Education Committee Highlights WGC-2019 – part 15

The Education Committee carefully selects presentations from the WGC-2019 for your benefit. This month Lisandro Sakata introduces the sessions: New frontiers in glaucoma and The Many Faces of Dreaded Bleb Complications.

New frontiers in glaucoma

In this stimulating session, top glaucoma researchers provide us their perception about the future of glaucoma care: the role of artificial intelligence, OCT evolution, neuroprotection therapy, genomics and role of autoimmunity. Of note, this session brings us some quite interesting discussions moderated by Dr. Peng Khaw and Dr. Janet Serle.

Deep learning to empower glaucoma docs in the future

Dr. Naama Hammel is a glaucoma specialist who participates in a Google team researching how to apply machine learning in medical data. Dr. Hammel presents a nice introduction on artificial intelligence concepts, how they work, and the great potential of deep machine learning in helping us in the future, although the caveats of accurate labeling of glaucoma images need to be tackled.

OCT in glaucoma: a look into the future

Dr. Lucy Shen presents her perceptions on how OCT may evolve, and discusses some interesting points related to wide-field RNFL map that include both peripapillary and macular region data in a single scan; the improvements in incorporating adaptive optics; the potential of the optic nerve head parameters, lamina cribrosa imaging, and OCT angiography data; how to improve structure-function relationship, and the possibility of associating different technologies that may enable the detection of ganglion cell apoptosis.

Resuscitating RGCs

Dr. Keith Martin presents some of his very interesting research work in retinal ganglion cells and starts by stating that there might be not only healthy or dead retinal ganglion cells, but somehow sick ganglion cells that may be recoverable. Interesting points are presented on the evidence of the location where neuron damage first occurs, the presence of viable ganglion cells that have lost their axons, the relevance in enhancing axonal transport, and what are the possible factors involved in visual function improvement observed particularly after acute IOP reduction.

Personalised glaucoma management: the role of genomics

Dr. Anthony Khawaja provides us a great lecture and discussion on how genomics may improve the precision of glaucoma care. As more data become available, genetic profile testing may allow us to detect individuals at higher risk for glaucoma due to genetical susceptibility for abnormalities in key places like Schlemm canal or optic nerve head. It may also eventually help predict response to treatments. All this genetic profiling would permit us to provide individualized glaucoma precision management and improve patient care with a more appropriate allocation of resources.

The role of autoimmunity and glaucoma therapy

Dr. Franz Grus finishes the session presenting the current research involving antibodies as biomarkers for glaucoma, its potential for identifying some antibodies that may be associated with a more aggressive course of the disease, and eventually its role in developing new therapeutic approaches. Although also limited by proper labeling of true glaucomatous disease, the antibody profile testing also has the potential to collaborate for a better-individualized assessment related to all steps of glaucoma care.

Watch the presentations

Please note that no separate slide decks are available with these presentations. 

The Many Faces of Dreaded Bleb Complications

Trabeculectomy remains our well-known reference standard surgery for uncontrolled glaucoma, however, this surgery may present some complications that requires our best management. In this course, experienced glaucoma surgeons discuss their preferred approaches for preventing and treating some of the most dreaded bleb complications.

The dysesthetic bleb

Dr. Ramanjit Sihota describes the morphological characteristics of a dysesthetic bleb, and its respective symptoms. Many relevant points in the management of the dysesthetic bleb were then discussed, such as timing for intervention (prevention vs. treatment), and surgical approaches for some individualized cases, mainly involving epithelium peeling and conjunctival advancement.

The encapsulated bleb

Dr. Eugenio A Maul presents the pathogenesis, risk factors, prevention, and management of encapsulated blebs. Prevention should mainly consider diffuse conjunctival/tenon dissection, wide mitomycin-C application, identification of related risk factors and, titration of the wound healing process, particularly while the encapsulation process is occurring. And management may vary from conservative medical therapy to needling procedures with adjunct antimetabolites agent.

The infected bleb
Dr. Fabian Lerner tackled one of the dreaded TRAB complications: blebitis and endophthalmitis, which may occur in around 1-2% of the eyes up to 5 years after TRAB with MMC. Dr. Lerner emphasize the relevant points for pro-actively preventing, as well as recognizing the signs and symptoms of bleb infection, including the “white on red” bleb appearance. The available treatment protocols and visual prognosis were also discussed.

The leaking bleb
Dr. Jody Piltz Seymour discusses all the clinical implications of bleb leakage, from early wound leak that may increase the risk for bleb failure, to chronic late leakage that may present as oozing/sweating blebs, which may lead to infection. Proper use of intraoperative mitomycin-C, wound closure, and pro-active prevention of bleb encapsulation may prevent a leaking bleb. Different treatment strategies that may be used were critically discussed.

The overfiltering bleb

Dr. Esther Hoffmann discusses the most appropriate timing for intervention on overfiltering blebs, which should rely not specifically on IOP values but mainly on functional or anatomical abnormalities. Treatments aims are to raise the IOP to restore normal morphology and best vision while not losing the TRAB efficiency in controlling glaucoma. Transconjunctival sutures seems a good alternative to reduce aqueous flow through an overfiltering flap, and Dr. Hoffman provides us with some good advice about this technique.

Watch the presentations

Please note that no separate slide decks are available with these presentations.