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News Flashes IGR 23-4

This study is compelling, showing a potential contribution of Müller cells changes that precede statistically significant elevations in IOP

These results highlight the prevalence of treatment failures in routine clinical practice

The main limitation of this study is that it is cross-sectional and provides evidence for an association but not a causal relationship

The study findings significantly lack generalizability as the population was ethnically homogenous and the data lacked information about glaucomatous status or past exposure to IOP lowering pharmacotherapy

Another issue is that the study excluded those that developed OSA, and would be more likely to create attrition from the control group and increase the likelihood of an association in the Study group. This might magnify the treatment of OSA

While the benefits to glaucoma of treating OSA is still controversial, it is important to refer patients with suspected sleep apnea for testing because treatment of sleep apnea has large health benefits for other health conditions

It remains to be seen if this strategy can mediate consistent neuroprotection or neuroenhancement in human glaucoma

The proportion of eye drops successfully reaching the eye was actually lower using the nose-pivoted delivery device, though this was not statistically significant (64% versus 59%)

Once the TM cells or Schlemn's canal endothelial cells are damaged and lose their function, the induction of MMP3 may not be effective

The 14-year number needed to treat to prevent one case of PAC was 12.4 compared to 44 at 6 years

The main limitation of the study is the generalizability of the results

As the annual incidence of PAC was low and AAC and PACG were relatively rare in the community-based population with PACS over the long term, clinicians should assess the risk factors for progression when treating patients with PACS and prophylactic LPI should be recommended preferentially to those at the highest risk of angle closure

This study's results, if replicated in other populations and other glaucoma types would place the XEN gel stent as a viable less-invasive alternative to trabeculectomy, especially when efficacy, safety, and patients' quality of life are weighted against each other

One additional topic that is pertinent to the entire MIGS space is the health economics of MIGS and cost implications of surgical choices

IOP fluctuation was significantly greater postoperative (4 vs. 11 eyes showing IOP fluctuation >6mmHg), and the authors hypothesized that procedures aiming to reduce aqueous production may not blunt IOP fluctuation

Although reducing the burden of multiple medications is desirable, there is a need to assess more clinically meaningful endpoints of the relatively new glaucoma surgical procedures to enable a better decision making process, particularly to properly allocate the limited resources for preventing glaucoma blindness worldwide

The relatively modest sample size of the European validation set elicits concerns, while the inherent dissimilarity in demographic metrics between the European and Asian datasets further compounds the issue

Despite the limitations, this study adds to the growing body of evidence supporting a protective effect of dietary niacin on glaucoma risk

Issue 23-4

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