EyeWorld Asia-Pacific March 2015 Issue

March 2015 49 EWAP GLAUCOMA 25 November 2014 Online abstract submission, Registration and Housing Open 25 February 2015 Deadline for abstract submission 5 May 2015 Deadline for 1st tier early bird registration 25 June 2015 Deadline for 2nd tier early bird registration 5-8 August 2015 28th APACRS annual meeting She was also cautious about interpretation of the findings, but offered a greater potential benefit in the future. “If confirmed by prospective clinical trials, these findings would offer new treatments for this sight- threatening disease and perhaps other diseases of aging, too.” Sartan drugs Sartan drugs, such as losartan, are angiotensin II receptor antagonists commonly used to treat systemic hypertension. Recently, sartans have been shown to be an effective treatment for Marfan syndrome, a disease caused by microfibril deficiencies. Previous work from Dr. Rachel Kuchtey’s laboratory has provided evidence that glaucoma may also result from microfibril deficiencies, suggesting sartan drugs as a possible glaucoma therapy. John Scichilone, BS, and colleagues at Vanderbilt University, Nashville, Tenn., reported a database study evaluating the protective benefit of sartan drugs in relation to open-angle glaucoma. This study included nearly 14,000 patients using sartan drugs and nearly 90,000 controls. “Overall, 1.82% of patients not using sartan drugs developed incident open-angle glaucoma, compared to only 0.74% of patients using sartan drugs,” he said. This was highly statistically significant (p<0.0001). Of note, some of this effect may not be unique to IOP reduction. “Previous studies have shown the beneficial effect of sartan drugs on reducing intraocular pressure and retinal ganglion cell death,” he said. A combination of both IOP-mediated and IOP-independent effects may explain the substantial magnitude of the protective effect in this study. Practical implications Granted, these are all exploratory studies and their results need to be confirmed in well-designed prospective trials. It is encouraging, however, that non IOP-based therapies may play a role in preventing or delaying the onset of open-angle glaucoma. These drugs are widely used for various systemic conditions and are generally well tolerated. Other approved systemic drugs, such as the cholesterol-lowering statin drugs, are also being evaluated for their protective effects on glaucoma. In the future, therapy for glaucoma may focus on systemic prevention rather than topical IOP reduction. EWAP Editors’ note: Dr. Stein, Dr. Richards, and Mr. Scichilone have no financial interests related to this article. Contact information Richards: richj@umich.edu Scichilone: john.m.scichilone@vanderbilt.edu Stein: jdstein@med.umich.edu Hills, Calif.), but Dr. Rhee said the second-generation devices will depend on having good gonioscopy skills. “You want to have very good angle anatomy associations in your head when you start doing these procedures,” he said. Dr. Rhee recommended that surgeons doing cataract surgery who intend to do angle procedures practice intraoperative gonioscopy at the end of cataract surgery by putting in a gonioprism and a cannula in the eye. He recommended surgeons tilt the microscope for MIGS procedures by about 45 degrees. “Instead of patients looking up, turn their head so the angle of the eye and microscope are roughly at 90 degrees,” he said. “It looks like the way the second-generation MIGS devices and procedures are going, all [are] angle-based,” he said. So gonioscopy skills will become increasingly important for surgeons. “We need to start getting into the groove of looking into the angle,” he said. EWAP Editors’ note: Dr. Rhee has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), AqueSys (Aliso Viejo, Calif.), Johnson and Johnson Vision Care (Jacksonville, Fla.), Merck (Whitehouse Station, N.J.), and Santen Pharmaceutical (Osaka, Japan). Contact information Rhee: douglas_rhee@meei. harvard.edu The value - from page 46