Dear Colleagues,
January was National Glaucoma Awareness Month, an important time to spread the word about this vision-robbing disease. Glaucoma is a leading cause of worldwide blindness; yet, half of the three million Americans with glaucoma are not aware that they have it. People of all ages (including children) and of all ethnic backgrounds are at risk. This includes Latinos, Asians, and especially people who are of black African or black Caribbean descent. By 2020, the number of people with glaucoma worldwide is expected to exceed 70 million.
While early diagnosis and routine monitoring remain the most essential tools to prevent glaucoma from causing irreversible vision loss, a new wave of diagnostic, medical, and surgical innovations are advancing treatments. For example, a new generation of pharmacologic drugs with novel outflow targets are now FDA-approved or in the pipeline. Minimally invasive glaucoma surgery (MIGS) procedures are also gaining popularity as alternatives to traditional major glaucoma surgery. MIGS procedures target various ocular tissues and can effectively reduce intraocular pressure with distinctly lower complication rates and shorter recovery times compared to traditional glaucoma surgeries—in some cases eliminating the need for medication.
Recent innovations also include the use of ultra-high resolution, three-dimensional optic nerve imaging. These new imaging methods have the potential to improve our ability to diagnose glaucoma, to more precisely detect structural changes associated with glaucoma progression, and to improve research methodologies. In genetic research, exciting progress has led to the identification of novel genes for primary open-angle glaucoma (including three new genes in 2016) and normal-tension glaucoma—a critical first step in developing targeted, gene-based therapies.
While still in its early stages, comprehensive, genetic diagnostic testing is becoming more widely available. Sensitive and specific genetic tests are now available for dozens of inherited eye diseases. Among its many benefits, genetic testing can diagnose disease, improve accuracy of a patient’s prognosis, identify gene mutations that could be passed on to children, and help guide genetic counseling. The Harvard Department of Ophthalmology Ocular Genomics Institute, based at Mass. Eye and Ear, is one of several sites to offer CLIA-certified comprehensive genetic diagnostic testing for inherited eye diseases, including early-onset glaucoma. Learn more...
We hope you find this issue of Eye Insights useful in your practice—it includes key information about glaucoma risk factors, guidelines for comprehensive eye exams, updates in the medical and surgical management of glaucoma, and links to patient handouts.
Joan W. Miller, MD
David Glendenning Cogan Professor of Ophthalmology
Chair, Harvard Medical School Department of Ophthalmology
Chief of Ophthalmology, Massachusetts Eye and Ear and Massachusetts General Hospital