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Top Ten at Glaucoma Subspecialty Day - Under Pressure: Vision Towards the Future
American Academy of Ophthalmology October 19, 2002, Orlando, FL, USA
Kuldev Singh
Glaucoma Subspecialty Day is an annual one-day meeting at which topics of interest are summarized for both the general ophthalmologist and the glaucoma specialist. The scientific information presented is usually not original work, but rather a review of the existing knowledge in the field. The following are highlights from the 2002 meeting, which was attended by 1050 individuals:
- The International Glaucoma Review Award was presented for the first time on American soil. The IGR Award-winning and IGR Special Recognition-papers were presented in IGR 4-1 and 4-2.
- Dr Robert Weinreb delivered the Glaucoma Subspecialty Day lecture entitled: Getting Closer to Glaucomatous Optic Neuropathy. Dr Weinreb showed that damage to the optic nerve generally precedes measurable vision loss. He produced evidence to show that careful examination of the optic nerve is rewarded with earlier diagnosis of the disease. Dr Weinreb also acknowledged Dr E. Michael Van Buskirk as being the one who coined the term 'Glaucomatous Optic Neuropathy'.Earlier, Dr Van Buskirk had introduced Dr Weinreb as the Subspecialty Day Lecturer.
- Three sections on National Eye Institute-sponsored clinical trials in the USA were presented. The sections focused on the Ocular Hypertension Treatment Study (OHTS), the Advanced Glaucoma Intervention Study (AGIS), and the Collaborative Initial Glaucoma Treatment Study (CIGTS). For each section, study design, outcomes, and implications for clinical practice were discussed by different speakers.
- In the Glaucoma Policy section, Dr Paul Sieving summarized the priorities
of the National Eye Institute as they pertain to glaucoma, and Dr Wiley
Chambers showed the US Food and Drug Administration policy on generic
medication approval. Dr Chambers also discussed the concept of BioCreep,
by which
a sequence of medications, all found to be statistically equivalent with regard to efficacy in a series of tests during which two were compared, may lead to an end result where the final medication is far inferior to the first one tested. - While a good case was made for the use of computerized imaging devices in glaucoma practice, there was an equally compelling rebuttal that these devices are not essential at the present time. Stereoscopic funduscopic examination combined with photography remains the gold standard. However, the future of computerized imaging devices appears to be bright.
- The beneficial effects of laser iridoplasty, goniosynechialysis, or cataract removal in eyes with angle-closure glaucoma have yet to be confirmed or adequately studied in a prospective, randomized fashion.
- A strong case can be made for the initial monotherapeutic use of prostaglandin analogues in the treatment of glaucoma. This is based upon efficacy, duration of action, safety, and convenience. However, the systemic safety profile of beta blockers, the other commonly-used initial monotherapeutic agents, may well be better than suggested by some.
- Corneal thickness measurement is becoming an increasingly recognized parameter in patients suspected of having glaucoma. This is due to the fact that intraocular pressure is underestimated in patients with thin corneas and overestimated in those with thicker than average corneas. The increasing number of individuals who have undergone LASIK, which results in corneal thinning, has increased the significance of this finding.
- The treatment of bleb leaks has become increasingly complex in the era of widespread antifibrotic use. While several different techniques to close wound leaks have emerged in the office and the operating theater, none is associated with universal success.
- Genetic testing for glaucoma is still in its infancy, and is probably not practical at the present time. In its current state, genetic testing is only useful for the screening of a small minority of glaucomas.
