Moderator
Jason Bacharach, MD
Panelists
Prasanna V Ramesh, MS, DNB
SU-HO LIM, MD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Lital Smadar, MD
Purpose
Ectropion in the elderly is commonly due to increased eyelid laxity. Glaucoma patients, who use eye-drops, stretch their lower eyelids, which we hypothesize may cause ectropion. The purpose of this study is to examine this assumption for the first time.
Methods
A prospective, case-control comparison between glaucoma patients who use anti-glaucoma eye-drops vs. patients without glaucoma and that are not use eyedrops was done. All participants had gone through slit lamp examination and lower eyelid laxity tests and measurements.
Results
56 patients , mean age 66 years; 26 (46%) with glaucoma, 30 (54%) without. Glaucoma patients had increased lower-eyelid laxity (2.85 mm vs. 2.00 mm, p=0.002; 4.65 mm vs. 2.38 mm, p=0.005). Higher rate of eyelid pathology in glaucoma patients (6 vs. 0, p>0.01); 65% had poor orbicularis muscle strength (p>0.01). Punctate Epithelial Erosion were more common in glaucoma patients (1.6 vs. 0.06, p<0.01). eye="" drop="" usage:="" 21.4%="" alpha="" agonists,="" 41.1%="" prostaglandins,="" 33.9%="" beta="" blockers,="" 19.6%="" carbonic="" anhydrase="" inhibitors.="" eye="" drop="" use="" correlated="" with="" increased="" horizontal="" eyelid="" laxity,="" especially="" prostaglandins,="" and="" with="" pee="">
Conclusion
In this study we found correlation between chronic usage of topical anti-glaucoma eye drops and increased lower eyelid laxity. Therefore, patients may need to be instructed to put the drops without stretching the lower eyelid.
Presenting Author
Amr F Ouda, FRCOphth, MD
Co-Authors
Malak ElShazly MD, Marwa Salama MD
Purpose
To study the effect of subscleral trabeculectomy with suprachoroidal scleral tongue regarding the intra-ocular pressure (IOP) control and its complications in cases with previously failed trabeculectomy.
Methods
A prospective interventional study was done on 21 eyes of 19 patients with previously failed subscleral trabeculectomy. They underwent subscleral trabeculectomy with suprachoroidal scleral tongue. They were followed up for at least one year. Seidel test was done during the 1st week postoperatively. The IOP was recorded, bleb status as well as complications-if present- were repoted at 1st week, 1st month, 3rd month, 6th month and one year post-operatively.
Results
The mean IOP was reduced significantly from 35.23 mmHg preoperatively to 13.17 mmHg by the end of the follow-up period (p value was <0.001). eighteen="" eyes="" (85.17%)="" were="" ended="" by="" complete="" success,="" while="" 3="" eyes="" (14.29%)="" were="" ended="" with="" qualified="" success.="" no="" failed="" cases="" were="" reported.="" hypotony="" was="" reported="" in="" 5="" eyes="" (23.8%).="" hyphema="" occurred="" in="" 3="" eyes(14.29%).="" both="" complications="" were="" managed="" conservatively="" during="" the="" 1st="" week="">
Conclusion
Subscleral trabeculectomy with suprachoroidal scleral tongue is an effective method to reduce the IOP in previously failed tabeculectomy with manageable complications
Presenting Author
Manjool M Shah, MD, ABO
Co-Authors
Sean McCafferty MD, MS
Purpose
Characterize the relationship between intraocular pressure (IOP) as measured by standard and modified Goldmann prisms and the progressive loss of retinal nerve fiber layer (RNFL) in a cohort of glaucoma patients
Methods
A Retrospective cross-sectional cohort study. 148 eyes, 75 patients met the inclusion criteria of a diagnosis of primary open angle glaucoma (POAG) with at least 5 sequential quality optical coherence tomographer (OCT) measurements. Sequential OCT images were obtained with the spectral domain Zeiss OCT5000. Participants were all diagnosed with POAG by untreated IOP ?22, disk changes, and visual field (HVF) loss consistent with glaucomatous optic neuropathy (GON). Retinal nerve fiber layer (RNFL) loss rate was calculated by serial linear fit of average RNFL thickness measurements. Demographics as well as central corneal thickness (CCT) and corneal hysteresis (CH) data were also collected.
Results
Included were 575 Goldmann IOP measurements with standard and modified Goldmann prisms. The study included a total of 940 OCT visits averaging 6.3 visits per eye over an average of 4.9 years. Each 2-mmHg increase in standard GAT IOP was associated with an additional RNFL loss of 0.99 �m per year (p=0.06). Each 2-mmHg increase in modified GAT IOP was associated with an additional RNFL loss of 1.89 �m per year (p=0.0005). A modified prism IOP measurement ? 22mmHg indicates a 2.57 times greater probability of significant RNFL loss than a standard prism IOP measurement ? 22mmHg, p<0.0001. each="" 1-mmhg="" decrease="" in="" ch="" was="" associated="" with="" an="" additional="" rnfl="" loss="" of="" 0.48="" �m="" per="" year.="" (p="">
Conclusion
Higher levels of GAT IOP during follow-up were related to higher rates of progressive RNFL loss detected by optic nerve OCT in treated POAG. A modified GAT prism surface demonstrates a significantly increased sensitivity to progressive RNFL loss when compared to a standard GAT prism measured IOP. Lower CH is associated with increased RNFL loss
Presenting Author
Raheem Remtulla, MD
Co-Authors
Shawn Cohen MD, FRCSC
Purpose
Topiramate is a medication used for epilepsy and many others. Topiramate is linked with severe ophthalmological complications, particularly topiramate induced acute angle-closure glaucoma (TACG). The mechanism of action in TACG is through choroidal effusion. However, clear risk factors for TACG have yet to be determine.
Methods
A retrospective case-control study was performed using data from the FDA from 1997-2023. Only healthcare practitioner-reported cases were considered. Patients experiencing angle closure-related events were compared with those experiencing other adverse events. Terms related to angle closure events included angle closure glaucoma, choroidal effusion, increased intraocular pressure (IOP), narrow angles, corneal edema, myopic shift, and conjunctival injection. Study variables included drug indication, biologic sex, and age.
Results
The analysis included 6038 participants using topiramate, with 505 cases of angle-closure glaucoma. The mean age of affected participants was significantly higher (38.04 years) compared to unaffected participants (34.91 years, p<0.001). females="" exhibited="" higher="" odds="" of="" developing="" angle-closure="" glaucoma="" (or:1.76,=""><0.0001) and="" other="" ocular="" symptoms="" such="" as="" choroidal="" effusion=""><0.01), increased="" iop=""><0.01), myopic="" shift=""><0.01) and="" conjunctival="" edema=""><0.01) compared="" to="" males.="" indication-specific="" analysis="" revealed="" higher="" frequencies="" of="" ocular="" complications="" in="" patients="" using="" topiramate="" for="" abdominal="" issues,="" pain="" and="" drug="" use="" compared="" to="" those="" using="" it="" for="" seizures="" or="" spasms="">< />
Conclusion
The findings highlight significant demographic differences in the risk of topiramate-induced ocular complications. Furthermore, indications for topiramate with higher doses had higher frequencies of TACG. This would be the first paper study identifying a dose dependent relationship between topiramate and secondary angle closure glaucoma
Presenting Author
Gagan K Sawhney, MD
Co-Authors
Brittany Bowman MS, OD
Purpose
To evaluate the long-term efficacy of netarsudil 0.02% in patients with mild, moderate, or severe normal tension glaucoma (NTG).
Methods
Three-year retrospective, single-site study of 127 eyes of 74 patients who had a diagnosis of mild, moderate or severe NTG and started netarsudil as adjunctive or initial therapy. To be included in the study, patients needed at least a 3-month follow-up after netarsudil initiation. The primary outcome measure was intraocular (IOP) reduction. The secondary outcome measures were mean deviation (MD) of the Humphrey visual field (HVF) and corrected visual acuity (VA).
Results
Mean IOP improved from 14.3+2.7mmHg at baseline to 10.7+2.4 mmHg (26% reduction), 10.7+2.1 mmHg (24% reduction), 10.7+2.5 mmHg (25% reduction), 10.5+2.1 mmHg (26% reduction), 10.2+1.5 mmHg (28% reduction) at 3, 6, 12, 24 and 36 months after netarsudil introduction, respectively. Two eyes (1.6% of all subject eyes) had a HVF MD worsening greater than or equal to 2.0 dB over the 36 months. VA demonstrated no change from 0.30+0.40 logMAR at baseline to 0.29+0.40 logMAR, 0.28+0.41 logMAR, 0.20+0.31 logMAR, 0.31+0.38 logMAR, 0.10+0.06 logMAR at 3, 6, 12, 24 and 36 months after netarsudil introduction, respectively.
Conclusion
Netarsudil significantly lowers IOP in patients with mild, moderate and severe NTG and results are sustained up to three years after drop introduction.
Presenting Author
Steven R. Sarkisian Jr., MD, ABO
Co-Authors
Angela Kothe OD, PhD, L. Jay Katz MD, Tomas Navratil PhD
Purpose
To evaluate the reduction in IOP and topical IOP-lowering medication burden through month 36 following the administration of the travoprost intracameral implant, 75 mcg (iDose� TR) in subjects with open-angle glaucoma or ocular hypertension from one of the prospective, randomized, multicenter Phase 3 trials, GC-010.
Methods
The trial enrolled subjects on 0 to 3 IOP-lowering medications pre-study, and baseline unmedicated mean diurnal IOP ? 21 mmHg, and IOP ? 36 at each baseline diurnal timepoint. Subjects received a slow-eluting travoprost intracameral implant (the commercially approved model) (n=197) or timolol 0.5% BID eyedrops (n=193). A fast-eluting travoprost implant (n=200) also was evaluated in the trial. Analyses were performed to determine the IOP-lowering treatment effect, and the percentage of eyes in the commercially approved travoprost intracameral implant group vs timolol group on the same or fewer IOP-lowering medications at Months 12, 18, 24, 30 and 36 compared to pre-study.
Results
Mean 8AM IOP reductions in travoprost intracameral implant and timolol eyes, respectively, were 6.5 and7.0 mmHg at Month 12, 6.4 and 7.0 mmHg at Month 18, 6.3 and 7.0 mmHg at Month 24, 6.3 and 7.0 mmHg at Month 30, and 6.2 and 7.0 mmHg at Month 36. Reductions from baseline at all visits in both groups were statistically significant (P<0.0001). a="" significantly="" greater="" percentage="" of="" travoprost="" intracameral="" implant="" vs="" timolol="" eyes="" were="" the="" same="" or="" fewer="" iop-lowering="" medications="" at="" month="" 12="" (92%="" vs="" 70%,=""><0.0001), month="" 18="" (84%="" vs="" 68%,="" p="0.0004)," month="" 24="" (80%="" vs="" 65%,="" p="0.0042)," month="" 30="" (76%="" vs="" 64%,="" p="0.0282)," and="" month="" 36="" (71%="" vs="" 59%,="" p="0.0338)" compared="" to="">
Conclusion
Both IOP and topical IOP-lowering medication burden were significantly reduced through 36 months in subjects with open-angle glaucoma or ocular hypertension following the administration of a travoprost intracameral implant, 75 mcg.
Presenting Author
Blaze Ann Carbonell, BSc
Co-Authors
Olivia Lee MD, Jose Giraldo MD, Jose Arthur Milhomens Filho MD, Ken Lin PhD, MD, Austin Fox MD, Jerald Lim BSc, Cinthia Kim MD, Melisa Karslioglu MD, Rolando Sceptre Ganasi BSc
Purpose
Ocular surface disease is often associated with eyes treated with topical antiglaucoma (A/G) therapy, yet the effects of these treatments on the ocular surface at the cellular level remain unclear. This retrospective cohort study aimed to assess the impact of A/G medications on corneal microstructures using in vivo confocal microscopy (IVCM).
Methods
Central corneal images were obtained using IVCM for control eyes (n=17) and eyes on A/G drops for at least 6 months, either monotherapy (prostaglandin analog, n=28; beta blocker, n=11) or polytherapy of three or more pharmacological classes (n=28). Eyes with a history of corneal disease, corneal surgery or laser procedure in the past 6 months, or use of topical anti-inflammatory medication were excluded. Corneal epithelial wing cell density (EWCD) and epithelial basal cell density (EBCD) as well as corneal nerve tortuosity (NT), reflectivity (NR), and density (ND) were manually graded by 2 independent observers and analyzed using a two-sample t-test and one-way ANOVA.
Results
Mean EWCD (6187.43 � 703.89) and EBCD (8055.16 � 872.65) of A/G treated eyes were significantly lower as compared to control (7038.44 � 622.11, p<0.01; 9536.35="" �="" 687.39,=""><0.01). there="" was="" no="" statistically="" significant="" difference="" in="" mean="" ewcd="" among="" all="" a/g="" treatment="" groups.="" mean="" ebcd="" was="" significantly="" higher="" in="" the="" prostaglandin="" analog="" group="" (8432.44="" �="" 905.33)="" as="" compared="" to="" the="" beta="" blocker="" (7605.73="" �="" 799.83,=""><0.05) and="" polytherapy="" (7874.94="" �="" 741.31,=""><0.05) groups.="" mean="" nd="" (mm/mm2)="" was="" significantly="" lower="" in="" eyes="" beta="" blockers="" (8.67="" �="" 4.90)="" as="" compared="" to="" all="" other="" groups="" (13.56="" �="" 5.94,="" p="0.03)." there="" was="" no="" statistically="" significant="" difference="" in="" nr="" or="" nt="" among="" all="" four="">
Conclusion
This study reveals that glaucomatous eyes on A/G drops are associated with significantly reduced corneal epithelial cells. Corneal nerves were only affected in density in beta-blocker treated eyes. Future studies should explore the significance of long-term changes in corneal nerves and epithelial cells and their clinical impact on A/G treatment.
Presenting Author
Jason Bacharach, MD
Co-Authors
James Peace MD, Ingeborg Stalmans MD, PhD, Sherif El-Harazi MD, MPH, Paul Harasymowycz FRCSC, MSc, MD, Eydie Miller-Ellis MD
Purpose
To evaluate the safety and efficacy of a preservative-free, topical bimatoprost ophthalmic gel 0.01% (T4032) in patients with open angle glaucoma (OAG) or ocular hypertension (OHT) in comparison with a benzalkonium chloride (BAK)-preserved bimatoprost ophthalmic solution 0.01% (Lumigan�)
Methods
Two large international Phase 3 trials enrolled 951 patients (?18 years) diagnosed with OAG or OHT, with the majority from the US and Europe. All patients had adequately controlled IOP (?21mmHg) with an ocular hypotensive monotherapy (?30 days). After a washout period (14 days to 7 weeks), patients were randomized T4032 (n=468) or Lumigan (n=483) groups. Study drugs were dosed once daily in the evening from Day 0 to Day 84 in both eyes. The study eye was defined as the one with the highest IOP at baseline at 8 am. The primary efficacy endpoint was the between group comparison in the change of IOP from baseline at each timepoint at Week 2, 6 and 12 (diurnal IOP measured at 8am, 10am, and 4pm)
Results
IOP reduction from baseline with T4032 and Lumigan was similar at all timepoints (27% to 39 vs. 29% to 38%, respectively), with 95% CI within 1.5mmHg in the study eye for all timepoints (9/9) assessed and meeting the more stringent noninferiority margin of 1 mmHg for the majority of timepoints (6/9). Adverse events were generally mild to moderate and primarily ocular. Fewer patients in the T4032 group experienced ocular treatment-emergent adverse event compared to the Lumigan group (34.7 vs. 37.8, respectively), and treatment-related ocular adverse events (23.8 vs. 27.6, respectively). The most common ocular adverse events were treatment-related conjunctival hyperemia and eye irritation.
Conclusion
The two large Phase 3 trials demonstrated significant IOP reduction by preservative-free bimatoprost gel 0.01% in patients with OAG or OHT, achieving noninferiority compared to Lumigan. The preservative-free bimatoprost gel 0.01% showed a better tolerability profile compared to Lumigan, with numerically fewer ocular adverse events.
Presenting Author
Tanner J. Ferguson, MD
Co-Authors
Thomas Samuelson MD, Leon Herndon MD, Daniel Terveen MD, Jason Bacharach MD, Jacob Brubaker MD, John Berdahl MD, Nathan Radcliffe MD
Purpose
The evaluate the nocturnal IOP-lowering ability of the ocular pressure adjusting pump (OPAP) in eyes with normal-tension glaucoma (NTG)
Methods
Prospective, randomized, controlled, 1-year study. Subjects with NTG had one eye randomized to receive nightly negative pressure (NP) application and the contralateral eye served as control. NP application was programmed for each subject as IOP minus 6 mmHg. Nocturnal IOP-lowering effectiveness was assessed at three time points: 11PM, 2AM, and 5AM in a sleep lab. For effectiveness, the proportion of study versus control eyes achieving an IOP reduction ?20% at the Week 52 sleep lab visit were evaluated. The mean IOP reduction was also reported.
Results
60 subjects successfully completed all visits for 1 year. For effectiveness, 58/60 (96.7%) study eyes versus 3/60 (5.0%) control eyes achieved a sleep lab ?20% IOP reduction. The mean nocturnal IOP reduction in the study eye at 11 PM, 2 AM and 5 AM was 7.8 mmHg (39%), 8.0 mmHg (38%) and 8.2 (39.3%), respectively. Across all three time points, the mean IOP reduction was 8.0 mmHg (39%) to 12.4 mmHg from a baseline of 20.4 mmHg.
Conclusion
The ocular pressure adjusting pump consistently and effectively lowers nocturnal IOP in patients with normal-tension glaucoma.
Presenting Author
Xiaowei Yu, MD
Co-Authors
Zhigang Fan MD, Yan Shi PhD, MD
Purpose
To establish the genetic and clinical landscape of nanophthalmos with secondary angle-closure glaucoma (NSACG) and to investigate its genotype-phenotype correlation in a Chinese cohort
Methods
This is a prospective cross-sectional study. A total of 88 NSACGpatients with Chinese origin were recruited. All participants underwent ocular and systemic examinations and whole-exome sequencing.Genetic and clinical features were integrated in pursuit of genotype�phenotype correlations. Main Outcome Measures: Axial length (AL), anterior chamber depth (ACD), intraocular pressure (IOP), glaucomatous optic neuropathy, the 6 most commonly implicated genes, onset age of angle-closure glaucoma.
Results
Of the 88 nanophthalmos patients from 87 unrelated families, 81 variants (37 frameshift, 33 missense, 5 nonsense, 5 splice site, and 1 intron deletion) were identified in 47 patients (53.41%). Variants in PRSS56 account for 42.55% of all genetic diagnosed patients, followed by MFRP (29.79%), MYRF (17.02%), TMEM98 (6.38%), CRB1 (2.13%) and BEST1 (2.13%). ACGSNpatients with a genetic diagnosis had shorter AL and younger onset age than those without. Patients carrying PRSS56 variants had shortest AL, followed by MFRP, MYRF and TMEM98. Though patients carrying MYRF variants had longer AL and deeper ACD, they showed younger onset age and bigger cup/dis ratio (C/D).
Conclusion
This study detailed the gene variant spectrum and clinical landscape in Chinese NSACG patients, and expended the genotype-phenotype correlations among patients with a genetic diagnosis.
Presenting Author
Douglas J. Rhee, MD, ABO
Co-Authors
Charles Guo BA
Purpose
Latanoprostene bunod (LBN) and latanoprost-netarsudil (LAT-NET) are thought to affect both trabecular and uveoscleral outflow. We hypothesize that LBN and LAT-NET are equivalent and more effective than latanoprost alone. IOP and correlational histologic changes within the extracellular matrix of trabecular and uveoscleral pathways will be tested.
Methods
Eyes of 6-8 week-old mice were randomly assigned to 3 treatment groups: latanoprost (LAT)(0.005%; 125 mcg/2.5 mL), LBN (0.024%), and LAT-NET (latanoprost 0.005%/netarsudil 0.02%). The contralateral eye of each mice received commercially available artificial tears containing benzalkonium chloride (BAK) (0.01%) as vehicle control. Each mouse received treatment and vehicle control for 4-weeks and were then enucleated for immunohistochemistry (IHC) analysis. IHC of the ciliary body stroma and trabecular meshwork will be analyzed for structural extracellular matrix components- collagens-1, -3, and -4, fibronectin, and laminin.
Results
Preliminary data show, no IOP lowering at 1 week for any medication. At week 2, compared to the placebo controlled contralateral eye, LAT (n=4), LBN (n=5), and LAT-NET (n=4) reduced the IOP by 9.8%, 7.2%, and 6.2%, respectively (p=0.007, 0.04, and 0.03, respectively). At week 3, the drops lowered IOP by 9.2%, 5.9%, and 12.3%, respectively (p=0.02, 0.2, 0.01). At this stage, LAT and LAT-NET lowered IOP and there are no differences between groups. Immunohistochemistry results of ciliary body and trabecular meshwork are pending.
Conclusion
This is a preliminary submission. Early results demonstrate superior IOP lowering of LAT and LAT-NET compared to LBN. The small sample size is likely masking efficacy and between group differences. Treatment of additional mice is in process to reach the pre-planned sample size as well as to the 4 week time point.
Presenting Author
Blaze Ann Carbonell, BSc
Co-Authors
Jose Giraldo MD, Olivia Lee MD, Jordan Jessen BSc, Ken Lin PhD, MD, Austin Fox MD, Sameh Mosaed MD, Andrew Smith MD, Jose Arthur Milhomens Filho MD
Purpose
Studies have shown that eyes on chronic topical antiglaucoma therapy suffer from ocular surface disease and have significantly greater corneal dendritic cell density (DCD) compared to control. This prospective cohort evaluated the use of topical anti-inflammatory drops on DCD in treated glaucomatous eyes using in vivo confocal microscopy (IVCM).
Methods
Patients on topical prostaglandin analog therapy for ?1 year and with ocular surface symptoms (ocular surface disease index (OSDI) > 13) were treated with topical anti-inflammatory medication (TAM), either cyclosporine or lifitegrast twice a day in each eye for 3 months. Prior to and 3 months post-TAM initiation, tear matrix metalloproteinase-9 (MMP-9) testing, OSDI score, and central corneal IVCM imaging were obtained. Eyes with a history of corneal disease/surgery/laser, glaucoma surgery, prior TAM use, or medication changes in the past 6 months were excluded. 2 independent observers manually graded DCDs. A 2-sample t-test was used to compare DCDs, tear MMP-9 tests, and OSDI scores.
Results
TBD
Conclusion
TBD
Presenting Author
Marco A Robles, MD
Co-Authors
Pablo Robles MD, Glenn Sussman BEng, Malik Kahook MD, Long Doan PhD, MPH, ScD, Briana Dorn BA
Purpose
This study presents 18-month interim safety and efficacy results following implantation of a monofocal intraocular lens (IOL) with mounted sustained-release bimatoprost implant in eyes with mild to moderate open-angle Glaucoma or ocular hypertension.
Methods
A single-center prospective cohort study was conducted with 23 eyes treated across three doses (75 mcg, 150 mcg, and 300 mcg). Eyes were examined at regular intervals, with planned follow up continuing for 3 years. Safety and efficacy were assessed through various measurements including best corrected distance visual acuity (BCDVA), intraocular pressure (IOP), and slit lamp examination.
Results
The sustained-release bimatoprost drug delivery system/IOL demonstrated statistically significant improvement in visual outcomes. Vision improved from a baseline preoperative range of 20/30 to 20/100 to an 18-month postoperative range of 20/16 to 20/30. IOP was reduced from a baseline post-washout IOP of 25.1 � 2.5 mmHg to 14.1 � 2.6 mmHg (P<0.0001) at="" 18="" months.="" there="" was="" no="" statistically="" significant="" difference="" in="" iop="" lowering="" across="" the="" three="" dosage="" groups="" and="" no="" device="" related="" adverse="" events="" (aes).="" all="" patients="" remained="" off="" topical="" iop-lowering="" medications="" at="" the="" 18-month="" follow-up="">
Conclusion
The sustained-release bimatoprost drug delivery system/IOL showed promising visual outcomes in this ongoing study. IOP lowering was statistically and clinically significant across all groups. No device related AEs. Longer-term data are being collected to see the potential for multi-year durability of both visual outcomes and IOP lowering efficacy.
To log in, click the teal "Login" button in the upper right-hand corner of this page. If you are logged in but still do not have access, please check your 2025 Annual Meeting registration.
