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    State of glaucoma therapy focus of keynote

    San Francisco—This could be a banner year for breakthroughs in glaucoma care. New understanding of the central nervous system and the nature of glaucoma has advanced researchers to the verge of changing the standard of care in this leading cause of blindness.
    “We are not talking about an eye disease any more when we talk about glaucoma,” said Louis B. Cantor, MD, chairman and professor of ophthalmology and director of glaucoma service at Indiana University, Indianapolis. “We are talking about a central nervous system disorder. We are redefining the optic nerve. I am very excited about new concepts in neuroprotection.”
    Dr. Cantor delivered the opening keynote address at the Glaucoma 360 New Horizons Forum on Friday. Current glaucoma treatment is still about controlling IOP, but care is on the verge of emphasizing earlier, more aggressive management to reduce and delay progression.
    Clinicians are coming to appreciate the reality that glaucoma is a multifactorial disease. Though treating IOP helps to some degree, there is a growing understanding that protecting the retinal ganglia is a key clinical goal. New treatments will come from a growing understanding of the pathophysiology of glaucoma as well as a new understanding of the structures and mechanisms at the neural-retinal rim and new clinical targets.
    “We are on the cusp of redefining the optic nerve and assessing the structural damage of glaucoma,” he said. “We are on the cusp of offering our patients an alternative to the torture of visual field.”

    New techniques are already suggesting ways the assessment of glaucoma is about to change. Four-channel multifocal VEP offers synchronized signal acquisition. Minimally invasive glaucoma surgical procedures continue to move toward clinical use. Suprachoroidal microstents, subconjunctival microstents, and laser trabeculectomy all offer improvements over conventional surgical interventions.
    “Not every patients needs a hole in the eye,” Dr. Cantor said. “This year could be our lucky 13. We have many developments on the horizon.”


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