Surgical Techniques Showcased at Glaucoma Meeting

Ingrid Hein

February 23, 2017

A new analysis of 5-year pooled data from two studies, along with highly anticipated reports on new surgical techniques, will be in the spotlight at the upcoming American Glaucoma Society (AGS) 2017 Annual Meeting in Coronado, California.

Bringing together data from the Ahmed Baerveldt Comparison (ABC) and the Ahmed versus Baerveldt (AVB) studies and reporting the strengths and weaknesses of surgical techniques will likely have an effect on the way glaucoma surgeons make decisions, said AGS Program Chair Steven Gedde, MD, from the Bascom Palmer Eye Institute–Anne Bates Leach Eye Hospital in Miami.

"The pooled dataset will definitely get surgeons talking. This is now the largest collection of data on common glaucoma surgery that exists," he told Medscape Medical News.

"There's a lot of interesting research coming out this year, across the board in all the categories, but especially in surgery," he added.

An analysis of 4-year safety data on a SIBS-based micro-shunt for the treatment of glaucoma, currently under review by the US Food and Drug Administration, will be presented by Paul Palmberg, MD, PhD, from the Bascom Palmer Eye Institute.

And 1-year results from the Primary Tube versus Trabeculectomy trial, a multicenter randomized controlled trial that Dr Gedde is involved with, will also be presented.

Interestingly, in that trial, the complication data seem to be favoring one option, showing a lower rate of reoperation, he said.

Dr Gedde said he is looking forward to hearing results from the retrospective study on tube erosion after glaucoma drainage device surgery by Azra Idrizovic, DO, from the Bascom Palmer Eye Institute, and her colleagues.

"We always had the feeling that both are effective; this is the first time we have information that one is superior," said Dr Gedde. "The results have the potential to influence what patch grabs we use in the future."

New Ways to Monitor Visual Field Progression

There is increasing interest in new ways to monitor visual field progression, both before and after surgery. An analysis of data from the ADAGES cohort, to be presented by Aakriti Garg, MD, from the Columbia University Medical Center in New York City, provides predictive models that support aggressive treatment goals to prevent visual impairment in patients with fast progression.

"This has great potential to guide treatment and to help determine how aggressive we need to be in lowering pressure," said Dr Gedde.

Significant results on the effectiveness of 24-hour contact-lens sensors in predicting the velocity at which a patient's vision loss is progressing will be presented by Carlos Gustavo De Moraes, MD, from the Columbia University Medical Center.

"We know that a single measurement does not reflect what is happening around the clock," Dr De Moraes told Medscape Medical News.

He and his team were able to capture the way intraocular pressure fluctuates overnight, which can only be detected with this type of technology. "You would never capture that during office hours," he explained.

A Paradigm Shift in Glaucoma

Dr De Moraes, who is director of the AGS education committee, said he is particularly excited about this year's conference.

"This is the most important scientific meeting in glaucoma worldwide," he said. "This is where we see all the results of brand new studies that may change our practice in the next few years."

He said he will be closely following research coming out of the labs of Felipe Medeiros, MD, PhD, at the University of California, San Diego School of Medicine.

"I've worked with him before; everything from his lab is exciting," Dr De Moraes told Medscape Medical News. "Dr Medeiros has been working on virtual reality applied to glaucoma, and looking at patient driving, daily activities, and how it all factors in to quality of life. This is pretty clinically important stuff that he's doing."

Many people think the field of glaucoma is progressing very slowly, compared with cataract research, for example, "but that's changing," he explained.

"In the last 5 years, we've seen new ways of tracking patients and five to 10 new surgical techniques, all minimally invasive and all affecting quality of life," he pointed out. The results of these changes will be a big part the research and lecture sessions at the conference.

"We are indeed in a paradigm shift in the field," he added.

In addition to research, symposia, education, discussion, and debate, the conference will keep glaucoma specialists active, with morning yoga, a 5-mile run, and, of course, cocktails and dancing. "I'm more likely to be at the cocktail bar than out for the run," Dr Gedde laughed. "I like to spend time with the young people."

Dr Gedde is a consultant for Alcon Laboratories, and has received grant support from National Eye Institute, Abbott Medical Optics, and Research to Prevent Blindness. Dr De Moraes is a consultant for Sensimed.


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