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EW MEETING REPORTER 82 November 2016 Reporting from the American Academy of Ophthalmology (AAO) meeting, October 15–18, Chicago Dr. Pasquale also spoke on Afri- can-derived OAG (AD-OAG). Those of African descent are more at risk for developing open-angle glauco- ma and at younger ages. As such, Dr. Pasquale said the siblings and children of these patients should be screened. Finally, Dr. Pasquale discussed estrogen deficiency OAG (ED- OAG). Several studies have shown increased glaucoma risk in women with estrogen deficiency, and the hormone proved to be neuroprotec- tive in an animal model. While POAG is a "remarkably heterogeneous disease," Dr. Pasquale said it has distinct, overlapping sub- types. These subtypes have different onset ages, IOP profiles, optic nerve features, genetic biomarkers, and thus more research is needed to find the secondary causes of POAG. Editors' note: Dr. Pasquale has finan- cial interests with Bausch + Lomb. Opening ceremony The AAO opening ceremony began with addresses from leaders in the organization. A panel examined the topic of "Physician Payment under MACRA – Choices for Ophthalmol- ogists." The session concluded with the Jackson Memorial Lecture given by Douglas Koch, MD, Houston, on seemed to agree with his assessment, with 60% voting that the patient only be followed as a suspect at this stage, not treated to lower IOP. Editors' note: Drs. Lin, Medeiros, and Singh have no financial interests related to their comments. A call to redefine primary open-angle glaucoma (POAG) Louis Pasquale, MD, Boston, thinks it's time to take the "p" out of POAG. "We really need to redefine this disease," Dr. Pasquale said. Why? Because, as he described through published research during the American Glaucoma Society's Subspecialty Day Lecture, POAG can be secondary to other things. Dr. Pasquale first proposed replacing the "p" with "pc" for paracentral. Some patients with PC-OAG have normal IOP, while others might have what's consid- ered hypertension glaucoma. What PC-OAG patients have in common is a triangular pre-laminar neuronal defect. These patients' target IOP is less than 10 mm Hg, and they should be encouraged to eat green, leafy vegetables as a source of nitric oxide, which is important for the regulation of IOP and could reduce risk of PC-OAG. from unknown causes or dementia/ delirium. Certain non-infectious eye conditions are also contraindi- cations, including retinoblastoma, malignant anterior segment tumors, adenocarcinoma in the eye, active inflammation, and congenital or acquired disorders. Editors' note: Dr. Woodward has no financial interests related to her comments. Difficulty in diagnosing, treating glaucoma suspects "Is it glaucoma? Is it progression?" These questions were asked during the opening session of AAO's Glau- coma Subspecialty Day. Shan Lin, MD, San Francisco, introduced the case of a 43-year-old male patient who was being fol- lowed as a suspect. His visual acuity was 20/20, visual fields were normal in each eye, and IOP was in the mid to high teens. OCT images taken every 6 months, however, showed his right eye, borderline at baseline, getting worse over time. The left eye with superior and inferior defects at base- line seemed to progress as well. "Is this glaucoma? Are we going to treat this patient or not treat this patient?" Dr. Lin asked. Felipe Medeiros, MD, La Jolla, California, defended treatment based on OCT alone. Dr. Medeiros cited research that found 19% of glaucoma eyes had progression only on OCT without visual field change. But can you wait to treat until a visual field defect is found? Dr. Medeiros said research shows 35% of nerve tissue is lost by the time an early visual field defect is detected and an additional 25% lost with more severe defects. Kuldev Singh, MD, Palo Alto, California, however, said treatment decisions should not be based on OCT alone. First, there could be false glaucoma diagnosis (red disease). OCT also does not correlate well with visual function, and there is no evidence that OCT has improved vision prevention or quality of life, he said. Dr. Singh said that having more data doesn't always lead to better decisions. Most of the audience Sponsored by

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