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158 EW MEETING REPORTER Reporting live from Hawaiian Eye 2013, Big Island, Hawaii Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from Hawaiian Eye 2013. March 2013 Signs a glaucoma patient will lose vision Variability of IOP and early optic nerve damage are indicators that a glaucoma patient will go blind from the disease, a speaker said at Hawaiian Eye 2013. Rohit Varma, M.D., said over a 20-year period of seeing patients, about 15-27% will go blind in at least one eye, and about 20% will go completely blind. Dr. Varma was recently appointed chair of the Department of Ophthalmology and Visual Sciences at the University of Illinois, Chicago. He estimated that 21-44% of patients over a 10-year period in the U.S. experienced progressive visual field loss. Interestingly, the group that progressed to blindness showed more variability of IOP while on therapy than the non-blind group. Patients with peaks in IOP also are likely to go on to lose vision. "The different sensitivities of patients to IOP indicate that ongoing monitoring of glaucomatous damage remains essential," Dr. Varma said. While establishment of a target IOP is a cornerstone of modern glaucoma practices, "over time, it's important to change and modify that based on response of the patients and whether or not they are continuing to have field loss," Dr. Varma said. The range of IOP is as important as the mean IOP. "Even though IOP may be low, there are times when people will continue to go blind or lose vision," Dr. Varma said. "That's why it is critically important to identify people early on." In another finding, only about one-third of individuals in the blind group when they were first identified had normal optic discs, whereas almost three-fourths of those who did not go blind had a normal optic disc. "What that says is that if you identify [those who have] a fair amount of optic nerve damage at the outset, they are at greater risk to become blind as compared to those who have minimal or no changes in their optic disc early on," Dr. Varma said. Editors' note: Dr. Varma has no financial interests related to this talk. IOP monitoring Allowing patients to monitor their IOP at home will be a boon to patients and physicians and give those physicians a clearer vision of how to treat glaucoma patients, according to L. Jay Katz, M.D., Philadelphia. When monitoring IOP in the office, "it's an incredibly small amount of time that the patient is around. In other words, you're taking a snapshot. You're not getting a movie reel of what the pressure is for the patient," Dr. Katz said. "When you think about it, we base so many of our decisions on whether to initiate treatment for glaucoma and responses to our treatments of glaucoma on pressure readings, it is startling that we don't have more information about what the pressure is over a period of time and between visits." At-home monitoring could offer the following improvements, according to Dr. Katz: • Increased amount of valuable information including the highest number and amount of fluctuation; • Fewer office visits; • Quicker adjustments in therapy; • Documentation of non-adherence with medical therapy; and • An increase in the patient's role and involvement in his or her care. Editors' note: Dr. Katz has financial interests with Sensimed (Lausanne, Switzerland), the makers of Triggerfish. Gene-based testing Gene-based testing for glaucoma can identify individuals at risk before they develop irreversible damage to the optic nerve, according to a second presentation given by Dr. Wiggs. "For glaucoma you really want to be able to treat people most effectively at the early stages of the disease," Dr. Wiggs said. "In addition to screening tests, we can develop diagnostic tests that will give a molecular diagnosis, which is becoming increasingly important in terms of gene-based therapies. In some instances, we also can help establish a prognosis based on the specific gene mutation the patient has." Today, doctors can test patients for mutations in genes that are known to cause dominant and recessive forms of inherited glaucoma. "These actually cause the disease, so we can give real information continued on page 160