Thousands of glaucoma experts from across the globe convened on Vancouver last month for the fifth annual World Glaucoma Congress.

By 2020, the number of individuals with glaucoma is expected to grow to 79.6 million.¹ With that sobering reality in mind, thousands of glaucoma experts from across the globe convened on Vancouver last month for the fifth annual World Glaucoma Congress (WGC), to share and absorb new insights in glaucoma research and patient care.

The WGC, hosted by the World Glaucoma Association, is an inclusive meeting where optometrists are given a seat at the table with ophthalmologists and other eye care professionals, says Murray Fingeret, OD, past president of the Optometric Glaucoma Society (OGS).

“The World Glaucoma Congress allows optometrists to learn about glaucoma from the world’s experts. The breadth of the courses allows one to hear about every facet in glaucoma in one meeting,” Dr. Fingeret says.

An estimated 50 optometrists attended the meeting, including members of OGS who presented a symposium “Normative Databases for Imaging Instrumentation.” The OGS panel offered insights on the construction of glaucoma databases, which individuals should be included, and the difficulty in developing one pertinent database for all population groups. OGS experts also reviewed the current normative database in OCTs used in the United States, and discussed whether specific reference sets are needed based upon ethnicity.

Another key symposium was “Biomechanics of the Eye,” which included compelling new data showing that the laminar microstructure is highly variable, and that new 3D reconstruction and analysis techniques are beginning to challenge the prevailing views on the relationship between regional laminar pore size and focal axon loss in glaucoma.

“The speakers focused on the differences in optic nerve head and scleral structure and mechanical behavior in groups at high risk of glaucoma: the elderly, persons of African ancestry, and high myopes,” says symposium chair Crawford Downs, PhD, director of the Center for Ocular Biomechanics and Biotransport, University of Alabama at Birmingham School of Medicine.

Other highlights of this symposium included:

• New computer simulations demonstrate that mechanical strain is the signal that drives remodeling in the lamina in glaucoma.
• Anatomic data shows why high myopes might be more susceptible to damage from IOP than normal eyes.
• New data indicates that the peripapillary sclera stiffens with age in donor eyes from persons of European descent, and even more quickly in persons of African descent.
• New IOP telemetry data from primates shows that up to 10% of the IOP energy that the eye must absorb comes from spikes in IOP over steady state.

	3D reconstruction of the connective tissue of the optic nerve head shows the pores through which the retinal axons must weave on their path from the eye to the brain. These axons transmit visual information, and get damaged in the optic nerve head in glaucoma. Image: J. Crawford Downs, PhD, and Christopher Girkin, MD MPSH

Other noteworthy symposiums included:

• Novel Diagnostic Targets in Glaucoma. The ability to diagnose glaucoma earlier and with greater precision remains an important goal in the management of the disease. This symposium explored novel diagnostic targets, including multifocal pupil perimetry; new approaches to the imaging of the optic nerve, laminar cribrosa and retina; imaging of the retinal vasculature and measurement of ocular blood flow; imaging of changes in the brain; and biomarkers associated with glial activation. Speakers discussed how these various approaches might lead to improved targets for the early diagnosis of glaucoma.

• Imaging Technology Advances. The application of imaging technology to the management of glaucoma has exploded in the past decade. This symposium presented new strategies to maximize the utility of current clinically available technologies, the assessment of blood flow and lamina cribrosa to uncover novel measures, in addition to an enhanced understanding of disease mechanisms.

The panel also looked toward the future with a discussion of progress towards in vivo imaging of dying retinal ganglion cells.

• Advances in Glaucoma Genetics. Experts presented an overview of recent advances in glaucoma, including research that has led to the successful identification of genes and genetic risk factors for primary open angle glaucoma, primary angle closure glaucoma, congenital glaucoma and pseudoexfoliation. Other studies have investigated the genes underlying quantitative traits that are important in glaucoma such as central corneal thickness and optic disc traits.

These discoveries are critical toward the future development of gene-based screening and novel therapeutic approaches based on molecular genetics. The International Glaucoma Genetics Consortium has been formed in the last few years to increase research and collaboration in this area.

• Exfoliation Syndrome and Exfoliative Glaucoma. This common, progressive, age-related disorder involves pathological synthesis and accumulation of extracellular matrix in ocular and systemic tissues and is the most common cause of secondary open-angle glaucoma (XFG) in the world. Recent evidence on the genetic and pathophysiological background of exfoliation syndrome (XFS) has greatly improved the understanding of this enigmatic condition, presenters said.

Risk of cataract surgery complications is significantly increased in patients with XFS and XFG. Clinically, XFG is associated with worse 24-hour intraocular pressure profile, faster deterioration and worse prognosis.

The current management of XFG is not ideal primarily because it does not address the cause of the problem (i.e., the synthesis and accumulation of exfoliation material). The presenters concluded that treatment approach in XFG should be specific to this condition and future therapeutic strategies should not be restricted solely to reduction of intraocular pressure.

• IOP Around the Clock. In this symposium, attendees were reminded that IOP has a circadian rhythm, and that a single IOP measurement is insufficient to show the true nature of an individual’s IOP. Experts also hit on lessons from IOP monitoring in both humans and primates. The utility of office diurnal IOP measurement, results of continuous IOP monitoring among various types of glaucoma, and 24-hour IOP data using a contact lens sensor were also highlighted. Finally, presenters provided a glimpse into the future of what awaits in continuous IOP monitoring and its application in clinical practice.

• A New Addition to the Glaucoma Management Team—The Patient. In the management of chronic, asymptomatic diseases such as glaucoma, long-term outcomes depend in part on adherence to medications and to overall management. These depend partly on physician-patient communication.

Presenters admitted the difficulties in achieving this, since they said most ophthalmologists do not appreciate the patient’s perspective and do not recognize real, practical problems of living with glaucomatous visual disability. To tackle this hurdle, the panel of experts provided pearls on how to connect more effectively with patients within the time and resource limits available.

The next WGC will take place June 2015 in Hong Kong, www.worldglaucoma.org.

1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262-67.