Glaucoma Research
Chat Highlights
December 16, 2009

On Wednesday, December 16, 2009, Dr. Michael Pro, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma Research".

Moderator: Tonight's Topic is “Glaucoma Research"

P: What is the newest glaucoma discovery in the last year?

Dr. Pro: Good topic. The newest discovery in glaucoma might be the realization that certain drugs used for retinal disease could be useful in glaucoma disease and surgery.

Specifically, there is a drug called Avastin (bevacizumab) and it was originally developed to fight colon cancer. It belongs to a new class of cancer drugs that attack the tumor's tendency to cause new and abnormal blood vessels to grow. This is called anti-angiogenesis. It was discovered maybe 10 years ago that this same medicine, when injected into the eye, could cause a certain kind of macular degeneration (wet form) to improve.

Avastin caused the abnormal retinal blood vessels that lead to vision loss in wet macular degeneration to shrink. A similar drug was developed called Lucentis and today both drugs are widely used by retinal specialists to treat various disorders related to the growth of abnormal blood vessels in the retina.

Now we find that these medicines can be used in glaucoma.

One type of glaucoma is called neovascular glaucoma; it is caused by abnormal blood vessels growing over the trabecular meshwork, the drain of the eye. This type of glaucoma can be seen in people with diabetes or retinal vein occlusions. Avastin can be injected into the eye and cause regression of these blood vessels much faster than the standard treatment (laser to the retina) and can save the person from needing glaucoma surgery.

Also, Avastin or Lucentis may be useful either at the time of or shortly after glaucoma surgery (a trabeculectomy). These medicines may be useful in preventing post-operative bleb scarring and failure.

P: Are there new findings on the use of antimetabolites, MMC & 5-FU, in trabeculectomies?

Dr. Pro: Well, not in regards to those medications, but there is research at Wills and in other institutions into using Avastin or Lucentis in place of or in addition to those medications at the time of glaucoma surgery.

P: Are there any new surgical techniques showing promise?

Dr. Pro: Yes, always. Firstly there is what I would call modifications on standard trabeculectomy; one modification is using a different anti-scarring agent, which we discussed above. Another modification is in technique, and or material. There is a new material called ologen which is a collagen matrix. This material can be placed over the scleral flap at the time of trabeculectomy and may increase the long-term success of surgery (We are waiting on long-term data).

The ExPress glaucoma mini-shunt is a 3 mm long stainless steel device that is placed under the scleral flap at the time of trabeculectomy surgery and may prevent some post-operative complications (like a too low IOP).

P: Have any major studies been released since the Ocular Hypertension Treatment Study? (OHTS)

Dr. Pro: Since OHTS the next major study is TVT, or “tube versus trab.” Tube versus trab is a large, multi-center study which just published three year data showing similar effectiveness in reducing the IOP from baseline with both surgeries.

The tube group tended to need more glaucoma medicines post-op, but seemed to experience fewer early post-op complications in that study.

P: For those not living on the east coast, what type of facility is Wills Eye Institute? Does Wills do research in-house? How is the focus of research for the institution decided?

Dr. Pro: Wills Eye Institute is one of the oldest eye care institutions and oldest residency programs in the United States. It has been a pioneer in many fields including the development of modern cataract and retinal surgery.

There are several departments at Wills: glaucoma, cornea, retina, pediatrics, oncology, pathology, and others and each department is active in research. Usually the research is clinical, i.e. new drugs, surgical devices, or techniques.

P: How do you decide what studies to personally participate in?

Dr. Pro: We have periodic staff research meetings where we review what trials are currently in process. Also one of the staff members periodically starts a study in an area of interest. We use the research meetings to discuss ideas.

P: Are there any studies right now related to repairing the damage to the optic nerve?

Dr. Pro: There is nothing close to clinical trials in humans. There have been studies showing optic nerve regeneration in certain animals, but we remain a long way off from human optic nerve regeneration.

P: If glaucoma patients would like to participate in a research study, how would we get involved?

Dr. Pro: We have a research staff at Wills who are asked to talk to patients who are candidates for specific studies, but anyone interested in participating in a study (and many are not drug or surgery studies, but visual field studies or functional studies) can talk to a research coordinator at any time; they're very approachable.

P: Is this a good method (participating in a research study) for those without insurance to receive free medical care?

Dr. Pro: Well for the duration of the study any visit is usually free.

P: Do study participants receive funds for their participation?

Dr. Pro: Sometimes if the study is funded by a pharmaceutical company, but most studies are funded by our research foundation and we receive no compensation for that.

P: Do you foresee a cure for this disease found in your lifetime?

Dr. Pro: I think glaucoma will increasingly become a chronic condition which can be managed successfully like diabetes. I foresee less blindness due the disease due to much more effective early detection and treatment, and certain specific genetic forms of glaucoma will be eliminated.

Moderator: Thank you Dr. Pro; our time is up. We always learn something when you share your knowledge with us.

Dr. Pro: Thanks! And thank you for such insightful questions!

On January 6, Dr. Pro discussed "NTG Treatments" in the Chat room. Click here for highlights of that meeting.

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