This document summarizes Andrew White's presentation on recent advances in glaucoma treatment. Some key points include: - Glaucoma is increasingly viewed as an optic neuropathy related to aging rather than just elevated eye pressure. Other factors like blood flow, metabolism, genetics also play a role. - While many potential neuroprotective drugs have shown promise in studies, none have yet proven effective in clinical trials at preventing vision loss from glaucoma. - New guidelines promote more collaborative care between ophthalmologists and optometrists. - Several new preservative-free glaucoma eye drop formulations have been introduced to reduce side effects. - Selective laser trabeculoplasty is

1. Andrew White
BMedSc(Hons), MBBS, PhD, FRANZCO
Glaucoma consultant, Westmead Hospital
Clinical Senior Lecturer, University of Sydney
Chair, Expert Advisory Panel, Glaucoma Australia
Chair, Project Steering Committee: Community Eye Care ACI
Associate Board Member, World Glaucoma Association
WHAT’S NEW IN GLAUCOMA

2. THERE'S MORE TO GLAUCOMA THAN
PRESSURE
• Increasing thought of as the
most common optic
neuropathy and a form of
accelerated aging
• Increasingly important factors
to consider
• Ocular Perfusion
• Metabolic/mitochondrial
dysfunction
• Oxidative status
• Scleral
compliance/capacitance
• Genetic sensitivity

3. CAN WE DO ANYTHING CLINICALLY
OTHER THAN REDUCE IOP?
• In a word: No
• Some way from neuroregeneration
• Approximately 50 potential neuroprotective agents validated in in vitro/ex
vitro and glaucoma models1
• No significant clinical trial findings to back this up and many notable failures
• There may be flaws in current trial design
Baltmr A et al Exp Eye Res 2010;91(5):554 –566.

4. WHAT’S NEW IN GUIDELINES

5. NEW GUIDELINES ARE OUT (MORE ON
THE WAY)

6. • Collaborative care is the way of
the future
• Generally positive response
from optometry
• In the process of building
better collaborative care model
COLLABORATIVE CARE GUIDELINES

7. WHAT’S NEW IN DROPS?

8. RECENT CHANGES
• Latanoprost 1st generic PGA 2012
• Increasing move away from BAK
formulations
• Saflutan and Lumigan PF: preservative
free PGAs. PF Ganfort on the way
(August)
• Travatan and DuoTrav now Polyquad
rather than BAK
• A variety of depot preparations in
development

9. PEOPLE DON’T TAKE THEM ANYWAY……
• Healey et al.
2014

10. ADVANCES IN LASER SURGERY

11. SELECTIVE LASER TRABECULOPLASTY
• Increasing use typically primary or
adjunctive therapy
• Cost effective vs drops
0
5
10
15
20
25
30
PreSLT 6 weeks 6 months 9 months 12 months
IOP (mmHg)

12. Zhekov I et al BMJ Open. 2013 Jul 6;3(7).

13. ‘AUGMENTED’ CATARACT SURGERY
Endoscopic Cyclophotocoagulation iStent
Hydrus Cypass

14. TUBES AND TRABS?

15. Trabeculectomy
• Described by Watson and Cairns in 1968
• Still the gold standard for reduction in
IOP
• Channels aqueous outflow into episcleral
venous network through a sclerostomy
under a partial thickness scleral flap
• Rate of flow controlled by
adjustable/releasable sutures
• Antimetabolites like Mitomycin C used
introperatively to reduce conjunctival
scarring and risk of failure
• Less likely to be combined with cataract
surgery than previously
15

16. AVERAGE IOP: MY DATA
0
5
10
15
20
25
30
35
pre op 1 7 30 60 90
AverageIOP(mmHg)
Days Post Op

17. TUBES

18. DRAINAGE TUBES
• Been around since 1969!
• Increasing use
• Trend to use earlier
• PTVT Study underway to assess
role as primary surgery
18