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WGC-2017 Highlights
Selection by Willie Nolan
Effect of co-morbidity + glaucoma
Simon Skalickypresented on the “Effect of co-morbidity + glaucoma”. He discussed the impact of ocular surface disease and demonstrated that there is a reduction of Quality of Life with increasing number of eye drops in patients with glaucoma. Glaucoma patients with co-existing cataract report worsening activity limitation at all glaucoma severity levels and it is important for clinicians to consider cataract surgery and its benefits in glaucoma patients. Finally he reported the results of a randomized controlled trial of patient centered education and counseling in newly diagnosed glaucoma patients. This intervention resulted in lower self-reported anxiety levels compared with the control group who received standard management.
Measuring QOL in glaucoma studies
Ecosse Lamaroux’s presentation “Measuring QOL in glaucoma studies” was given by Mani Baskaran.
A case-control study using psychometric analysis attempted to measure the impact of glaucoma-related reduction in visual acuity and visual field on psychosocial functioning. The key findings of this study (which used the Glaucoma QOL 36 questionnaire) were that glaucoma patients report a 63% increase in anxiety, 71% lower self-image, 38% less emotional well-being and 32% reduced confidence in health care provision when compared with unaffected controls. Clinicians should be aware that visual acuity and visual field losses at different stages of glaucoma may negatively impact on patient’s self-confidence and emotional well-being.
Patient reported outcomes
Christof Hirneiss talked on “Patient reported outcomes”. He discussed the need to develop better Patient reported outcomes (PROMS) for glaucoma, which would aid clinical decision-making. A study to assess clinical measurements as predictors of PROMS compared patient reported functioning (using the Glaucoma activity limitation 9 questionnaire) with visual field loss and glaucoma imaging. The mean defect on VF testing was the best predictor with a 2.4dB loss in visual field correlating with a significant reduction in the patient reported functioning scale.
Selections by Ingeborg Stalmans
Phaco with goniosynechiolysis: role and evidence
Rahat Husain: Cataract surgery as a standalone procedure or combined with goniosynechiolysis when treating angle closure glaucoma has an intra-ocular pressure lowering effect. No statistically significant results in success nor in complications were noted. Only when performing subgroup analysis, a phaco-emulsification combined with goniosynechiolysis might have better results in patients with primary angle closure versus primary angle closure glaucoma.
Eagle and impact on angle closure management
Augusto Azuara-Blanco:The EAGLE study compares clear lens extraction versus laser peripheral iridotomy as a treatment for primary angle closure and primary angle closure glaucoma. The results of the study indicate that a clear lens extraction should be considered as a first-line treatment for primary angle closure glaucoma and primary angle closure with increased intraocular pressure.
Role of MIGS in modern glaucoma surgeryt
Ike Ahmed: Minimally Invasive Glaucoma Surgery (MIGS) is changing the view on surgical treatments in glaucoma by opening a wide range of options for mild to moderatwwe disease. Safety, control, predictability and rapid recovery are the basis for MIGS. The COMPASS trial showed combining the CyPass microstent provided additional benefit in combination with cataract surgery versus cataract surgery as a standalone that sustained through 2 years.
Phaco: an effective glaucoma treatment?
Tina Wong: Cataract surgery can be an effective treatment for glaucoma with good patient selection. Intra-ocular pressure lowering effects are very significant in acute angle closure glaucoma, significant in primary angle closure glaucoma and modest in open angle glaucoma. The reduction in the amount of medications is minimal in open angle glaucoma, but very significant in primary angle closure glaucoma. Long term worsening of the pressure is significant in open angle glaucoma, modest in primary angle closure glaucoma and acute angle closure glaucoma.
Anti-VEGF in trabeculectomy
Luis Pinto: The anti-VEGF bevacizumab has an impact on wound healing after glaucoma surgery. When administered intracameraly during trabeculectomy, the filtration bleb is less hyper vascularized and less additional interventions are required to meet the target IOP comparing with trabeculectomy without the use of bevacizumab.
Selections by Arthur Sit
In vivo imaging of the distal outflow system
Alex Huang (United States): Dr. Alex Huang presented research on aqueous angiography (AA) with real-time aqueous humor outflow (AHO) imaging of live human patients during routine phacoemulsification. Fluorescent tracers, commonly used as capsular stains, were delivered into the anterior chamber and AHO was imaged using a FLEX module Heidelberg Spectralis. AA showed segmental AHO patterns with a nasal predilection. Pulsatile flow was seen with a new dynamic behavior where angiographic signal could spontaneously increase or decrease in distinct parts of the eye. Future application of this technique to glaucoma patients may enable a more targeted application of angle-based minimally invasive glaucoma surgery (MIGS).
Tree shrew - a rodent model for lamina cribosa Brian Samuels (United States)
Dr. Brian Samuels presented research aimed at establishing a tree shrew (Tupaia belangeri) model of glaucoma to overcome limitations with the commonly used non-human primate (NHP) and rodent models of glaucoma. NHP have a collagenous load bearing lamina cribrosa (LC) that is ideal for optic nerve head biomechanics and other glaucoma studies, but they are expensive, and some centers have begun to restrict NHP research. Rodent models offer a platform to examine the genetic basis and molecular pathways involved in glaucoma pathogenesis. However, rodents have an astrocytic/ glial lamina that is not load bearing, and some of the findings have not translated well to humans. In contrast, tree shrews are a para-primate a load bearing collagenous LC, they are less expensive than primates, and their genome has been fully sequenced, enabling the use of newer, advanced molecular techniques. Dr. Samuels reported that intracameral injection with magnetic microspheres causes sustained IOP elevation, associated with progressive LC bowing, reduction in retinal nerve fiber layer, and reduction in optic nerve axon count consistent with human glaucomatous changes. This novel tree shrew model of glaucoma appears to show significant promise as a tool for future glaucoma research studies. Not featured as captured session.
24-hour IOP
Kaweh Mansouri (Switzerland): Dr. Kaweh Mansouri presented on the complexities of 24-hour IOP, which is a dynamic parameter with an individual circadian rhythm, and technological advances in 24-hour IOP monitoring in humans. First was an implantable sensor (Implandata, Hannover, Germany; CE-marked) that is implanted into the ciliary sulcus and measures IOP directly. Several years of data are available for 22 patients and show that it is generally safe and provides reliable measurements. Second was the Triggerfish contact lens sensor (Sensimed, Lausanne, Switzerland; FDA approved), which measures changes of IOP and ocular biomechanics. Studies suggest that 24-hour IOP patterns may reflect the propensity of eyes for future glaucoma progression. Both approaches are promising and potentially complimentary. Longitudinal studies are needed to address their impact on clinical decision-making.
Trabecular meshwork biomechanics
Darryl Overby (United Kingdom): Dr. Darryl Overby described how mechanical forces within the trabecular meshwork may act to modulate aqueous humour outflow resistance and thereby regulate IOP. As IOP increases, the trabecular meshwork distends, imposing biomechanical stretch on trabecular meshwork cells and shear stress on Schlemm’s canal endothelium. These mechanical cues trigger the release of VEGF, nitric oxide and other factors that reduce outflow resistance and oppose the elevation in IOP. This mechanosensitive feedback loop allows the trabecular meshwork to sense and respond to IOP, modulating its own resistance to maintain IOP homeostasis. Increased trabecular meshwork stiffness, as occurs in glaucoma, disrupts this mechanosensory mechanism, leading to loss of IOP homeostasis and ocular hypertension.
