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

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.

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

Victoria L Tseng, MD, PhD: 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.