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Top-ten on Glaucoma at the 2001 American Academy of Ophthalmology Annual Meeting

October 10-14, 2001, New Orleans, LA, USA

Theodore Krupin

The unfortunate and shocking events of September 11^th had a negative impact on the attendance at this year's AAO meeting. However, 'the show must (and did) go on' in New Orleans, a charming city with great convention facilities and wonderful restaurants.

Two interesting glaucoma studies were presented in the General Medical Care section of the meeting.

• 1. Delayed suprachoroidal hemorrhage following filtration procedures, by Drs Tule, WuDunn, Ciulla, and Cantor
  The authors identified 66 cases of delayed suprachoroidal hemorrhage (DSCH; incidence of 2.9%) after filtration surgery. As expected, visual outcomes were poor following DSCH. The occurrence of this complication was significantly greater after tube shunt procedures than after trabeculectomy (p < 0.0001).
  Posterior tube shunt glaucoma implant surgery should be added to the previously reported risk factors for DSCH, which include aphakic vitretomized eyes, prolonged postoperative hypotony, and ciliochoroidal effusion. This highlights the wisdom (caution) to limit the use of tube shunt implants in high-risk glaucoma eyes that have failed (or are not candidates for) standard antifibrotic filtration surgery.
• 2. Prevalence and significance of presumed optic nerve head collateral vessels in glaucomatous eyes, by Drs Jones, Shields, Weinstock, and Call
  The authors retrospectively reviewed optic disc photographs of 1913 glaucoma subjects and identified 67 (3.7%) patients with collateral vessels. Thirty-eight eyes (49.4%) were presumed to be secondary to venous occlusions and 39 (50.6%) presumed to be due to glaucoma. The authors concluded that, unless there are other signs or symptoms, collateral disc vessels in glaucomatous eyes do not require evaluation in search for an extraocular source.

Three Glaucoma Scientific Posters attracted my attention:

• 3. Morphologic risk factors for progressive glaucomatous optic nerve head changes, by Drs Jonas, Budde, Hayler, Juenemann, and Martus
  The authors presented results from a prospective study of 300 eyes of 186 Caucasian patients with open-angle glaucoma. At baseline, neuroretinal rim area was smaller (p = 0.001) and the beta zone of parapapillary atrophy larger (p = 0.002) in the study group which showed progressive glaucomatous optic disc changes (n = 115), compared to the study eyes without progression (n = 185).
  This study continues to support the value of quantitative optic nerve-related measurements in the prospective management of glaucoma.
• 4. Histopathological findings in iris specimens from patients with glaucoma treated with latanoprost, by Drs Albert, Green, Grossniklaus, Zimbric, and Gangnon
  The authors reported results from their ongoing study on the histological features of irides obtained at the time of filtering surgery comparing eyes treated with latanoprost (n = 286) with eyes not receiving this medication (n = 117). They reported an increased number of freckles in the latanoprost treated eyes compared to controls (p < 0.0005). In addition, the irides of female patients treated with latanoprost had increased stromal cellularity (combined fibroblasts and melanocytes) compared to controls (p < 0.0001), but not to male patients receiving latanoprost.
  The difference in treated brown-eyed female patients was detected by post-hoc subgroup analysis. Histopathological appearance of the iris specimens was similar between treated and nontreated eyes. The authors indicated, "plausible biological mechanisms for different effects of latanoprost in males and females", but urged that their results be interpreted with caution.
• 5. Surgical management of glaucoma associated with aniridia, by Drs Arroyave, Scott, Gedde, Parrish, and Feuer
  Fifteen eyes of nine aniridia patients underwent 21 surgical procedures, including goniotomy (24%), trabeculotomy (9%), trabeculectomy (24%), and drainage devices (43%). Three eyes required multiple surgery. At three years, 59% of eyes had a pressure < 21 mmHg and final vision was 20/400 in 61% of eyes.
  It is encouraging that our current surgical options can have high success in aniridia. Limited vision in most of these eyes results from associated macular abnormalities.

The following presentations deserve mention:

• 6. Retinal thickness analysis (RTA): a paradigm shift for early glaucoma diagnosis? by Drs Asrani, Challa, Herndon, Lee, Stinnett, and Allingham
  RTA was performed in 100 eyes of 100 early glaucoma or glaucoma suspect patients. RTA maps correlated (r = 0.75) with the appearance of the optic nerve; however, both these parameters correlated only moderately (r = 0.54) with the visual field.
    Measurement of retinal thickness at the posterior pole may provide an early objective measurement of early glaucomatous damage. Long-term prospective studies comparing RTA, other methods of computerized analysis of the optic nerve (e.g., HRT and GDx), and computerized analysis of the visual fields are needed to determine the clinical usefulness of quantitative measurements in our management of glaucoma.
• 7. Effect of travoprost on IOP in black and non-black patients with ocular hypertension and open-angle glaucoma in a twelve-month study, by Drs Netland and Sullivan
  The authors present data from a prospective analysis on the greater IOP-lowering effectiveness of travoprost compared to timolol or latanoprost in black (n = 177) compared to non-black (n = 610) patients. The major effect was present at 14 hours after dosing (at peak).
    This is an ongoing discussion on the racial difference in response to antiglaucoma medications. Obviously, the response to medical therapy in any given patient (independent of race) must be determined individually. Also, the IOP response in clinical studies should probably consider corneal thickness (pachymetry) since thinner corneas have been shown to have greater IOP reduction than thicker corneas. This is important since several studies have shown that blacks have thinner corneas than non-blacks.
    Note from the editor: In all fairness, it has been suggested (Roy Wilson) that the perceived difference between latanoprost and travoprost is negated because the baseline diurnal IOP measurements were higher in the latanoprost group.
• 8. The Collaborative Initial Glaucoma Treatment Study (CIGTS) interim outcomes report with up to 5 years of follow-up, by Dr Lichter et al.
• 9. Initial quality-of-life findings with up to 5 years of follow-up in the Collaborative Initial Glaucoma Treatment Study (CIGTS), by Dr Janz et al.
  The first presentation of the early results of this important clinical trial comparing initial medical treatment or trabeculectomy in 607 patients with newly diagnosed open-angle glaucoma was a major highlight of the meeting. Fortunately these two papers were published in the November issue of Ophthalmology, since the massive amount of data presented is too great to summarize in this overview. I highly recommend careful reading and analysis of the data, and look forward to continuing reports from CIGTS.
• 10. Glaucoma Update: combined meeting with the Association for Research in Vision and Ophthalmology (ARVO)
  Dr Robert N. Weinreb and Mr Roger A. Hitchings organized a superb symposium featuring presentations by Drs Quigley, Caprioli, Cioffi, Sample, Kass, Kaufman, Khaw, Levin, and Wax. All the presentations were excellent, and I highly recommend purchase of the CD-ROM as a digital reference to this outstanding symposium.