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Top-Nine of the American Glaucoma Society Annual Meeting
February 28 - March 3, 2013, San Francisco, CA, USA
Arthur Sit
The American Glaucoma Society (AGS) Annual Meeting featured ground-breaking research from AGS members across the United States and Canada.
- Comparing the Rate of Rim Area Change in Eyes with Visual Field and Optic Disc Endpoints: The Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study The rate of rim area loss was analyzed for eyes of ocular hypertensive patients enrolled in the CSLO Ancillary Study to OHTS who developed primary openangle glaucoma endpoints. The rate of rim area loss was approximately twice as fast in eyes with optic disc endpoints compared eyes with visual field endpoints and eyes with Optic Disc Reading Center change only. These results suggest that measuring the rate of structural change can provide important clinical information, but does not replace visual field testing. (Linda M. Zangwill et al., USA)
- Deformation of The Non-Human Primate (NHP) Optic Nerve Head (ONH) Connective Tissues within 3-D Histomorphometric Reconstructions of Moderate and Severe Experimental Glaucoma (EG) Eyes Optic nerve head (ONH) tissue from non-human primates (NHP) with experimental glaucoma were serial sectioned and reconstructed in 3D computer models. Global posterior deformation of the ONH and thickening of the lamina cribrosa was detected in these eyes. In contrast, lamina cribrosa is thinned in eyes with severe disease. This suggests that lamina cribrosa thickening occurs early in disease, but thinning occurs as the neuropathy progresses. (Ruojin Ren et al., USA)
- Long-term Surgical Risks Of Trabeculectomy In The Collaborative Initial Glaucoma Treatment Study Long-term post-operative complications in patients randomized to trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS), including time-related probability of endophthalmitis, blebitis, and hypotony were estimated using Kaplan-Meier analyses. The risk of blebitis and hypotony was each 1.5% at five years, and the risk of endophthalmitis was 1.1% at five years. Anti-metabolite use (5-fluorouracil) was not associated with a greater risk of bleb-related complications. The low incidence of complications supports the use of trabeculectomy when surgically-induced low IOP is necessary. (Paul R. Lichter et al., USA)
- The Cost Of Glaucoma Care Provided To A Sample Of Medicare Beneficiaries From 2002-2009 Payments for glaucoma care among Medicare beneficiaries from 2002 to 2009 were estimated from a 5% random subsample of Medicare billing information from the years 2002, 2006 and 2009. Data were collected from the carrier, outpatient hospital, inpatient hospital and beneficiary summary files. In 2009, office visits comprised nearly one-half of glaucoma-related costs, diagnostic testing was about one-third, and surgical and laser procedures were about 10% of costs each. The non-glaucoma eye care for glaucoma patients was 67% higher than that for glaucoma care. From 2002 to 2009, glaucoma care costs per person per year rose from $197 to $228, less than 1/200th of all Medicare payments, and increasing at less than the rate of general or medical inflation. (Harry A. Quigley et al., USA)
- The Ocular Hypertension Treatment Study: Difference in the Effect of Long Term IOP Variability on the Risk of Developing POAG Baseline and follow-up IOP in participants randomized to observation (OBS) and topical ocular hypotensive medication (MED) in the Ocular Hypertension Treatment Study (OHTS) were analyzed to determine if the risk of developing POAG is increased by higher long-term IOP variability. Measures of variability included standard deviation (SD), maximum IOP, range, coefficient of variation (CV) and percent change. In the OBS group, none of the measures of IOP variability increased the risk of POAG. In the MED group, SD (HR 1.21, p = 0.024) and CV (HR. 1.19, p = 0.045) independently increased the risk of developing POAG. (Mae O. Gordon et al., USA)
- Prospective Randomized Study Comparing ExPRESS to Trabeculectomy: 1 Year Results Patients with open-angle glaucoma scheduled for filtration surgery were prospectively randomized to standard trabeculectomy or ExPRESS, both with MMC. The mean baseline IOP decreased from 22.6 ± 10.2 and 22.0 ± 6.8 to 11.0 ± 5.5 and 10.0 ± 4.5 at one year in the ExPRESS (n = 31) and Trab (n = 30) groups respectively (p < 0.0001). There was no significant difference in IOP between ExPRESS and Trab groups at any time point. As well, there were no significant difference in the rate of complete or qualified success, number of patients using glaucoma medications, final visual acuity, complications, or additional procedures. Visual acuity recovery was faster in the ExPRESS group. (Yvonne M. Buys et al., Canada)
- Nerve Fiber Layer and Ganglion Cell Complex Measurements by OCT as Risk Factors for Visual Field Progression in Glaucoma Data from perimetric glaucoma patients enrolled in the multi-center longitudinal Advanced Imaging for Glaucoma Study were analyzed to determine whether optical coherence tomography (OCT) anatomic measurements are useful in predicting the development of glaucomatous visual field defects. The most significant risk factor for visual field progression was ganglion cell complex thickness, measured using Fourier-domain OCT (HR = 1.16, per 1% higher, p = 0.004), based on Cox proportional hazard models. This provides a potential parameter, in addition to nerve fiber layer thickness, that can be used for assessment of glaucoma progression. (Xinbo Zhang et al., USA)
- Large and Sustained Blood Pressure Dips Are Associated with Visual Field Progression in Normal-Tension Glaucoma The nocturnal fall in mean arterial pressure (MAP) was analyzed as a risk factor for progressive visual field (VF) loss in normal-tension glaucoma (NTG). NTG patients with reproducible glaucomatous VF defects were included, and ambulatory blood pressure (BP) monitoring was performed at six-month intervals, with measurements every 30 minutes for 48 hours. The total time that the MAP during sleep was below the daytime mean was a significant predictor of subsequent VF progression (p = 0.022) in multivariate analysis. This suggests that 24-hour BP monitoring may be useful in NTG patients. (Carlos Gustavo De Moraes et al., USA)
- A Prospective Randomized, Multicenter, Single-masked, Parallel, Dose Ranging (VOYAGER) Study to Compare the Safety and Efficacy of BOL-303259-X to Latanoprost in Subjects with Open Angle Glaucoma or Ocular Hypertension BOL-303259-X is a nitric oxide donating prostaglandin F2α agonist. Following randomization, 413 eligible subjects with a diagnosis of open-angle glaucoma or ocular hypertension were assigned to one of five treatment groups: BOL-303259-X 0.006%, 0.012%, 0.024%, 0.040% or latanoprost 0.005% ophthalmic solutions. After 28 days of once-daily treatment, mean diurnal IOP reduction in the BOL-303259-X 0.024% (9.0 mmHg; p = 0.0051) and 0.040% (8.9 mmHg; p = 0.0089) treatment groups was greater than in the latanoprost group (7.8 mmHg); on Day 29, a greater mean diurnal IOP reduction was still observed in the BOL-303259-X 0.024% group (7.20 versus 6.25 mmHg, p = 0.0505) compared to latanoprost. Conjunctival hyperemia was similar across all treatment groups. These results indicate that BOL-303259-X is a safe and effective IOP-lowering agent, with greater IOP reduction than latanoprost with the 0.024% concentration, while retaining a similar side effect profile. (Robert N. Weinreb et al., USA)
