Understanding glaucoma presents many challenges for physicians

Robert N. Weinreb, MD, discussed several challenges facing glaucoma specialists during the World Glaucoma Congress.

VIENNA, Austria — Forming a better understanding of IOP and its role in causing and preventing glaucomatous damage is one of many challenges facing glaucomatologists in the future, according to Robert N. Weinreb, MD, PhD. Dr. Weinreb, president of the Association of International Glaucoma Societies, listed some of the challenges for glaucoma researchers in the future in his speech during the closing ceremony of the World Glaucoma Congress here.

As a method for creating a better understanding of the dynamics of IOP, Dr. Weinreb said he looks forward to the introduction of a 24-hour continuous IOP compliance monitoring device within the next 5 years.

He said easier-to-use experimental models that mimic human glaucoma, such as the transgenic mouse, will be important for future disease research.

He said he would like to see “the establishment of clinical methods for assessing the entire visual pathway,” as well as a method for clinically imaging the retinal ganglion cells to detect accelerated cell loss.

"I expect that in the future we won't have arguments about structure or function because we'll be able to quantitate the number of retinal ganglion cells and determine whether glaucoma is progressing or stable and whether our therapies are effective or not," Dr. Weinreb said.

Another challenge facing glaucoma specialists, Dr. Weinreb said, is refining risk factor information to better determine who needs which treatment. He cited the work of Felipe Medeiros, who reported on the development of a 5-year risk calculator in a poster at the meeting. Dr. Weinreb called his risk calculation model a “promising turn” in understanding risk factors.

Glaucoma specialists also must understand “the cellular and molecular mechanisms that regulate aqueous humor outflow through the trabecular meshwork and the uveoscleral outflow pathway,” he said.

Dr. Weinreb said he expects to see progress in the future "with a number of drugs that can directly affect the trabecular meshwork and open up the uveoscleral outflow pathway."

Understanding and improving patients’ lifestyles -- through factors such as smoking cessation, exercise and reducing obesity – is another challenge Dr. Weinreb said will need more attention from the glaucoma research community.

"Not only is it important to understand these risk factors, but these are modifiable risk factors that might improve the prognosis of patients with glaucoma," he said.

Another challenge is finding a practical method or methods for drug delivery to the retina, he said.

“It’s obvious we have wonderful neuroprotective agents, … however, we still don’t have the means for delivering them. This is a very important challenge for glaucoma in the next decade,” Dr. Weinreb said.

He said glaucoma specialists must learn more about protecting healthy retinal ganglion cells, develop the ability to rescue damaged cells and design safer, more titratable and more predictable IOP-lowering surgeries.