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Issue 24-3
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IGR 24-3
The protective effect of a prior diagnosis of anatomic narrow angles is an important finding, suggesting that earlier detection and intervention may help prevent blindness from PACG
The results highlight the challenges of using VCDR in glaucoma screening
No statistically significant correlation between segmental TM pigmentation and segmental AHO angiographic signal was found
Unfortunately, the authors did not report the specificity in detecting progression with the smoothed and original data. This takes away important context to determine whether the small increase in detection rate came at the cost of increased false positive detections
While many new head-mounted perimeters have been developed in recent years, associated validation studies are sparce and mostly focus on agreement of summary statistics without evaluating other relevant performance metrics
The diagnostic accuracy is reduced in individuals with self-reported African descent as compared with individuals with self-reported European descent
It is important to consider that the use of race or ethnicity as a factor in diagnosis or in clinical algorithms could have the unintentional consequence of worsening health disparities among groups with the possible propagation of stereotypes and biases
Unmeasured factors such as physical activity, which has been shown to influence glaucoma susceptibility and visual field loss, may confound the effects of alcohol and smoking on the development of glaucoma
Larger and longer-term studies are however required to determine whether PERG recovery is sustained and predicts the effectiveness of glaucoma treatment
A pivotal finding reported by the investigators is the survival analysis, i.e., time from SLT to treatment escalation. This significantly favored the 360-high SLT protocol and revealed a treatment effect that was more than twice as pronounced, supporting prior data from other studies supporting significant duration of effect for SLT
The study highlights that the efficacy of IOP reduction might not depend on the incisional cross-sectional area of TM postoperatively
The study also underscores the current limitations of trabecular MIGS, a need for better understanding of the impact of trabecular injury and repair mechanisms, and development of pharmacological agents that target and inhibit wound healing in the TM after MIGS procedures
The authors propose that increasing the concentration of mitomycin C could enhance the effectiveness of the Microshunt, supported by previous studies
Interestingly, when subjects with low baseline IOP (< 18 mmHg) were analyzed, there was no statistically significant difference between the two groups, although trab eyes still seemed to be doing better
Despite these shortcomings, this study demonstrates one more time that being able to perform classic filtration surgery remains a mainstay of glaucoma management and should continue to be an important part of a training curriculum for aspiring glaucoma surgeons
AGMs are not without risk and their use may be associated with poorer outcomes in terms of angle surgery
This study demonstrates improved success of trabeculectomy with intraoperative intravitreal anti-VEGF therapy
A key and novel finding was that the difference between measured IOP and target IOP was a better predictor of progression than absolute IOP values
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