A Brave New World in Glaucoma

Could Glaucoma Be Reversible?

Jonathan S. Myers, MD: Hello. I am Dr. Jonathan Myers, Associate Attending Surgeon and Director of the Glaucoma Fellowship at Wills Eye Hospital in Philadelphia. Welcome to Medscape Ophthalmology Insights, coming from the American Academy of Ophthalmology (AAO) meeting in New Orleans. This is part of a series of commentaries produced in cooperation between Medscape and Wills Eye Hospital.

Joining me today are Dr. George Spaeth, Dr. Sonya Shah, and Dr. Victor Cvintal. Dr. Spaeth is the Louis J. Esposito Research Professor at Wills Eye, and also the Medical Director of Wills Eye Glaucoma Research. Dr. Shah is a glaucoma clinical fellow at Wills Eye. Dr. Cvintal is a glaucoma research fellow at Wills Eye.

Today, we will be discussing some of the hot topics in glaucoma being presented at this year's meeting.

Dr. Spaeth, you have been impressed by the work that Dr. Joseph Caprioli^[1] has done on visual field progression. Can you share some of your thoughts on that?

George L. Spaeth, MD: He gave an absolutely terrific talk, because it was courageous and had beautiful science in it. He was talking about his belief -- now well-demonstrated by the evidence -- that visual fields in patients with glaucoma can get better. That has been very controversial, and he showed that there is no question that it happens when the pressure is adequately lowered in people with relatively early glaucoma and high pressures to start with.

He followed up on Roger Hitching and Fred Fitzke's way of looking at point-by-point places on a visual field. He looks at regions rather than the whole field. He finds that you can define, very specifically, localized change getting worse, and the rate at which it gets worse. He separates the slow rate that occurs in everybody caused by progressive cataract and aging from the rate of deterioration caused by the glaucomatous process. It was beautifully done.

Dr. Myers: Dr. Shah, you had some thoughts on his work as well.

Sonya B. Shah, MD: This work is very exciting. Sometimes it is discouraging to think about glaucoma as a disease in which the blindness is permanent. This gives us a glimmer of hope that some of this damage might be reversible. It is very interesting to hear that there are some procedures that can lower the pressure and perhaps bring back some visual field.

Dr. Myers: In the past, you have done work that seems to have shown some reversibility of various aspects of glaucoma.

Dr. Spaeth: Yes. Actually, the current Director of the Glaucoma Service, Dr. Katz, and I published a paper that showed, we thought quite convincingly, that both the optic nerve and the visual field could improve in patients with glaucoma. It was not well received, I should say.