A Brave New World in Glaucoma

American Academy of Ophthalmology 2013

Jonathan S. Myers, MD; George L. Spaeth, MD; Sonya B. Shah, MD; Victor Cvintal, MD


December 06, 2013

Editorial Collaboration

Medscape &

In This Article

Personalized Approach to Angle Closure

Dr. Myers: There are some new thoughts on angle-closure glaucoma, which also seems to be getting much more complex than "fire your laser PI (peripheral iridotomy) and forget."

Dr. Spaeth: Angle-closure glaucoma tends to be forgotten. That's unfortunate, because it's the single largest cause of visual loss in the world in terms of permanent visual loss. Preventing those attacks from happening is key. Many of us have been very aggressive. The angle looks narrow; it looks like it's occludable. We develop grading systems to try to help answer that sort of situation -- is it really narrow? If it looks occludable, I treat with a laser peripheral iridotomy.

Now, new information is coming out that maybe in Asian patients that is not the right approach, because their mechanism of angle closure is different. Maybe the best treatment for those patients is to take the lens out, even if it's clear, because it is going to prevent them from going blind from angle-closure glaucoma.

Dr. Quigley at the Wilmer Eye Institute has very interesting new ideas about where the flow of aqueous goes in the eye and how it might be pushing the lens forward in certain patients, sort of a semi-malignant glaucoma. There are lots of new thoughts about what causes this, and that is going to result in a much more personalized approach to treating each person properly for their particular type of angle-closure glaucoma.

Dr. Myers: It seems as though the new imaging technologies are changing the way we look at some of those glaucomas. Some of the larger studies that are being done with innovative designs in Asia also may have real impact.

For Medscape Ophthalmology and Wills Eye Hospital, thank you for joining us.