Glaucoma therapies, technology expand in '08

Key Points

Although 2008 was not a year of major advances in glaucoma, it still was a time of progress. Structural imaging devices continue to improve; more data are emerging on surgical alternatives to trabeculectomy; and some novel medical therapies appear interesting, even though they are in very early stages of clinical investigation.

March 6 was the date of the first World Glaucoma Day. The international event was sponsored by the World Glaucoma Association and the World Glaucoma Patient Organization. The Ophthalmology Times Group served as the official news source, providing coverage of awareness and educational activities organized by glaucoma institutions and local patient support groups worldwide through e-newsletter reports.

More than 1,000 events were planned for the day, including volunteer-staffed glaucoma screening programs in more than 60 countries, educational activities to raise glaucoma awareness, and lobbying efforts to promote glaucoma awareness and obtain increased federal funding for glaucoma research. The day was recognized by the White House and other governmental authorities worldwide, and by many other metrics, the first World Glaucoma Day was a resounding success.

"All things considered, it is a very exciting time to be taking care of glaucoma patients," said Joel S. Schuman, MD, Eye and Ear Foundation Professor and Chairman of Ophthalmology, University of Pittsburgh School of Medicine.

"I believe we are refining our approach to glaucoma management with greater appreciation that the treatment of slowly progressive, chronic disease is aimed at reducing the risk that a disability will occur during the patient's lifetime and that tools that better detect progression will inform us about our success or lack of success," said Robert D. Fechtner, MD, professor of ophthalmology and director, glaucoma division, New Jersey Medical School-UDMNJ, Newark.

Speaking in Ophthalmology Times interviews, Dr. Schuman and Dr. Fechtner, along with Kuldev Singh, MD, MPH, professor of ophthalmology and director, glaucoma service, Stanford University, Stanford, CA, provided their perspectives on recent developments and current controversies.

Diagnostics

One of the most dynamic areas in glaucoma has been in the field of diagnostic imaging devices. Seven spectral domain optical coherence tomography (OCT) devices currently are commercially available from manufacturers in the United States and Europe (Bioptigen, Carl Zeiss Meditec, Heidelberg Engineering, OPKO, Optopol Technology, Optovue, and Topcon Medical Systems), and most of these instruments have normative databases for retinal nerve fiber layer thickness measurements.

"The performance of some of the software programs for determining differences between the patient in your chair and the healthy population still needs to be validated, but we know already that the new spectral domain OCT technology has better reproducibility from one exam to the next than the commercially available time domain platform [Stratus OCT, Carl Zeiss Meditec]," Dr. Schuman said. "Based on this feature, they have the promise of better sensitivity and specificity in detecting progression."

Currently, the question of whether the spectral domain devices offer an improvement over time domain OCT for detecting disease remains unanswered. The development of software for the spectral domain systems, however, is an area of intensive research, and progress is occurring at a fast pace.

"It's been exciting to see how rapidly the spectral domain platforms have been adopted into clinical use, and we can look forward to new software and methods of analysis for these platforms for the detection of both disease and progression," Dr. Schuman said.

In the area of functional assessment, Dr. Schuman said that an interesting paper was presented at the American Academy of Ophthalmology (AAO) annual meeting on the use of pupillographic perimetry, a technique for assessing visual fields based on measuring pupillary responses to light. The idea of being able to measure visual function objectively without having to depend on patient response to a question is very exciting and the results reported were encouraging, but need to be validated, he said.