HMS Ophthalmology Center of ExcellenceCenter of Excellence

New Image of Glaucoma

David S. Friedman, MD, PhD, MPH
Janey L. Wiggs, MD, PhD
See a list of Glaucoma faculty

The Glaucoma Center of Excellence was established with the explicit goal of shrinking the timeline in bringing sight-saving advances to our patients and people throughout the world.

Glaucoma encompasses several conditions that cause optic neuropathy, or damage to the optic nerve. Glaucoma affects an estimated 60 million people worldwide—making it the second-leading cause of blindness internationally, according to the World Health Organization. Although glaucoma is much more common in older adults, it can occur at any age.

Glaucoma often develops slowly. It typically affects peripheral vision first, but symptoms may go unnoticed for several years because visual acuity is maintained until late in the disease.

Primary open-angle glaucoma (POAG) is the most common form of glaucoma. It is associated with increased intraocular pressure (IOP), also known as ocular hypertension, which may in turn, lead to retinal ganglion cell death and optic neuropathy. Secondary glaucoma occurs as a complication of eye surgeries, injuries, infections, or other ophthalmic conditions. Glaucoma may even occur without increased IOP in normal tension glaucoma, and many kinds of glaucoma have strong genetic and/or environmental risk factors.

Major Research Breakthroughs

Research programs in glaucoma investigate risk factors for glaucoma, as well as methods for early disease detection and novel therapeutics. In the last 20 years, our investigators have:

  • Demonstrated the use of spectral domain and 3D swept-source optical coherence tomography to detect retinal nerve fiber layer thinning, which can occur before clinically detectable, irreversible vision loss in glaucoma
  • Identified structural remodeling of astrocytes as a potential new target for disease pathogenesis
  • Identified over 100 novel genetic risk factors for glaucoma and related ocular traits
  • Identified environmental risk factors for exfoliation glaucoma, including residence in northern latitudes
  • Identified subtypes of glaucoma based on machine learning of visual field defects and specific optic nerve features

2020 Vision: Promising Areas for Future Research

Investigators aim to develop models for disease screening and risk prediction based on machine learning, fundus images, and genetic risk factors. The glaucoma team hopes to further elucidate the underlying molecular and environmental mechanisms of glaucoma. “Imagine if a patient with stable glaucoma only had to be seen once every one or two years,” says Co-Director David S. Friedman, MD, PhD, MPH. “As we learn more about the disease mechanisms, we’ll eventually be able to provide more precise treatment plans based on individualized risk assessments. And with the use of telemedicine, we will be able to monitor patients more closely than we do today to ensure that any early changes are detected and treated quickly.”

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