Eyeworld

70 | EYEWORLD | SUMMER 2026 G UCOMA may not need treatment. It's also helping us rule out IOP and perhaps glaucoma as a causative disease for a visual field defect," she said. Dr. Wirostko said Wilmer Eye Institute and Moran Eye Institute have been working on data coming from iCare HOME2 that is showing that certain therapies have a better effect on early morning pressure spikes, which go unnoticed without home tonometry monitoring. "We're finding that if you want to completely eliminate those early morning spikes and reduce any variability in IOP, you need to bypass the whole outflow system, either with a trabeculectomy, tube, or shunt like PRESERFLO [Glaukos]. Even with some angle-based surgeries, you're still getting some early morning elevations of IOP, probably higher than what we would want for those patients with advanced disease," she said. Dr. Wang said right now in glaucoma, treat- ment options are often applied in a stepwise and escalating approach for patients, taking time to find the most effective treatments. With clinical decisions supported by big data predic- tion tools, ophthalmologists might be able to go straight to selecting the most effective treat- ments for a given patient, bypassing potentially less effective treatments altogether. In addition to using data amassed from EHRs, large-scale surveys, and other data sourc- es, the availability of multimodal data is a game changer, Dr. Wang said. With imaging from OCT, visual fields, and more, incorporating these different types of modalities into data models can help pick up patterns and help establish if a patient may be progressing or if they're stable. "That would be enormously helpful. That's certainly an area of research that I'm interested in. It'll take some work, though, to get there because of the complexity both of developing those multimodal models and deploying them into real clinical environments and IT infra- structures," Dr. Wang said. One thing that Dr. Wirostko is excited about is the availability of polygenic risk scores for glaucoma. "Right now, if we have a patient who has a family history and their pressures are borderline, but they don't have any noticeable damage yet, how do we know the best way to follow that patient? … I think for these pa- tients, when you start to incorporate big data and consider genetic risk scores, that's going to be very exciting to help us determine who we should be following more closely and perhaps intervening on sooner." In the future, Dr. Wang is excited for AI to assist in glaucoma screening, identifying glauco- ma suspects correctly, and not missing patients with real glaucoma and progressive disease. As previously mentioned, she looks forward to it helping clinicians decide what treatment or procedure would most benefit a patient. "These things excite me, and I hope that we can make those applications a reality in a way that is responsible, fair for everyone, and improves healthcare access," Dr. Wang said. Dr. Wirostko said she's excited for big data to provide answers to questions like why some patients experience elevated IOP in early waking hours. She's also looking forward to more development in virtual reality visual field testing. She thinks the Humphrey for visual field testing is still more reliable than virtual visual fields, but it is also what we know, she said. She envisions being able to ship a virtual reality continued from page 69 87-year-old cardiologist with severe glaucoma in the right eye and loss of vision; OS preop and postop iCare HOME readings for a cataract extraction and Hydrus Microstent (Alcon) Source: Barbara Wirostko, MD, FARVO

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