How I Learned to Stop Worrying (and Love Studies on Glaucoma Pathogenesis)

Glaucoma is a mystery — a whodunnit. A whats-the-pathogenesis? It’s something I’ve always been fascinated by. How can we be this far into human history, with this many tools, and still have so little knowledge about this disease which affects some 67 million people, and will cause nearly 7 million to lose most or all of their vision?

When I was first learning about ophthalmology and how to write about it? — about 12 years ago — the editor I was working for at the time called me into his office. I had written an article that identified a rise in intraocular pressure (IOP) as the cause of glaucoma. Or maybe it was that glaucoma caused a rise in IOP. Either way, it was wrong, or at least, it was wrong of me to presume the causality. The experience left me a little paranoid. How sure am I about causation in general? Maybe I’m a better journalist because of it. Maybe I’m just an overall more pedantic person. (If you think it’s the former, let me know. If it’s the latter, don’t say anything!)

Not only are we unsure of what causes glaucoma, we don’t even agree on a definition for what glaucoma is. Some forms of the disease are linked with a rise in IOP, but glaucoma doesn’t require a rise in IOP. Glaucoma damages the optic nerve, but not all damage to the optic nerve is glaucomatous. An IOP of 21 mm Hg was once considered diagnostic of ocular hypertension, but advancements in IOP measuring technologies are now offering a more complete picture of how pressure fluctuates throughout the day. People with glaucoma usually have a specific pattern of visual field loss that respects the horizontal midline, but once this pattern appears, significant damage has already occurred.

There’s a thrill in the challenge of uncovering how to better understand, diagnose, prevent and treat this disease. Each little advancement in research is another piece fit into the puzzle. One day, maybe in our lifetime, researchers will finally lock in enough pieces to see the full picture. At the American Glaucoma Society , everyone is working on it together, and this year, Ophthalmology Advisor reviewed some of the top research presented at the American Glaucoma Society . If you weren’t able to attend in person, take a look at what we found interesting.?

We also offer a special report on a recent JAMA Ophthalmology study detailing the associations between retinal artery occlusion and systemic diseases — written by the original researcher, Karen Wai, MD , MD. Another recent article highlights how disturbances in the gut microbiome might affect ocular disease risk.

Anat Galor , MD, offered opinions about developments in research there. Finally, our regular features, Ophthalmology Dx and the latest FDA announcements , are available.

With all this, and our daily news coverage, we’re hoping that we can play some small role in helping solve the glaucoma mystery. Then I can finally start publishing articles that confidently explain the cause of the disease without worrying!

— Bill Kekevian , Senior Editor of Ophthalmology Advisor & Optometry Advisor , of Haymarket Medical Network

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