Looking to the Future of Glaucoma Treatment

As far as we know, intraocular pressure (IOP) is the only modifiable risk factor with respect to altering glaucoma’s characteristic death of retinal ganglion cells. IOP quantifies the balance between aqueous humor secretion by the ciliary body epithelia and its drainage through the conventional, pressure-sensitive pathway and unconventional, pressure-insensitive or “uveoscleral” pathways. IOP will increase along with any resistance to aqueous outflow. This can result from age-related cellular dysfunction in the conventional outflow pathway or a normal outflow system unable to handle overproduction. Since altering other mechanisms in the pathophysiology of the disease is not possible without profound risk to the patient, lowing IOP is the only means of arresting disease progression. In the United States, the current guidelines for the initial intervention of newly discovered cases of primary open-angle glaucoma recommend a first-line approach with topical ocular hypotensives. To that end, three new agents that are under investigation aim to decrease IOP without upsetting the physiology. If successful, these medications could help keep the primary outflow pathway functioning.

Hitting a Nerve

Neurostimulation has been an invaluable addition to the medical field since the 1950s with the invention of the first implantable pacemaker.

Today, it’s used in implantable defibrillators and cochlear implants and for treating chronic pain, refractory epilepsy, Parkinson’s disease and essential tremor, obsessive- compulsive disorder, obesity, depression and migraine prophylactically. As a means of applying stimulation to regions of the nervous system to alter neurophysiological signals affecting tissues and organs, it has the potential to affect almost any part of the body—and that includes the eyes.

Glaucoma Surgery: Are You Ready to Refer?

While optometrists can serve the needs of most patients with glaucoma, many will eventually require a referral to a glaucoma specialist. The most frequent reasons for a consultation are for surgical care, diagnostic dilemmas and complex or unusual cases. The timing of surgical consults, however, can be tricky, as the need may arise early or late in the course of open-angle glaucoma, depending on the case. In addition, optometrists should be prepared for patients susceptible to angle closure. Here, we discuss the available surgical options for glaucoma, when optometrists should consider a referral and post-op care.

Every Picture Tells a Story

It’s debatable whether all acute isolated oculomotor cranial neuropathies, in patients older than 50 with or without vascular factors, should undergo neuroimaging. Here, we review cranial nerve three, four and six palsies and provide reasons for neuroimaging all isolated cranial mononeuropathies.