What’s new and what do I need to know about Glaucoma

Glaucoma research continues globally, offering new and improved treatments, diagnostic methods, and insights into the nature of the disease.

Scientists and clinicians are collaborating around the world, conducting careful research to design and evaluate new technologies, while also working with industry to bring them into clinical practice.

So, what’s new in glaucoma? Here are some insights into recent advances:

• Vitamin B3 supplements: to take or not to take?

While we are still awaiting the results of randomized control trials, more evidence is pointing to the beneficial role of Vitamin B3 in glaucoma. Vitamin B3 supports many aspects of metabolism important in maintaining optic nerve health, making optic nerve cells (neurons) more resistant to raised eye pressure. Vitamin B3 supplements are not yet recommended to all patients, but people with severe or uncontrolled glaucoma should consider this vitamin – please discuss with your clinician before taking the supplement.

• Minimally invasive glaucoma surgery: what are the benefits?

New surgical devices are being developed and critically evaluated for the surgical management of glaucoma. These devices range from tiny, titanium micro stents used at the time of cataract surgery to improve the eye’s natural drainage pathways; to larger collagen stents that traverse the eye, allowing drainage of fluid from inside to outside of the eye, where the fluid collects in a reservoir under the eye’s lining, hidden by the upper eyelid. The idea is to make glaucoma surgery safer and more predictable.

These new surgical options for glaucoma offer more options for patients, and potentially more alternatives to topical glaucoma eyedrops. This is important, as topical eyedrops cause side effects, dryness and discomfort in and around the eyes, and are often not as reliable in controlling glaucoma as we would hope. 

As our use and research into these devices evolves, we are learning better when to use them and when not to use them for glaucoma treatment. In many cases the promise of a new surgical technology does not live up to the reality; that is why carefully conducted clinical trials are so important to help guide us in our decision making.

• Novel means of vision testing

Assessing an individual’s peripheral vision is crucial for the diagnosis and monitoring of all people with glaucoma, and many people at risk of glaucoma. This peripheral vision test (known as a visual field test) is currently performed with office-based dedicated machinery. However, these machines have their drawbacks; they are large, bulky, expensive, and are often not enjoyable for patients to perform. Much work is being done to develop alternative forms of peripheral vision testing, which could potentially be performed at home and with devices and computers that are cheaper, more enjoyable, and easier to access.

I am privileged to be working on a computer-based system of visual field testing which has great promise, with excellent accuracy of measurement and a very positive user experience for patients – see www.eyeonic.com.au

• Genetics and glaucoma

New research into the genetics underlying glaucoma has revealed that over 100 genes are responsible for glaucoma. These many genes interact in a complex way to influence many factors such as the type of glaucoma they have, how bad the glaucoma is, and whether they will require glaucoma surgery.

However, there is no clear-cut relationship between individual genes and a person’s risk for glaucoma. Because there are over 100 genes linked with glaucoma, it is not as easy to test for all of these, and even harder to interpret the testing results. What’s more, non-genetic factors, such as age, lifestyle, previous trauma, medications, co-morbid diseases, are also major influences of glaucoma – clearly the genes make up only part of the story. For this reason, it can be hard to predict anyone’s risk of glaucoma, or its severity, based on their genes alone.

• Artificial Intelligence in glaucoma diagnosis

Artificial Intelligence (AI) is being used to improve diagnostic accuracy of traditional tests (optic nerve scans and visual field tests) in glaucoma. This may lead to earlier and more accurate diagnosis, saving sight by early detection.

• New classes of topical medications

New classes of glaucoma eye drops are being evaluated. New classes of medication (such as the Rho Kinase inhibitors) might be useful for some people who are otherwise intolerant to the current topical drops available.