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Decade ahead to bring momentous advances in glaucoma care

The next 5 to 10 years will be a period of remarkable research discoveries for glaucoma and their translation into enhanced patient care, said Robert N. Weinreb, MD.

“Glaucoma research has a number of areas that will be transformative and will dramatically change our clinical practice,” said Dr. Weinreb, chairman of ophthalmology, director of the Shiley Eye Center and the Hamilton Glaucoma Center, University of California, San Diego.

Looking forward to what is next in glaucoma, Dr. Weinreb discussed improvements in risk-prediction and risk-modification strategies, increased knowledge of glaucoma pathophysiology, the advent of 24-hour IOP monitoring, and advanced technologies for structural and functional imaging.

A broadened understanding of glaucoma’s genetic associations is one of the first events on the horizon, and the information will be valuable in helping clinicians better determine an individual’s risk for becoming functionally impaired. To date, there is only limited information about genetic variations associated with glaucoma. However, it is expected that this will change with findings from ongoing studies, including research being funded by the National Eye Institute and others.

“Not all patients progress along the glaucoma continuum to the stage where they become functionally impaired,” Dr. Weinreb said. “In the future, we will incorporate findings from genetic analyses in our risk calculators to identify patients who are at highest risk for progression. Equipped with that information, we can best allocate limited resources for healthcare.”

Increased understanding of the mechanisms of glaucomatous optic nerve damage is also forthcoming, as multiple laboratories elucidate the role of the microcirculation, immune system, and the milieu of inflammatory cytokines associated with glaucoma. More complete articulation of the mechanisms of optic nerve damage will also provide a foundation for developing more effective glaucoma treatment, Dr. Weinreb added.

The advent of 24-hour IOP monitoring will transform the care of patients with glaucoma and usher in a new era of personalizing IOP. 24-hour IOP monitoring set to revolutionize glaucoma research and clinical care.

Listen as Gil Kliman, MD, managing director of InterWest Partners, interviews Richard Lindstrom, MD, in a one-on-interview at the 2014 Glaucoma 360 meeting. Dr. Lindstrom recalls how he was primed as a boy for the construction business by his father, but decided to go to medical school. The decision catapulted Dr. Lindstrom’s career as ophthalmologist, surgeon, and product innovator.

The search for glaucoma biomarkers is in high gear. Funded by Catalyst for a Cure, the research program has already produced new biomarker candidates and novel techniques that promise to advance research in glaucoma. Research is focusing on ways to diagnose glaucoma early and detect the specific, minute changes that could allow researchers to reduce vision loss.

Intraocular pressure (IOP) monitoring is based on fiction. Clinicians typically measure IOP over a single visit and extrapolate the value to the patient’s overall condition and the degree of control over their IOP. “New Horizons in IOP Monitoring and Digital Health” session showcased six companies trying to turn the IOP challenge into commercial success.

The availability of technologies for ambulatory IOP measurement will usher in a new era in glaucoma patient management. L. Jay Katz, MD, said the technologies will provide better understanding of IOP and patient adherence to topical medications and to make more timely adjustments in therapy while reducing the number of office visits.