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Top-Five from the Australia and New Zealand Glaucoma Society Annual Scientific Meeting Brisbane, Australia, February 4–5, 2017

Anne Brooks

1. Keith Martin, Cambridge, UK
   Glaucoma beyond IOP (Lowe Lecture)
   We were reminded of the fact that many glaucoma patients progress to visual disability despite careful clinical follow up and treatment. The lecture went on to describe treatments using gene therapy and stem cells that have been successful in reducing retinal ganglion cell loss in animal models of glaucoma and explored their possible application to patients in the future.
   
    
2. Stuart Graham, Sydney, Australia
   Vascular factors revisited
   Several researches were summarized on the role that vascular factors might play in glaucoma pathogenesis and progression. Studies involving nocturnal hypotension and reduced perfusion pressure, effects of longstanding systemic hypertension and vascular dysregulation were discussed. Recent findings included reduced venous pulsation in glaucoma and measuring retinal pulse wave velocity in rodents and human eyes as a marker of arterial stiffness.
   
    
3. Bill Morgan, Perth, Australia
   Longer-term intraocular pressure reduction with XEN microfistula implantation
   Between 2008 and 2011, 23 XEN microfistula implants were inserted into 23 eyes of 21 patients in the initial pilot trial, all of whom were pseudophakic with prior failed trabeculectomy. Four failed in the first three years requiring additional surgery. The remaining have been followed for a median six years with mean IOP 13 ± 3 mmHg and with 53% off medication at final follow-up. Kaplan Meier survival analysis of all data reveals 82% with IOP less than 21 mmHg and 56% with IOP less than 16 mmHg at seven years. The device appears safe long term with good overall IOP control.
   
    
4. Jamie Craig, Adelaide, Australia
   Recent advances in glaucoma genetics
   Knowledge regarding severe mutations in Myocilin, Optineurin and TBK1 was summarized. A population based strategy to identify individuals with mutations in these genes of high penetrance was carried out using the Australian and New Zealand Registry of Advanced Glaucoma. A cascade genetic testing strategy showed this identified carriers at a significantly earlier stage of disease compared with standard ophthalmological pathways.
   
    
5. Fiona C. Pearce, Melbourne, Australia
   Gonioscopy and progression after laser peripheral iridotomy in angle closure disease
   Sixteen percent of primary angle closure suspects (PACS) and 40% of primary angle closure disease (PACD) patients progressed within six years. Thirtyeight percent of both PACS and PACD had a closed angle at eight weeks post- LPI. Neither degree of angle improvement nor persistent angle closure were associated with progression, which supports the notion that angle closure is a multifactorial and dynamic process.