2009 SAGS CONGRESS AT SPIER WINE ESTATE
TOP-TWELVE HIGHLIGHTS
19 – 21 JUNE, 2009, SPIER, CAPE TOWN, SOUTH AFRICA
GUEST SPEAKER – HANS LEMIJ, ROTTERDAM, NETHERLANDS
• Glaucoma patients are reported to have more falls and MVA. Bilateral glaucoma reduces mobility performance. (Hans Lemij)
• Up to 50% of glaucoma patients have a positive family history. First degree relatives have a 3 to 9x risk of developing glaucoma. (Sudan Williams, Johannesburg).
• IOP is used to monitor the effect of an intervention, not to diagnose glaucoma disease. Mean IOP level remains the strongest risk factor for glaucoma progression (Marta Misiu-Hojlo, Poland).
• Never say die on a trabeculectomy. Try saving a trabeculectomy versus sacrificing a trabeculectomy (Rashika Ojageer, Durban)
• IOP reducing treatment was not associated with the presence of disc hemorrhages. Factors related to the presence of disc hemorrhages: myopic eyes, lower baseline, IOP, lower follow-up IOP, female patients, higher frequency of disc hemorrhages with current smoking. (Grant McLaren, Johannesburg)
• In OHTS a low number of disc hemorrhages (DH) was recorded. There was no difference in the frequency of disc hemorrhages between the treated and untreated group (EMGT study). DH had a significantly shorter time to progression. A trabeculectomy reduced DHs in high IOP POAG and NTG patients.
Despite a clear association between DH and progression, progression in eyes with DH cannot be prevented by IOP reduction. The EMGT study suggests that a DH is a predisposition, an independent risk factor for progression. (Grant McLaren, Johannesburg)
• Both structural and functional measurements are necessary to detect progression. The most difficult disc assessment poses a small or large disc and a tilted disc. The visual field index has the advantage to scale according to ganglion cell density, is less sensitive to cataract than MD. (Hans Lemij, Netherlands)
• A HA VF evaluation should question: is it the right VF?, was it carried out correctly? how should I interpret the results? (Hans Lemij, Netherlands)
• Automated optic disc analysis by imaging devices (GDx,HRT) appears to yield better diagnostic classification than clinical judgment of optic disc stereo photos and offer objective documentation for FU. (Hans Lemij, Netherlands)
• Glaucoma specialists outperformed general ophthalmologists. Measurable structural changes probably precede SAP in most glaucomatous eyes. The most sensitive structural measure currently available (clinically) is the GDx of RNF layer. (Hans Lemij, Rotterdam, Holland)
• One of the most popular modern myth is the concept that IOP fluctuations represent a key risk factor or even a more important risk factor than IOP itself for progression. So far there is no clear evidence to support this concept. (E Ancker, Cape Town).
• Fourier domain OCT is still not proven to be an imaging device to detect early glaucoma or predict progression. Frequency doubling technology and SWAP are no better than SAP in detecting glaucoma. (Hans Lemij, Netherlands)
TOP-THREE HIGHLIGHTS SENT FOR PUBLICATION IN INTERNATIONAL GLAUCOMA REVIEW JOURNAL
SAGS Editor: Dr Ellen Ancker, Cape Town
Frequency doubling technology is not better than SAP in detecting glaucoma. In 92% of 416 patients SAP showed glaucoma defects prior to or simultaneously with SWAP.
Both structural and functional measurements are necessary to detect progression. When evaluating a HA 24-2 test, always ask: is it the right visual field? Was it carried out correctly? How should I interpret the results?
Automated optic disc analysis by imaging devices (GDx, HRT) appears to yield better diagnostic classification than clinical judgment of the optic disc. Optic disc stereo photos offer objective documentation for follow-up.
Measurable structural changes probably precede SAP in most glaucomatous eyes. The most sensitive structural measure currently available clinically is obtained with the GDx imaging device of the RNF layer. (Hans Lemij – Rotterdam, Netherlands)
HIV vasculopathy may lead to neovascular glaucoma. It responds well toPRP, Ahmed drainage device augmented with MMC and intra-cameral Bevacizumab. (Sven Obholzer, Cape Town, South Africa)
Despite the recognized hereditary component to glaucoma, research into its genetics is difficult because it encompasses a heterogeneous group of disorders that are complex and multifactorial in nature. Gene associations can be investigated using linkage analysis and, more recently, genome-wide association studies. Using these metholds at least 14 loci (as well as numerous other gene variants) have been identified that are associated with primary open-angle glaucoma (POAG). Within these loci only 3 genes have been identified – mycocilin in the GLC1A locus of chromosome 1 (accounts for 3 to 6% of POAG), optineurin in the GLC1E locus on chromosome 10 (associated with normal tension glaucoma) and WDR36 in the GLC1G locus on chromosome 5. A recent genome-wide association study found a highly statistically significant association with the LOXL1 gene on chromosome 15 and exfoliation syndrome and exfoliative glaucoma that has subsequently been replicated around the world. Three genetic loci have been found to be associated with congenital glaucoma and one of these loci (GLC3A on chromosome 14) yielded the CYP1B1 gene (cytochrome P450 1B1). (Susan Williams, Johannesburg, South Africa)