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Lowering IOP may restore visual function in glaucoma
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SAN ANTONIO – L. Jay Katz, MD, encouraged attendees to dismiss their preconceived notions of glaucoma and to drop the ideas that have been repeatedly taught in the industry, during his presentation here at the Optometric Glaucoma Society annual meeting prior to the American Academy of Optometry meeting.
“We often tell glaucoma patients, ‘The best we are going to do is to stop you from getting worse.’ Our patients deserve better,” Katz, an OGS honoree, director emeritus of the glaucoma service at Wills Eye Hospital and professor of ophthalmology at Thomas Jefferson University in Philadelphia, said.
He asked the audience whether it is possible to take patients who are blind or near blind, with a lot of functional loss from glaucoma and reverse the process.
“It’s a very complex process of taking visual information from the eye. If it’s damaged in some way, can we repair it in a way that restores visual function?” Katz asked.
An estimated 6 million are blind worldwide from glaucoma, he said. In the U.S., it’s the third leading cause of irreversible blindness and the first cause in African Americans and Hispanics.
Of those who go blind due to glaucoma, one-third go undiagnosed until they have significant vision loss, one-third have inadequate treatment, and one-third are not compliant with their treatment plan.
“I think we need to do better. We need to have better strategies for helping patients and, perhaps, reversing the process,” Katz said.
Researchers are using neuroprotection to inhibit retinal ganglion cell death as a means to reverse disease, he said.
Measurements of improvement in glaucoma include structural changes, optic nerve photography imaging, blood flow, perimetry and contrast sensitivity.
“Could retinal ganglion cells in the optic nerve that are dysfunctional prior to death be restored to health?” he inquired. “I think that’s going to be an important step for us to attack, in a multifaceted manner.”
Reducing IOP and increasing ocular perfusion are steps practitioners can take to improve the disease. He said other clinical examples of disease reversibility outside of optometry are myocardial infarction, stroke and spinal cord injury.
He cited published reports of reversibility of glaucoma.
“Can conventional therapy do more than provide stability?” Katz asked.
Reversibility can change how we manage the expectations and goals for therapy in glaucoma, he said. His project as a fellow was to try to show that reversibility of pressure reduction was correlated to the amount of total pressure reduction.
Three masked glaucoma specialists looked at optic nerve photographs before and after treatment and serial visual fields before and after treatment. They reported reversed optic disc cupping and visual function improvement in the adults with glaucoma.
With pressure reduction, you can get improvement on OCT imaging of nerve fiber layer and improvement in visual fields in the same population, he said.
With pressure reduction, researchers have seen improvement in electroretinogram readings.
“Lowering pressure is a risk factor; we can show that perhaps by lowering pressure a significant amount, we can get some restoration of function by looking at different parameters – and structural improvement as well,” Katz said. – by Abigail Sutton
Reference:
Katz LJ. Is glaucoma a reversible disease? Presented at: Optometric Glaucoma Society Meeting; San Antonio, Texas; November 6, 2018.
Disclosure: Katz is chief medical officer for Glaukos.