey ran through the key finding of over 50 papers. He highlighted important findings in glaucoma gene discovery from MYOC to CDKN2BAS and the key of a family history of glaucoma in better management and prevention of the disease. Most importantly, the work of GIST is ongoing with many of the younger researchers who studied with GIST continuing their work in glaucoma genetics research. (David Mackey, Australia)
- BDNF/TrkB signalling is critical for retinal ganglion cell (RGC) function in normal and glaucoma models as evidenced by studies using BDNF heterozygous mice where there was relative loss of STR compared to wild type, and a greater susceptibility to IOP induced damage. A natural flavanoid 7,8-Dihydroxyflavone (DHF) is a potent BDNF mimetic and TrkB agonist, and demonstrated a neuroprotective effect with significantly preserved structure and RGC function in an ocular hypertensive rat model. (Stuart Graham, Australia)
- A method for detecting visual field progression was developed using a structural/functional understanding of adjacent optic disk regions to identify adjacency weightings for adjacent field loci. One thousand four hundred forty-eight fields from 194 eyes taken over three years were fitted to an iterating Bayesian model incorporating average sensitivity trend over time with spatial adjustment of trend and influence of adjacent loci. This technique reduced field noise and found 42% progression, the closest to the 25% detected by clinicians and had the highest ROC area (0.69) compared to any of the standard linear regression techniques. (Bill Morgan, Australia)
- Peter described work from his team to develop a patient-reported Glaucoma POEM (Patient-generated Outcome and Experience Measure). He described the qualitative research methodology used to develop this tool, starting from an interactive forum between patients and health professionals - the UK National Glaucoma Think-Tank. The Glaucoma POEM contains six questions covering both PROM and PREM domains and is under current evaluation in clinical practice. (Peter Shah, UK)
- The presentation described use of a novel sequential hyperspectral imager to undertake retinal intra vascular oximetry. The imaging technique and image analysis was detailed, and examples of retinal oximetry maps from normal volunteers were presented. The normal group was compared with a small group of patients with asymmetrical glaucoma. Whilst there was no significant difference in the levels of retinal arteriolar oxygen saturation between normals and glaucoma, there were statistically higher levels of venous oxygen saturation in the glaucoma eyes. Those glaucoma eyes with the more marked visual field damage had the highest recorded venous saturation. The authors speculated that the higher levels of venous saturation in the glaucoma eyes might reflect reduced oxygen utilization in the damaged inner retina'. (Andrew McNaught, UK)
