Glaucoma Section Newsletter

‌

A Message from

the Glaucoma Section

Glaucoma Section Newsletter - Winter 2019

In This Issue:

Message from the Immediate Past Chair
Message from the Glaucoma Section Chair
Recap of 2018 Glaucoma Section Symposium
Literature Review
Glaucoma Section Google Group

Message from the Immediate Past Chair

Dear Glaucoma Section Members:

That was a great meeting! Thank you to all who attended our symposium, Rapid Fire sessions, Diplomate Prep Course, or reception for helping to make the Glaucoma Section events well attended, interactive, and informative for all. I will now pass the reins to our newly elected executive council, led by the extremely capable Dr. Jennifer Brown, who have already began planning Academy 2019 Orlando and the 3rd World Congress of Optometry. Check them out or contact any of the executive council by visiting the Academy's Glaucoma Section webpage .

Lauren Ristin, OD, FAAO

Immediate Past Chair

laurenristin@gmail.com

Message from the Glaucoma Section Chair

Dear Glaucoma Section Members:

I would like to introduce myself as the new Glaucoma Section Chair. I am very excited to take on this role but even more excited to see the success of the Glaucoma Section continue. We had a wonderful meeting in San Antonio and appreciate your attendance at our spectacular glaucoma educational events. Some highlights for me were attending the Section education, the Diplomate Prep Course, and knowing that we had a Diplomate Candidate complete and pass the written examination. I also enjoyed interacting with all of you, the Glaucoma Section members, and our hard-working, dedicated members of the executive committee. Our committees work very hard to plan and prepare our events and I would like to give a big thanks to everyone who volunteered to make Academy 2018 San Antonio a success. A special thanks to our Immediate Past Chair, Lauren Ristin, OD, FAAO, for her hard work and passion for the Glaucoma Section. I hope to build on her success. We have already begun planning more great events, lectures, and symposium for Academy 2019 Orlando and look forward to this year working together to make it all possible.

I would like to encourage you to participate and volunteer in the Glaucoma Section. You can participate in dialogue and case discussions through our Google group emails, become committee members in the Section, or go through the rewarding and prestigious process of becoming a Diplomate in our Section. If you are interested, please contact any of us through the Academy's Glaucoma Section webpage or email me directly.

Going forward, with the efforts of our current executive committee members and Section members, I hope to continue the mission statement of our Section and promote excellence in the care of patients with glaucoma by developing evidence-based educational activities, fostering original research endeavors, and promoting inter-disciplinary collaboration.

Jennifer Brown, OD, FAAO

Glaucoma Section Chair

Jenniferbrown0726@gmail.com

Recap of 2018 Glaucoma Section Symposium

Contributed by Programs Committee

(Andrew Rixon, OD, FAAO)

On Thursday, November 8, the Section presented "Overcoming Aggressive Glaucomas" in the Hemisfair Ballroom of the Henry B. Gonzalez Convention Center in San Antonio. The session was moderated by Richard Madonna, OD, MA, FAAO (SUNY College of Optometry) and speakers were Michael Cymbor, OD, FAAO (Nittany Eye Associates), Daniel K. Roberts, OD, PhD, FAAO (Illinois College of Optometry) and Tammy Than, OD, MS, FAAO (Carl Vinson VAMC). A comprehensive review of angle closure, pigmentary and exfoliation glaucomas was provided. The panel was exceptional and their insights were appreciated by the attendees, with feedback being overwhelmingly positive for this topic and these speakers. After another successful symposium we look forward to your attendance at the Section's 2019 symposium in Orlando.

Literature Review: Low Nocturnal Diastolic Ocular Perfusion Pressure as a Risk Factor for Progression: A 5-year Prospective Study

Eye , 2018 Jul; 32 (7): 1183-1189.

Review and commentary by Austin R. Lifferth, OD, FAAO

Normal tension glaucoma patients can sometimes show structural and/or functional progression despite low and seemingly stable intraocular pressure measurements. This frequent and concerning clinical challenge is both worrisome to the patient and to the doctor. What other factors may be contributing to this progression? Are there other tests that we can do on a routine basis that may help us better understand this progression?

According to our recent Glaucoma Section Google Groups survey*, only 47% of us check blood pressure on our patients as part of our glaucoma evaluations. Based on the results of the following article, checking blood pressure on a routine basis for our patients may give us more pieces and added perspective to this persistent puzzle.

Background/Purpose

Recent studies have documented the effect of fluctuating intraocular IOP, blood pressure (BP), and ocular perfusion pressure (OPP) in the development and progression of glaucoma. More specifically, the Barbados Eye Study and the Baltimore Eye Survey showed that low diastolic ocular perfusion pressure (DOPP)** was a risk factor for developing glaucoma and the EMGT study showed faster rate of progression in those patients with lower OPP at baseline.

The purpose of this study was to determine the relationship between intraocular pressure, blood pressure, ocular perfusion pressure, and visual field progression in normal tension glaucoma (NTG) patients over the course of five years.

Design/Methods

This prospective, longitudinal study followed 65 NTG patients from the University of Malay Medical Centre Department of Ophthalmology. To rule out possible high-tension glaucoma patients, all subjects on topical IOP-lowering medication had a washout period of 4-6 weeks followed by baseline 24-hour IOP and blood pressure monitoring and then restarted on topical treatment as indicated. Visual field progression (based on modified Anderson criteria) was defined as repeatable defects noted on two consecutive VF examinations. Baseline demographics and systemic co-morbidities were similar with no significant differences other than baseline MD between the progressing and nonprogressing groups.

Results/Conclusions

I) Although there was no statistical difference in 24 hour IOP parameters, the progressing group had significantly lower diastolic pressure and DOPP throughout the day, evening, and night-time readings compared to the non-progressing group.

“…intraocular pressure and its fluctuation is not a significant factor in the progression of this disease [normal tension glaucoma] unlike in high-tension glaucoma.”

II) “…nocturnal [hypotension] events are the main key players that influence the disease process.”

“…DOPP at night emerged as a major risk factor that predisposes NTG patients for VF progression.”
“…most tissue perfusion occurs during diastole.”

III) “Lower nocturnal DOPP is an independent predictor of glaucomatous VF progression in these [normal tension glaucoma] patients.”

IV) “A [1] mmHg decrease in nocturnal DOPP increases the hazard of progression by 1.4 times. Patients with DOPP<35 mmHg have a 2.3 fold higher probability of progressing compared to the patients with DOPP >43.7 mmHg.”

*32 doctors responded with a range of 0% to 100%.

**DOPP = difference between diastolic BP and IOP

Glaucoma Section Google Group

Are you interested in participating in a forum with 500+ peers for inquisitive discussions? Join your fellow clinicians, educators, and researchers in the Glaucoma Section Google Group where you can ask challenging questions, present interesting cases, and have stimulating conversations.

If you are a Fellow interested in joining the Glaucoma Section Google Group, please e-mail glaucomasection@gmail.com with your request.

We look forward to hearing your thoughts, discussions, and questions in the Google Group!