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Heidelberg Engineering: Enhancing the Patient Journey

Clinical

1rem

Ahead of the ESCRS congress and iNovation day, we go behind the scenes with Ciliatech founder Philippe Sourdille, MD, and president Olivier Benoit

 Ciliatech leadership comments on CE mark for novel glaucoma device

Can AI compete with the well-oiled machine of the contemporary clinic?

Feasibility of artificial intelligence in leading glaucoma care

The nitric oxide-donating bimatoprost therapy is intended to lower intraocular pressure in patients with glaucoma or ocular hypertension

Nicox and Kowa enter commercialisation agreement for NCX 470 glaucoma eye drop

Phil Lai, MD, chief medical officer of Perfuse Therapeutics, said the company's goal is to pioneer disease-modifying treatment that targets an underlying pathology of ischemia

Perfuse Therapeutics shares findings from glaucoma and diabetic retinopathy trials of PER-001

The framework covers ocular hypertension to severe progression

A new set of guidelines for implementing interventional glaucoma

At the American Society of Cataract and Refractive Surgeons annual meeting, Sheng Lim, MD, FRCOphth discusses the benefit of endoscopic cyclophotocoagulation for patients with primary open angle glaucoma and cataracts in the CONCEPT study

At the American Society of Cataract and Refractive Surgeons (ASCRS) annual meeting in Los Angeles, California, the scientific programme went beyond refractive correction and cornea care. Gene and cell therapy, collaboration with retina specialists and pearls for glaucoma management were all part of the agenda as well.

Sheng Lim, MD, FRCOphth, is a professor of glaucoma studies at St. Thomas’ Hospital and King’s College London, both in the United Kingdom. At this year's meeting, he presented findings from a recent study, Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser and Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT).

 editorial teams to illustrate why endoscopic cyclophotocoagulation (ECP) has major potential for patients with glaucoma. "We had over 160 patients in the study and randomisations 1 to 1, so it's interesting, the results we're getting so far, [after] 1 year," Prof. Lim said. "What the CONCEPT study has shown in 1 year is that we're seeing a median difference in IOP of 2 mm mercury, in support of use of ECP in primary open-angle glaucoma."

Prof. Lim also addressed a real-world postsurgical outcome which may differ from the clinical trial result: incidences of uveitis. "What we see in this study is that, during that follow up period, particularly in the first 2 months, you're seeing a higher incidence of anterior uveitis in the groups of patients who had ECP," he said. "Really, it's not surprising, because [patients who received ECP] were subjected to 

 the same post-op regime as a cataract surgery patient would have. But in real world, I think most people realise that if you combine cataract surgery with ECP, you have to increase the dosage and the length of steroid drop treatment for those groups of patients. So, I'm sure with those two adjustments, the incidence of significant anterior uveitis will be much reduced, if you do ECP with more steroid drops post operatively."

Videos

Endoscopic cyclophotocoagulation (ECP) has major potential for patients with glaucoma

Sheng Lim, MD, FRCOphth, brings data from the CONCEPT study to the ASCRS meeting

AGS 2025: Clemens Strohmaier, PhD, on improving aqueous humour outflow following excimer laser trabeculostomy

At the 2025 American Glaucoma Society (AGS) Annual Meeting, held from February 26 to March 2 in Washington, DC, US, Clemens A. Strohmaier, PhD, presented research on improvements in aqueous humour outflow following the Elios procedure. His study utilised aqueous humour angiography, a technique pioneered by Alex A. Huang, MD, PhD, at the Shiley Eye Institute in San Diego, California. Strohmaier’s poster was recognised as a Top Poster Presentation by AGS.

Aqueous humour angiography involves infusing specialised dyes into the anterior chamber, allowing real-time visualisation of outflow patterns before and after the procedure in live patients. The study consistently demonstrated improved outflow across all examined cases, further supporting Elios' potential in enhancing the effectiveness of minimally invasive glaucoma surgery (MIGS).

One of the study’s key goals was to explore the variability in efficacy observed in MIGS procedures, despite their established safety. Supported by Elios, the research aims to optimise trabecular bypass surgery by identifying the most effective placement strategies. Interestingly, the study found that improved outflow did not always occur precisely at the site of laser energy application, challenging conventional assumptions about direct trabecular bypass-outflow correlation. Instead, the enhancement was observed in adjacent areas, prompting further investigation.

Building on these findings, an ongoing clinical study is applying insights from Huang’s lab to determine whether targeting low-flow regions of the trabecular meshwork results in better surgical outcomes. Preliminary lab results suggest improved efficacy when these areas are treated, with the clinical trial expected to confirm this approach.

Strohmaier emphasised that while the Elios procedure is a simple, safe, and effective way to improve outflow, broader challenges remain in translating MIGS success from laboratory research to clinical practice. He also suggested that episcleral circulation might play a limiting role in MIGS efficacy—an area requiring further exploration through advanced angiographic techniques. These findings contribute to the development of more precise, patient-specific surgical strategies aimed at optimising glaucoma treatment outcomes.

The Elios procedure shows promise in improving aqueous humour outflow and enhancing the effectiveness of minimally invasive glaucoma surgery, with ongoing research exploring optimal treatment strategies.

Sara M. Thomasy, DVM, PhD, DACVO, a veterinary ophthalmologist at UC Davis, talks about how her research can align with human glaucoma research to move the entire field

At the Glaucoma 360 meeting in San Francisco, California, Sara M. Thomasy, DVM, PhD, DACVO, spoke to 

about her research. Dr Thomasy is a veterinary ophthalmologist at UC Davis. She addressed the ways that glaucoma affects dogs, cats, horses and non-human primates, and why collaboration between veterinary and physician ophthalmologists is key to proogress.

Editor's note: The below transcript has been lightly edited for clarity.

: Hi, I'm Dr Sara Thomasy. I'm a veterinary ophthalmologist at UC Davis, and I have dual appointments in the School of Veterinary Medicine, the School of Medicine in the department of ophthalmology and vision science, as well as the California National Primate Research Center, where I'm a core scientist.

I think what I really wanted the audience to take away is that people aren't the only species that get glaucoma. That glaucoma affects our companion animals on a daily basis. Dogs, cats, horses, pretty much any species you can think of can suffer from glaucoma. I also want people to realise that dogs are excellent models of angle closure glaucoma, and that there are new non-human primate models of glaucoma, such as the steroid-induced ocular hypertension model that I mentioned, as well as optic nerve degeneration. We have a very exciting autosomal dominant optic atrophy model that we think can help speed development of neuroprotective therapies.

The future of glaucoma is so incredibly bright. This meeting has absolutely inspired me. I have so many takeaways from this meeting. For example, we were sort of mystified by a problem in horses, a response to therapy that we couldn't understand. And today, because of a wonderful presentation about suprachoroidal delivery and the effects on non-conventional outflow, I think I understand why horses are having this response to this particular drug in in the suprachoroidal space. I think that there is so much opportunity for veterinary and physician ophthalmologists to collaborate. Indeed, our residents present at every grand rounds that our medical school has. I think that UC Davis really is the poster child for collaborations between veterinary and physician ophthalmologists. Our residents do microsurgical training together. I collaborate with numerous physician ophthalmologists on non-human primate and dog models, and I do think there's so much for physician ophthalmologists to learn from veterinary ophthalmologists. A One Health approach is really the best approach to understanding the best animal models possible to answer questions about human glaucoma.

College is the Diplomates of the American College of Veterinary Ophthalmologists. So that's our board certification process. Residents have to do a 3- or 4-year program, and then have to pass a very difficult boards qualifying exam. And there are now over 400 veterinary ophthalmologists that are board-certified in the American College of Veterinary ophthalmology. Europe also has this analogous certification process, but their college is even smaller than ours. So we are an intimate group, but a group that can help physician ophthalmologists and glaucoma researchers answer many questions regarding animal modeling and and therapeutic development.

Sara M. Thomasy, DVM, PhD, DACVO, discusses the importance of examining how glaucoma affects companion animals like dogs, cats and horses

Veterinary ophthalmology can foster insights and progress in glaucoma care

I. Paul Singh, MD, an anterior segment and glaucoma specialist, discusses the use of artificial intelligence (AI) in glaucoma care.

At the 2025 Glaucoma 360 conference in San Francisco, California, I. Paul Singh, MD, an anterior segment and glaucoma specialist, took time to speak with the Eye Care Network. He shared insights from a panel discussion on artificial intelligence (AI) and a symposium which focused on drug delivery methods. Here, he speaks about these two vital areas of consideration in glaucoma management.

 Hey everybody! Paul Singh, I'm the president of the Eye Centers of Racine and Kenosha, out in southeastern Wisconsin. I'm an anterior segment and glaucoma specialist. I'm here at Glaucoma 360 2025, and I was on a panel with Felipe Medeiros, MD, a fantastic surgeon out in Baskin Palmer, and we had a panel session on artificial intelligence in glaucoma. And it's pretty impressive to see the new technology that's coming out, or that's already out right now. From diagnostics and helping us with flow and efficiency in the practice, helping us better understand who are progressing, who are not. I mean, we don't have a lot of time in these exam room lanes to take all the data that we have at our disposal, from fields to OCTs to history to pachymetry, you name it, and then trying to synthesise all that into a plan of action. It can be difficult, as well. But having AI to help us along the lines and taking all that data and helping us understand, is there progression? Who may be more rapidly progressing? And then, also, helping us with some of the decision-making processes, I think, is really going to help us with efficiency and flow, and really, I think, treat patients earlier.

There's also AI for research centres. Personally, I have a research centre, and we are really having a hard time keeping up with all the research projects that we have. Having AI help with some of the kind of backend issues that we face as well, with some of the protocols that we need to do—having AI help with the operations side of it as well, both from the sponsor as well as from the end user and the research centres—I think is going to help us a great deal. Then we have AI with outreach, patient education. So I think AI is not just something that we see in the future, helping us. AI is already here today, from diagnostics to treatment planning to outreach to research. So I think it's an exciting time, something that we I think all are embracing. We had a great talk this morning, showing us, from market scope data, that most doctors are utilising some form of AI now, and are very positive, [looking at] the future, of adopting more AI as well. So, exciting times ahead.

I also had a panel, along with Courtney Bovee, MD, on drug delivery. I think drug delivery is an exciting topic. We have a couple products out right now, DURYSTA and iDose, and a lot more products that are in development right now. Hopefully the next couple of years, they're going to be available to us. And I think what we're seeing with this interventional glaucoma mindset is this understanding that compliance is real. For us to treat these patients, and to not understand the impact of compliance, I think, is part of the reason why we see some of our patients progressing. The frustrations we have as physicians when a patient comes in and is progressing: Do we know if they're compliant? Is the drop working? Are they getting it in their eye? And then also understanding the decision making process. When someone is on a topical medication, and we have a patient coming in who's progressing, what do I do next? It's hard to know, because it could be a lack of compliance. Are the drops working? Are they getting them in the eye? Well, if you're not on a drop—let's say you did drug delivery—and they're still getting worse...Hey, now it's an easier decision that we can make as well. 

I think we're having drug delivery in different formulations, and different delivery mechanisms and technologies, whether it's IOLs, whether it's superchoroidal space, intravitreal, in the anterior chamber. And so I think we're seeing more and more technologies coming our way. So drug delivery is no doubt here to stay, and I think it falls beautifully within this interventional glaucoma mindset, along with SLT, with minimally-invasive glaucoma surgeries, with MIBS. We're seeing, now, all of these technologies finding their places. And it's not one or the other anymore. At any given time, with a patient in my room, how do I maximise quality of life as well as be as aggressive as I can with IOP, and minimise compliance issues? All these devices and technologies all work together as well. I think drug delivery is a big part of that.

I think what's going to happen in glaucoma, first of all, is just the population is growing. We don't have a lot more ophthalmologists, especially glaucoma specialists, coming out. So we need more efficient, better ways of addressing patients, identifying those patients, and more importantly, identifying which patients are going to progress more rapidly, and which ones will not progress more rapidly. We can triage how often we have to see them in our clinics and how aggressive we have to be, I think we'll be utilising more procedures, more diagnostics as well, to allow us to understand, again, who we should be wore aggressive [when] treating as well. I think the biggest issue we face is population growth. Providers [are] not growing at the same rate. How do we take care of these patients in a way that they deserve to be taken care of, and minimise rate of progression of any of these patients? And I think someday we're going to have the ability to restore vision, which I think is something that's probably the most exciting part of all of this. It's not just neuroprotection, but can we actually restore some of the functionality? I think we're going to get there some day, too.

The interventional glaucoma mindset can maximise quality of life, but requires clinicians to act fast

I. Paul Singh, MD, says artificial intelligence will help glaucoma specialists make decisions

AAO 2024, minimally invasive glaucoma surgery, MIGS, glaucoma treatment, ophthalmologists, patient outcomes, innovations, breakthroughs, glaucoma management, surgical techniques

AAO 2024: Progress in minimally invasive glaucoma surgery elevating patient care

At the 2024 American Academy of Ophthalmology meeting, held from October 18 to 21 in Chicago, Illinois, US, Vikas Chopra, MD, from Doheny Eye Institute, UCLA, led a course on minimally invasive glaucoma surgery (MIGS), highlighting its transformative impact on ophthalmology and glaucoma management, especially in challenging cases. The course featured both lectures and a hands-on wet lab, allowing participants to engage directly with experts, review their techniques, and practice the steps in a supportive environment. Chopra highlighted the importance of teaching practical skills, as many attendees were seeking refreshers on procedures they had previously encountered in their own practices.

The evolution of technology in ophthalmology has played a crucial role in improving patient outcomes. Collaborations between ophthalmologists and industry partners help refine surgical techniques and develop safer devices, enhancing predictability and effectiveness in these interventions. Chopra stressed the significance of sharing “pearls,” or insider tips learned from experience, as these insights are often not documented in textbooks but are essential for successful surgery. This hands-on course brought together specialists who have performed hundreds of cases to share their expert knowledge and experience with attendees in the lab.

Chopra emphasized that patient safety is always a priority, and surgeons must understand their limitations. This mindset encourages humility and collaboration, as even experienced surgeons like himself consult with colleagues for advice on complex cases. He mentioned seeking input from ophthalmologist-peers, illustrating a shared commitment to the best patient outcomes.

The course reflects a broader trend in ophthalmology where practical knowledge, mentorship, and continuous learning are key to success. While technology advances, MIGS empowers physicians to address glaucoma earlier and more safely. By learning from specialists with extensive experience, attendees gain valuable insights, helping to foster a community that prioritizes excellence in patient care and precision in glaucoma treatment.

Vikas Chopra, MD, focused on minimally invasive glaucoma surgery (MIGS) and its significance in enhancing glaucoma treatment. He highlighted how MIGS allows ophthalmologists to perform interventions at an earlier stage and with increased safety, resulting in improved patient outcomes.

Canonical

AAO 2024: Elevating patient care through progress in minimally invasive glaucoma surgery

Victoria L Tseng, MD, PhD, professor of ophthalmology and glaucoma specialist, UCLA

At this year's American Academy of Ophthalmology (AAO) meeting, Victoria L Tseng, MD, PhD, took time to speak with the Eye Care Network during a jam-packed conference. Prof Tseng served as a panelist alongside Victoria M Addis, MD, during the "Glaucoma Original Papers" session, chaired by John T Lind, MD. The Sunday morning session explored a broad range of topics in the glaucoma space, from selective laser trabeculoplasty outcomes to genetic disease markers.

Here, Prof Tseng discusses the papers presented in the session by Giovanni Montesano, MD; Jason D Horowitz, MD; Christopher M Edwards, BS; Eamonn Thomas Fahy, BMBCH; Kiana Tavakoli, MD; Hani El Helwe, MD; and Joseph F Panarelli, MD.

: My name's Victoria Tseng. I am an assistant professor of ophthalmology and a glaucoma specialist at UCLA. It was a very nice mix of clinical data-oriented and basic science studies that were discussed in this session. 

There were two kind of secondary studies of the LiGHT trial. I think most of this audience is familiar with the LiGHT trial, and that it was looking at SLT versus drops for glaucoma. But one of the follow up studies they did that was presented today was monitoring visual field progression in people who were enrolled in the LiGHT trial and comparing visual field progression in people who got SLT versus those who got eye drops. They used some advanced statistical techniques to analyse the visual fields where they could filter out some of the noise from taking the test. And the overall conclusion was that SLT might be associated with slightly slower visual field progression compared to eye drops. The other one with the LiGHT trial database was looking at associations between baseline intraocular pressure and outcomes after SLT versus eye drops. And what they found, overall, was that people who had higher baseline IOP might do better with SLT as an initial therapy for glaucoma, while those with lower baseline IOP may not necessarily have a difference between the two types of treatment modalities. 

There was one interesting study looking at intraocular pressure rises after retinal injections. It's really wonderful that we have so many retinal injections available now, but one of the new things that is happening as part of this is that the injection volumes are increasing for certain types of injections. Before, they were all 0.05 CCs, and now some of them are 0.07 [CCs] or even 0.1 [CCs]. So there was one study where they looked at patients who got all these injections in the eye clinic, and measured their intraocular pressure at multiple time points after the injection, until it came down to under 35 millimeters of mercury. And it did look like the larger injection volume may have been associated with higher intraocular pressures and higher return to baseline. So that is something that I think we will need to look into further in the future, especially for our patients with glaucoma. 

There was a database study using the All of Us database, where they were looking at people from different ancestral backgrounds to see if there were specific genes that might be associated with glaucoma in these different populations. And the interesting part was that, in addition to looking for these genes, they did what's called an impact analysis to see which of these genes actually bind to transcription factors, which might actually translate to something that's more clinically interesting. So in people from different ancestral backgrounds, they did find different subsets of genes. So I think this is a very, very early first step, and hopefully one day creating more personalised glaucoma therapies and monitoring plans for people. 

There was also a basic science study looking at [Apolipoprotein E] APOE and Galectin-3 as biomarkers for microglia activity, both in the aqueous humor of the eye and in the serum. That was very interesting, as well. They definitely found elevated levels of both of these things in the aqueous humor, but the results in the serum were less consistent. But I think it's a very good thought process, because if we are ever going to start coming up with neuroprotective therapies, we're going to have to have ways to monitor the activity of these therapies, and I think that's where the application of this might come in the future. 

And finally, the results from a trial comparing the Preserflo shunt (Glaukos) to trabeculectomy were presented. This was mainly more in relation to the safety and adverse events. And the Preserflo shunt did have slightly more safety events, but really, in the grand scheme of things, the adverse events in both study groups were very low. So that was encouraging as well. I'm kind of amazed at how much data has come out of the LiGHT study, because when that first came out, you know, it was already such a big trial, but we just keep getting more and more information from it. So I think it's really influenced how a lot of us practice in terms of thinking about the role of SLT.

Victoria L. Tseng, MD, PhD, discusses SLT, microshunts and what glaucoma specialists can learn from large data sets

AAO 2024: New data illuminate glaucoma care paradigms for surgical interventions

AAO 2024: Clinical trials of travoprost

At this year's American Academy of Ophthalmology (AAO) meeting, John Berdahl, MD, spoke about the recent clinical trials of travoprost and its use in patients with prior SLT.

Editor's note: This transcript has been lightly edited for clarity.

Hello, John Berdahl here at the American Academy of Ophthalmology. I'm a ophthalmologist at Vance Thompson Vision in Sioux Falls, South Dakota, and was lucky to participate in the iDose clinical trials. And some of the data that we're presenting here is, how did iDose do in patients that had prior SLT, in particular those that had failed prior SLT. And the good news is it works. And you know, we know that prostaglandins work. We also know they can be tough on the surface of the eye. And so what we hope for is that by putting the travoprost directly inside the eye, we get better access to the trabecular meshwork with lower doses, and don't have to fight the barrier of the cornea or the side effects that come from applying a drug to the ocular surface. And indeed, that was the case. 

And there's actually other data out there that shows that, in those big trials, the intracamral delivery of prostaglandins show that it lowers IOP even further. So it's good news for us. It's good news, most importantly, for our patients that in these difficult to treat patients, like those that had had a prior SLT, or maybe even in those that prostaglandins aren't quite good enough, that the iDose can help us in those situations.

Dr Rick Lewis discusses the FLigHT procedure and ViaLase laser at the 2024 European Society of Cataract and Refractive Surgeons (ESCRS) meeting

This year, the European Society of Cataract and Refractive Surgeons holds its congress in Barcelona, Spain. We spoke with Rick Lewis, MD, about the femtosecond laser image-guided high precision trabeculotomy (FLigHT) procedure from ViaLase, the company’s recent CE mark and 36-month results he presented at the meeting.

Editor’s note: The below transcript has been lightly edited for clarity.

 This year, the meeting of the European Society of Cataract and Refractive Surgeons is in Barcelona. Joining me today, I have Dr Rick Lewis, who is the Chief Medical Officer at ViaLase, who's going to talk about what he's bringing to the meeting. Dr Lewis, thank you so much for being here.

 Thank you for the kind introduction. You know, it's a pleasure to be here and share what I think is very exciting data from our initial phase one safety study at ViaLase. We evaluated channel patency, intraocular pressure and safety over a 36-month period in our initial cohort of open angle glaucoma patients, looking at the FLigHT treatment; FLigHT stands for [femtosecond laser] image-guided high precision trabeculotomy. This was a prospective, single-centre study. It wasn't randomised. It was 18 eyes with 12 patients and started back in 2020. We had our prototype machine and were able to create, without any safety issues, a channel in the trabecular meshwork of 200 by 500 microns, and this is a non-incisional trabeculotomy. What separates the approach with ViaLase is that the patient interface, like what you get with IntraLase or LenSx, is applied to the patient's eye after applying topical anesthetic. The procedure takes minutes. There's no incision, there's no restrictions post-op, there's no hyphema, and the patient has a trabeculotomy.

We were able, in the study, to follow them over the course of 3 years. Our data is impressive. We got pressure reductions of almost 7 millimeters. A few patients did need to require medications, but the vast majority did not, and our safety, both initially and at 3 years, was remarkably good. So we're very excited about this.

We're actually in the middle of other studies now, some of our pivotal studies, and we're happy to report that we have applied for and received EU approval, European Union approval, to launch this product in Europe, [either at the] end of this year, or more likely, the first quarter of next year. This will be, again, the FLigHT treatment with ViaLase. So it's an exciting time. We have a number of presentations at this year's ESCRS meeting, including the iNovation session.

This particular abstract will be presented in the scientific programme. We have a series of other meetings, and are very excited to launch this new approach to treating glaucoma.

: I was lucky enough to report on that CE Mark that the ViaLase laser received in the EU just just a few weeks ago. What do you think that that approval, and this procedure, says about the changing landscape of both glaucoma care and refractive care?

 I've been in glaucoma for close to 40 years, and it's always been frustrating. You know, historically, we have treated glaucoma with topical eye drops, which we all know patients are non-compliant and create a significant ocular surface problem for those patients, not only in glaucoma, but for refractive and cataract surgery. The ability to create a trabeculotomy without a corneal incision will add a unique and special opportunity in treating these patients, both early and late in the disease. And I think that represents, truly, like you say, a paradigm shift in the management of this disease. I'm excited by it. And when you look at the technology, most everyone gets excited by it. This is very unique, and it isn't even the creation of the trabeculotomy. It's our imaging system, both gonioscopic imaging and OCT imaging, that allows very precise placement. With a commercialised device, we will be able to place one, two, three or even four channels. And there is very little risk involved in this, and it avoids all the problems that happen with intraocular trabeculotomy. So a very exciting opportunity. And again, between this and some of the other laser treatments, I think the paradigm of using medications early will probably be changed.

: The other major aspect of the FLigHT procedure that makes it so unique is that it's something that extends treatment to patients regardless of their lens status. What do you think is so important about accessibility, especially for patients in Europe?

: Well, you know, the issue with lens status has to do, of course, with all the approved MIGS treatments. In any area, whether it's Europe or North America, the approval process demanded that a cataract surgery be done in conjunction with most of the device-related MIGS procedures. Well, not everybody, of course, has cataracts, or perhaps has had cataract surgery in the past, and cannot be a combined procedure. The opportunity here to do it in phakic eyes and pseudophakic eyes, in primary glaucoma and secondary glaucoma, in a variety of age groups, whether it's...an ideal treatment in the future for early juvenile-onset glaucoma, and certainly even in the elderly. Because the risk factor is significantly reduced. Now, we don't have data yet on some of these secondary glaucomas, but the opportunity is obvious and will certainly be pursued.

: I know that you and I have discussed how we're both turning our European conference travel into vacations this year, because we're smart! But the ESCRS is 

 a big congress. Tell me a little bit about what you're looking forward to discussing or debating with your colleagues there.

: You know, ophthalmology is such an exciting field, and there's so many things going on at all these different levels. You know, whether it's cornea, refractive or cataract, the new lenses, the laser-adjusted lenses, the ability to treat glaucoma with non-pharmaceutical ways, you know, the cornea treatment, there's exciting areas of replacing cornea. You learn so much at these meetings, and just getting to see your colleagues and hear the latest presentations, I feel very fortunate that I'm in ophthalmology. I can't think of a more exciting field than this.

: Well, I feel very fortunate that you've joined me this morning to discuss the meeting, and I'm sure that our viewers will feel the same. Thank you so much for your time and safe travels!

Rick Lewis, MD, speaks about a non-pharmaceutical approach to treating glaucoma with laser technology

ESCRS 2024: 36-month results following femtosecond laser image-guided high precision trabeculotomy (FLigHT)

Osamah Saeedi, MD, MS, at ARVO 2024

At this year's ARVO meeting in Seattle, Washington, the Eye Care Network spoke with Osamah Saeedi, MD, MS. Dr Saeedi is an Associate Professor of Ophthalmology, Director of Clinical Research and Director of the Glaucoma Division at the University of Maryland School of Medicine in Baltimore, Maryland. Prior to the ARVO annual meeting, he presented a poster at the Imaging in the Eye Conference on 4 May, and took time to share his research with our team.

 I'm at ARVO 2024. Yesterday, I presented at the ARVO Imaging in the Eye Conference; I presented a poster entitled, "The repeatability and reproducibility of fluorescence lifetime imaging ophthalmoscopy (FLIO) and erythrocyte mediated angiography in a non-human primate model." The key findings here are we adjusted intraocular pressure in a non-human, in an acute IOP elevation model, in a nonhuman primate. And what we found essentially that the fluorescence lifetime imaging ophthalmoscopy and erythrocyte mediated angiography were...highly repeatable in this model. 

This is particularly important, because both of these modalities are going to give us further insight, potentially, into the metabolic and non-pressure related changes in glaucoma. So we wanted to make sure that they were not affected by intraocular pressure. While this work is early, it is important as glaucoma specialists that we look for biomarkers for the disease that are not related to intraocular pressure. Hence, knowing the metabolic activity of a tissue, knowing the retinal blood flow, may ultimately help us both monitor the disease early on in, the in the process, as well as develop new treatments that are not related to intraocular pressure. So we have now established that these measurements are highly repeatable in this model of glaucoma, and so we will now look at the long-term changes with elevated intraocular pressure chronically in this model.

Osamah Saeedi, MD, MS, discusses his poster presentation from the ARVO Imaging in the Eye conference

ARVO 2024: Imaging provides insight into the metabolic aspects of glaucoma development

David M Lubeck, MD, speaks at the 2024 ASCRS meeting

 spoke with David M. Lubeck, MD, a refractive surgeon and glaucoma specialist from Chicago, Illinois. Dr Lubeck detailed highlights from the meeting, including his presentations on the minimally invasive glaucoma surgery (MIGS) space, the need for artificial intelligence (AI) to offset the limitations of "human intelligence," and the long-lasting impact of canaloplasty procedures.

I am David Lubeck, from Chicago. I'm speaking to you on the last day of the 2024 ASCRS in Boston. This has been a very busy meeting. I've been unexpectedly busy and focused primarily on MIGS and within MIGS, the canaloplasty space.

My three paper presentations, two of them were various aspects of the iTrack global data registry. The registry has become a very important part of my thinking, about not only canaloplasty, but the entire MIGS space. For this procedure, it is now the largest single data set, which has begun prospectively and is generating more and more data and sub data sets, which previously we didn't have. And so we were mostly working on conjecture, and theory.

We're at the point that our human intelligence, or HI, is almost no longer able to sift and sort and make the best sense of the data that we're getting. The session yesterday afternoon, when all these MIGS papers were being presented. Everything, different procedures, combined procedures, various scenarios, different surgeons, all had fairly similar results. So, pressure reductions of between 20 to 30%, medication reduction by at least 50%, but not always to zero. Didn't matter the paper or the topic, the data sets were almost almost interchangeable. So, I would like to see somebody build an AI engine, which is going to be specifically focused on MIGS procedures, and then the analysis of these larger data sets to give us much more nuanced and specific information about treatment paradigms in this space.

The things that are surprising to me, again, canaloplasty–I do mostly canaloplasty for a number of reasons. I'm surprised now at the longevity of effect. There's data at now 6 and 7 years out that it is still providing effective pressure lowering. Specifically in this last session, the most impressive thing to me, or the thing that surprised me, was that one presenter showed a study where up to four MIGS procedures were done in combination, in the same procedure. And the results of four surgeries was not that much better than one or two or three. So there's so much we don't understand that, again, I don't think as human intelligence, we're getting right yet.

David Lubeck, MD, talks about the biggest surprises from ASCRS in the glaucoma space

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