The following transcript has been edited for clarity.

Hello, everyone. My name is Brian A. Francis, MD, and I'm a glaucoma specialist at the UCLA department of ophthalmology and Doheny Eye Institute. I wanted to welcome everybody and wish them a happy Glaucoma Awareness Month. We're going to be talking a little bit about new advances in glaucoma, what I consider important as a glaucoma physician, and what I feel is important to our glaucoma patients.

Glaucoma Physician: As glaucoma care continues to evolve, what recent research advances are most likely to change how clinicians manage patients over the next few years?

Dr. Francis: As glaucoma care and research evolves, there is basically long-term research and there are short-term research goals. So I think the long-term research goals are still really the establishment of neuroprotection and neuroregeneration. I tell patients that there's basically 3 aspects of that kind of therapy. One is neuroprotection, which I think will develop the earliest. One is neuroregeneration, and one is neuroresuscitation. So, neurorescuscitation means that the nerve cells are not functional, but they're not dead yet, and they can be brought back to life and functionality. The holy grail is neuroregeneration, which is, basically, replacing nerve cells that have died or regrowing those cells into functional, visually capable retinal ganglion cells. That’s further down the line. I do think that there are some candidate molecules that are under study right now, so I think that is promising. However, you're looking at probably about a 5-to-10-year window for that.

GP: How are better diagnostic imaging technologies improving earlier detection or monitoring of glaucoma progression?

Dr. Francis: As far as recent advances, I think we can divide those into diagnostic, medical treatment, and surgical treatment. So, I think diagnostically—imaging, of course, is there. OCT imaging is improving every year, and it's able to detect more and more things, so not just the retinal nerve fiber layer, but now the macular ganglion cell complex. [Now there is also] OCTA, looking at angiography and blood vessels and eventually blood flow to the optic nerve, and then other elements of optic nerve exam and structure, such as the lamina cribrosa. I think those are going to be of more importance going forward in terms of OCT imaging.

In terms of visual field and functional imaging, I think that automated perimetry is still the gold standard. There have been some improvements in terms of automated perimetry with the head-mounted virtual reality headsets. I think they are more easily usable by patients. The user interface is a little bit better, and a little more comfortable for patients, especially those who cannot sit for an extended period of time with their head in the visual field machine. So that continues to improve, and I think it’s especially helpful in pediatric patients as well. But we’re working on that technology very carefully, and also adding on other capabilities. So it's not just visual field, it's going to be pupillometry, extraocular motility, visual acuity, color vision, contrast sensitivity—all of these things can be incorporated into one device, which will, of course, help with the functionality and reduce the footprint in your office that you need for all these different testing capabilities.

GP: From a patient perspective, what is new or on the horizon that will make a difference?

Dr. Francis: From a patient perspective, I think a lot of patients are wondering what they can do besides lowering intraocular pressure (IOP) to help their glaucoma or help prevent glaucoma loss. I think lifestyle factors and nutritional supplements are going to be studied more, and we’re going to understand more and more about those, and what to tell patients, other than just lowering pressure with medicine, laser, or surgery. So there's more and more data coming out on that, and I think that's more important for patients because they're trying to take proactive steps, and these are things that they can control, and I think it gives them a little more feeling of control over their disease, rather than putting everything into the hands of the treating doctor, so I think that’s important.

It's also important, both from a doctor and a patient perspective, to try to identify things as early as possible. So don't wait for visual field loss and ganglion cell death. There are newer technologies that are looking at retinal ganglion cell function, in terms of looking at things like oxidative stress. So, to be able to identify retinal ganglion cells that are under stress from glaucoma, rather than those that have already died from the disease. So, there are areas that are looking at that kind of metabolic imaging, if you will, of the retinal ganglion cells, and that’ll be important in early diagnosis, but also will be important in gauging the effectiveness of treatment. Presumably, after starting treatment and lowering IOP, we may be able to see reversal of metabolic stress and improvement in these patients’ parameters. I think that's very important as well.

GP: When you’re speaking with patients, how do you explain what’s new in glaucoma care without overwhelming them?

Dr. Francis: I think it’s important to not overwhelm patients. There's a lot of stuff out there, but we’re trying to make glaucoma into a very tailored, patient-specific treatment. I think it's important to see where the patient is in their disease process, what they need, what they may benefit from, and explain that new developments and future developments to them.

Certainly, my conversation is going to be different for someone who’s an ocular hypertensive, who may have a family history of glaucoma and high pressure but no damage vs someone who has very advanced glaucoma and has already failed multiple surgeries and medical therapy. I think it's important to look at the specific patient and give them the information that is pertinent to their disease process and to what they're going through. That's very important, I think.

GP: Are there other emerging advances that could meaningfully change how glaucoma is diagnosed or managed?

Dr. Francis: One other thing that we haven't yet covered is in the diagnostic and prediction category, and that’s genetics of glaucoma. With a better understanding of the human genome and ability to study that, we are looking at identifying more genes that are associated with different types of glaucoma. That will help diagnose patients [and] will help stratify the risk factors for them and for their relatives. That is very important for the near future.

I want to thank everyone for joining us today for this quick discussion on glaucoma diagnosis and treatment from both a physician and a patient perspective. This is Dr. Brian Francis signing off, and wishing you a good and happy Glaucoma Awareness Month and New Year. GP