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The Science of Glaucoma Management

From Translational Research to Next-Generation Clinical Practice

1st Edition - May 18, 2023

Editors: Kevin Gillmann, Kaweh Mansouri

Paperback ISBN:

9 7 8 - 0 - 3 2 3 - 8 8 4 4 2 - 6

eBook ISBN:

9 7 8 - 0 - 3 2 3 - 8 8 4 4 3 - 3

The Science of Glaucoma Management: From Translational Research to Next-Generation Clinical Practice bridges the gap between laboratory research and clinicians by bringing the… Read more

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The Science of Glaucoma Management: From Translational Research to Next-Generation Clinical Practice bridges the gap between laboratory research and clinicians by bringing the latest promising research directly from researchers to clinicians long before they translate into clinical advances, and often before they are presented at conferences. Organized as a series of clinically relevant topics written by world-leading experts, this book summarizes the current state of laboratory and translational research and draws on the potential implications for day-to-day clinical practice. It offers new insights and mind-opening statements through contributions from some of the most respected glaucoma research groups. The book allows glaucoma specialists to explore novel ways to refine and rethink their practice based on the latest discoveries in basic sciences and breakthrough technologies, and to gain a better understanding on how their specialty is evolving and how research may shape tomorrow’s practice.

Cover image
Title page
Table of Contents
Copyright
Dedication
List of contributors
Foreword
Preface
Section 1: Currently accepted glaucoma practice
Chapter 1. Glaucoma pathology
Abstract
1.1 Quick reference summary
1.2 Introduction to glaucomatous pathology
1.3 Causes of glaucomatous pathology (linking ocular hypertension to optic nerve degeneration)
1.4 The processes of neurodegeneration
1.5 Unmet needs
References
Chapter 2. Epidemiology of glaucoma
Abstract
2.1 Quick reference summary
2.2 Global epidemiology of glaucoma
2.3 New trends in glaucoma epidemiology
2.4 Discussion
References
Chapter 3. Diagnosis and investigations in glaucoma
Abstract
3.1 Quick reference summary
3.2 Conclusion
References
Chapter 4. Follow-up
Abstract
4.1 Quick reference summary
4.2 Intraocular pressure and general considerations
4.3 Optic nerve head and retinal nerve fiber layer
4.4 Visual field
References
Chapter 5. Glaucoma management
Abstract
5.1 Quick reference summary
5.2 Aims of management
5.3 Management protocol
5.4 First-line treatments
5.5 Surgical options
5.6 Angle-closure glaucoma
References
Chapter 6. Section summary: into the unknown—identifying the needs
Abstract
6.1 Glaucoma detection and screening
6.2 Early diagnosis and identification of progression
6.3 Pressure-independent treatments
6.4 Minimally invasive glaucoma surgery
6.5 Pathophysiology and biomarkers
6.6 Patient-centered care and personalized medicine
Section 2: Pathophysiology and investigation methods
Chapter 7. Considerations for an effective screening program for glaucoma
Abstract
7.1 Quick reference summary
7.2 Review of accepted practice
7.3 Considerations for an effective screening program
7.4 Discussion and conclusion
References
Chapter 8. Vascular health and glaucoma
Abstract
8.1 Quick reference summary
8.2 Review of the currently accepted knowledge
8.3 Novel concepts on vascular factors in glaucoma
8.4 Discussion on current and future implications
8.5 Conclusion
References
Chapter 9. The role of circadian and extrinsic intraocular pressure fluctuations
Abstract
9.1 Introduction
9.2 Research and technological advancements
9.3 Implications in clinical practice
References
Chapter 10. Pseudoexfoliative glaucoma: epidemiology, pathophysiology, and clinical implications
Abstract
10.1 Quick reference summary
10.2 Introduction
10.3 Epidemiology
10.4 Pathophysiology
10.5 Clinical implications
10.6 Conclusions and perspective
References
Chapter 11. Angle-closure glaucoma: epidemiology, pathophysiology, and clinical impact
Abstract
11.1 Quick reference summary
11.2 Overview
11.3 Novel concepts/promising research
11.4 Discussion
References
Chapter 12. The role of optical coherence tomography angiography in glaucoma
Abstract
12.1 Quick reference summary
12.2 Introduction
12.3 Optical coherence tomography angiography in glaucoma
12.4 Discussion
References
Chapter 13. Structural testing modalities: RNFL, GCIPL, BMO-MRW, or vessel density?
Abstract
13.1 Quick reference summary
13.2 Structural assessment of the retinal nerve fiber layer and neuroretinal rim in the current practice
13.3 New approaches for structural assessment of glaucoma
13.4 Summary - The changing landscape of glaucoma diagnostics
References
Chapter 14. Visual field testing: how frequent is frequent enough, and other developments
Abstract
14.1 Quick reference summary
14.2 Background
14.3 Novel concepts and promising research
14.4 Discussion
References
Chapter 15. Novelties in functional testing: the role of contrast sensitivity, electrophysiology, and color vision
Abstract
15.1 Quick reference summary
15.2 Current practice for glaucoma diagnosis
15.3 Novel functional tests
15.4 Discussion
References
Chapter 16. Managing uncertainty in glaucoma
Abstract
16.1 Early diagnosis of glaucoma
16.2 Early detection of disease progression
16.3 Early detection of angle-closure disease
16.4 Summary
References
Section 3: Medical and laser therapies
Chapter 17. Psychological barriers and innovations in glaucoma adherence
Abstract
17.1 Quick reference summary
17.2 Current practice
17.3 Current research in adherence
17.4 Discussion
References
Chapter 18. Topical medications and the ocular surface
Abstract
18.1 Quick reference summary
18.2 Introduction: the overlooked ocular surface
18.3 Ocular surface effects of eyedrops and preservatives
18.4 Discussion
References
Chapter 19. Novel approaches to reducing intraocular pressure—today and tomorrow
Abstract
19.1 Quick referencesummary
19.2 A review of the currently accepted practice
19.3 Novel concepts and promising research
19.4 Discussion and conclusion
References
Chapter 20. Novel ocular drug delivery systems in glaucoma
Abstract
20.1 Quick reference summary
20.2 The limitations of topical glaucoma treatments
20.3 Sustained-release drug delivery systems for glaucoma treatment
20.4 Choosing the best delivery system for each patient
References
Chapter 21. Selective laser trabeculoplasty: physiology and effects of SLT
Abstract
21.1 Quick reference summary
21.2 Selective laser trabeculoplasty’s evolving role in therapy
References
Chapter 22. Aqueous humor, glaucoma, and corneal health
Abstract
22.1 Quick reference summary
22.2 Aqueous humor contents, aqueous humor dynamics, and cornea health
22.3 Novel concepts/promising research in understanding the function of aqueous humor
22.4 Discussion
References
Chapter 23. Meditation for glaucoma management: cellular mechanisms and clinical impact
Abstract
23.1 Quick reference summary
23.2 Glaucoma and current standard of care
23.3 Meditation and glaucoma
23.4 Meditation, a holistic approach for glaucoma
References
Chapter 24. Section summary: recommendations in treatment-naïve open-angle glaucoma, treatment escalation protocols, and patient-specific considerations
Abstract
24.1 Recommendations in treatment-naïve open-angle glaucoma
24.2 Treatment escalation protocols
24.3 Patient-specific considerations
References
Section 4: Surgical options
Chapter 25. Anatomical, mechanical, and physiological effect of cataract surgery in open-angle and narrow-angle glaucoma
Abstract
25.1 Quick reference summary
25.2 Cataract surgery to control intraocular pressure in eye with glaucoma
25.3 How cataract surgery lowers intraocular pressure and its impact on glaucoma management
25.4 Cataract surgery and glaucoma: present and future
References
Chapter 26. 21st-century functional outflow system anatomy for surgeons
Abstract
26.1 Introduction
26.2 Noninvasive aqueous angiography and transformation of our field
26.3 Clinically visible aqueous outflow abnormalities in glaucoma
26.4 Trabecular meshwork: mobile wall of the compressible chamber we call Schlemm’s canal
26.5 Schlemm’s canal inlet valves—structure and function
26.6 Schlemm’s canal outlet valve structure and function
26.7 Aqueous pump model of outflow regulatory mechanisms
26.8 Ciliary body: crucial component in the control of aqueous outflow
26.9 Diagnosis of structural deterioration: surgical guidance
26.10 Recovery of normal function: restoration of elastance
26.11 Summary
References
Chapter 27. The role of ocular inflammation, fluid dynamics, and bleb morphology in surgical outcomes
Abstract
27.1 General bleb morphology
27.2 Bleb imaging and its role in confirming surgical outcomes
27.3 Fluid dynamics and the effects of intraocular pressure on bleb morphologies and surgical outcomes
27.4 Inflammatory and wound-healing effects on surgical outcomes and their alleviating interventions
27.5 Effects of implants on surgical outcomes
27.6 Biomarkers as trabeculectomy predictors
27.7 Infectious complications
27.8 Conclusions
Funding
References
Chapter 28. Aqueous humor outflow imaging and minimally invasive glaucoma surgeries
Abstract
28.1 Quick reference summary
28.2 Introduction
28.3 Ocular imaging of aqueous humor outflow
28.4 Conclusion
Acknowledgments
References
Chapter 29. Microinvasive glaucoma surgery device design considerations
Abstract
29.1 Quick reference summary
29.2 Currently accepted practices in microinvasive glaucoma surgery
29.3 Current breakthroughs, research and future directions of microinvasive glaucoma surgery
29.4 Concluding considerations on microinvasive glaucoma surgery
References
Chapter 30. Adjustable drainage devices
Abstract
30.1 Quick reference summary
30.2 Short review of the currently accepted practice/knowledge
30.3 Novel concepts
30.4 Discussion
Further reading
Chapter 31. Continuous intraocular pressure measurement
Abstract
31.1 Quick reference summary
31.2 Definitions of intraocular pressure fluctuation
31.3 Intraocular pressure fluctuation, therapeutic response, and glaucoma progression
31.4 Conventional intraocular pressure assessment
31.5 Home intraocular pressure monitoring
31.6 New technologies
31.7 Conclusion
References
Chapter 32. Cyclophotocoagulation: a look at the history, the accepted norm, and the future possibilities
Abstract
32.1 Quick reference summary
32.2 Introduction (the conventional)
32.3 The new era
32.4 Future implications
References
Chapter 33. Section summary: determination of the ideal patient–surgeon–procedure match
Abstract
33.1 Minimally invasive glaucoma surgeries and devices factors
33.2 Surgeon factors
33.3 Patient factors
References
Section 5: New technologies
Chapter 34. Artificial intelligence and big data: technical considerations and clinical applications
Abstract
34.1 Quick reference summary
34.2 Artificial intelligence and glaucoma
34.3 Current state of artificial intelligence and big data
34.4 Future obstacles
References
Chapter 35. Detection of apoptosing retinal cells in glaucoma
Abstract
35.1 Quick reference summary
35.2 Currently accepted practice
35.3 Recent developments
35.4 Discussion
35.5 Conclusion
References
Chapter 36. Neuroprotection and neuroenhancement
Abstract
36.1 Quick reference summary
36.2 Neuroprotection in current clinical practice
36.3 Promising advances in neuroprotection
36.4 Potential applications
References
Chapter 37. Clinical trials in neuroprotection: special considerations
Abstract
37.1 Quick reference summary
37.2 Historical approaches in glaucoma clinical trials
37.3 Special considerations for neuroprotection trials
37.4 Summary
References
Chapter 38. Neuro-regeneration and stem-cell therapies
Abstract
38.1 Quick reference summary
38.2 Introduction
38.3 Optic nerve regeneration
38.4 Stem-cell therapies
38.5 Summary
Acknowledgments
References
Chapter 39. Genetic testing and gene therapy in glaucoma
Abstract
39.1 Quick reference summary
39.2 Impact of current knowledge of glaucoma family history on risk assessment and therapeutic approach
39.3 Role for genetic testing and gene-based therapies in glaucoma risk assessment and treatment
39.4 Implications for clinical practice and impact on future glaucoma care
References
Chapter 40. Conclusion: glaucoma, moving forward
Abstract
Index

Kevin Gillmann

Dr Kevin Gillmann is an ophthalmologist, glaucoma specialist and researcher. He shares his clinical work between Geneva and London, where he is an honorary fellow of Moorfields Eye Hospital. He graduated from Newcastle University Medical School in 2013 (MBBS) and became a Fellow of the European Board of Ophthalmologists in 2018. In 2019, he completed his residency within Professor André Mermoud's glaucoma unit and graduated a Medical Doctorate (MD) on Minimally-Invasive Glaucoma Surgery (MIGS) from the University of Lausanne. His research with Stanford University and the Swiss Glaucoma Research Foundation focuses primarily on minimally invasive glaucoma surgery, neuroprotection and personalised glaucoma therapies. His work was featured on the frontpage of several magazines and in high-impact journals such as Nature's Eye and the British Journal of Ophthalmology, and received grants from the BrightFocus Foundation. With over 50 peer-reviewed articles, contributions to several book chapters and international guidelines, he was recently ranked amongst the top 0.5% glaucoma experts worldwide by ExpertScape. Dr Gillmann frequently gives lectures both nationally and internationally, including at the University of Liverpool and the University of London, where he was awarded a prize for academic achievements. Aside from his activities as a clinicians and educator, Dr Gillmann has also devoted some of his research to the study and improvement of patient experience in healthcare services. He was awarded a postgraduate certificate in Media and Medicine from Harvard Medical School, a Master of Business Administration (MBA) with distinctions from the University of London, and a Master of Architecture from the University of Paris LaVillette where he wrote a thesis on the interconnections between hospital design, patient perception and society.

Affiliations and expertise

Glaucoma fellow at Moorfields Eye Hospital, London, UK, and a research coordinator at the Glaucoma Research Centre with the Swiss Glaucoma Research Foundation, Lausanne, Switzerland

Kaweh Mansouri

Prof. Mansouri is currently a consultant ophthalmologist at Montchoisi Clinic, Lausanne, Switzerland; and an Adjoint Professor at the Department of Ophthalmology in University of Colorado School of Medicine, Denver, USA. He pioneered the use of 24-hour IOP-monitoring technology for patients with glaucoma by contributing to the development of the IOP-sensing contact lens, Triggerfish, and was the first ophthalmologist to give a TEDx talk. A MIGS pioneer, Kaweh leads many instructional courses at international meetings and has over 75 peer-reviewed publications, including several high-profile publications and journal covers. He has contributed to a number of glaucoma textbooks, including the World Glaucoma Association Consensus Series. Prof. Mansouri is also President of the Swiss Glaucoma Research Foundation, Executive Vice President of the World Glaucoma Association, and Glaucoma Editor of the Asia-Pacific Journal of Ophthalmology.

Affiliations and expertise

consultant ophthalmologist at Montchoisi Clinic, Lausanne, Switzerland; and an Adjoint Professor at the Department of Ophthalmology in University of Colorado School of Medicine, Denver, USA