The glaucoma community was excited to meet in person in Nashville, Tennessee, for the 2022 American Glaucoma Society meeting. The first conference day focused on surgical topics, highlighted by continued debate on new bleb-based procedures compared to trabeculectomy. Kuldev Singh, MD, argued that trabeculectomy offers the most titratable surgery with a potential for long-term pressure lowering. George Tanaka, MD, discussed his success with the Xen gel stent (Allergan). He reminded participants that in the “tsunami” of advanced glaucoma we will soon be facing, a safe and simple filtering surgery is desperately needed. The Preserflo (Santen) microshunt was presented by Georges Durr, MD, who discussed the recent prospective randomized trial vs trabeculectomy. He noted that a key failure risk for Preserflo is an inadequate dose of mitomycin C.
The optimization of Xen results was continued in poster presentations. Arsham Sheybani,MD, presented the 12-month results of the Gold Standard Pathway Study (GPS), which was a prospective, randomized study of ab-interno closed-conjunctiva Xen vs trabeculectomy. The primary endpoint of a 20% reduction in IOP without serious complications or increase in medications was found to be 63.2% in Xen vs 68.2% in trabeculectomy. Trabeculectomy had a lower mean IOP (11.8 in trabeculectomy vs 14.4 in Xen) whereas Xen was associated with more stable vision postoperatively. An additional study by Kim et al presented the results of the EXPAND study, which was a retrospective analysis of ab-externo Xen placement. In 60.7% of cases, the endpoint of 20% reduction without clinical hypotony was achieved. Mean IOP was reduced from 22.4 mmHg to 14.8 mmHg.
The conference’s second day focused on looking at the whole picture of glaucoma with discussions of glaucoma pathophysiology and detection. A highlight of the day was an update from Michael Fausch, PhD, on his lab’s work on new therapeutics. Their medication CKLP1 works by lowering episcleral venous pressure and is currently being investigated in a phase 1/2 clinical trial, QLS-101. In another talk with an eye on the future, Felipe Medeiros, MD, updated attendees on the status of emerging technologies in progression detection, such as OCT angiography, deep learning, and head-mounted perimetry techniques.
The final full day of the conference addressed a variety of topics including symposia on clinical trials and physician decision making. Tony Realini, MD, provided a recap of the various studies in trabeculoplasty, including the ongoing COAST trial. He argued that selective laser trabeculoplasty is a strong initial treatment option and that we should be asking ourselves, “Is there a reason we shouldn’t be doing SLT on this patient?”
