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TGF'S ANNUAL INTERNATIONAL THINK TANK
The Glaucoma Foundation’s Annual Optic Nerve Rescue and Regeneration Think Tank provides a unique opportunity for scientists and clinicians to apply their research and progress to the challenges of glaucoma. Beginning in 2012, the interdisciplinary Think Tank sharpened its focus on exfoliation syndrome (XFS), the most common recognizable cause of open-angle glaucoma worldwide, comprising the majority of cases in some countries.
This year’s Think Tank in New York City in June was the fifth to deal with exfoliation, with some 60 participants from the United States as well as Australia, Canada, China, Germany, Japan, Singapore and Spain.
Collaboration is the key to the success of the Think Tank, which strives to create an open and effective dialogue among those attending. The hope is to foster new relationships among the participants that will lead to communication and collaboration across disciplines and between laboratories – long after the meeting has ended.
In 2007 scientists identified genetic variants in the lysyl oxidase-like 1 (LOXL1) gene that have been strongly associated with XFS, but do not alone cause the condition. Environmental effects appear to play a role in whether or not someone predisposed to the disease will develop it. Collaborations have already advanced the understanding of exfoliation and yielded important new findings.
Several new genes have now been discovered and associations with elastic tissue disorders are being described. New information about the LOXL1 gene and its variations offer the possibility of devising treatment approaches directed toward the gene. Altogether, recent studies have provided new insights into the genetics, pathology and biology of XFS, opening the door to new approaches to preventing or reversing or even curing XFS.
Growing patient-derived XFS cells in cell culture has revealed that similar to other age-related diseases such as Age-related Macular Degeneration and Alzheimer’s, the cellular machinery that degrades protein aggregates is not working properly. In the case of XFS, the theory is that exfoliation material cannot be degraded leading to an accumulation of “cellular trash” both inside and outside the cell that becomes toxic.
A related area of interest is the growing appreciation of the systemic nature of exfoliation. It has been known for decades that exfoliation material can be found in most tissues and that numerous conditions, such as hearing loss, and cardiovascular and cerebrovascular disease, are associated with XFS.
A recent study looked at female patients in the large, inclusive Utah Population Data Base (UPDB) to see if there was a link between XFS and pelvic organ prolapse. Researchers found that women with pelvic organ prolapse were at approximately a 50 percent increased risk of having XFS and that women 30-65 years of age who had a pelvic organ prolapse diagnosis, when followed for 20 years, had a 48 percent increased risk of developing XFS during that time period. The findings could lead women with pelvic organ prolapse to get early screening for XFS, and potentially save their vision.
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WHAT YOU SHOULD KNOW
FIVE RX SUMMER TRAVEL TIPS
- Start your trip with new refills of your glaucoma medications. Pack a sufficient supply of each medication, and talk to your doctor in advance about extra prescriptions, just to be safe.
- Carry medications with you on an airplane. For air travel, pack eye drops, with other liquids, in a one-quart, zip-top plastic bag in 3-ounce or smaller containers. If you are traveling by car, do not store medications in the trunk.
- Set an alarm on your cellular phone, watch or travel alarm clock to remind you when to take your daily doses.
- Many doctors recommend adapting your medication schedule to the local time at your destination and not worrying about a missed dosage due to time zone changes. Ask your doctor to be sure.
- And don’t forget: make a list of all your medications, noting each prescription dosage, the medication’s trade name as well as its generic name – especially important if you are traveling abroad.
A NEW TREATMENT OPTION
There is a new option in the growing arsenal of microinvasive glaucoma surgery (MIGS) devices available to glaucoma surgeons in their quest to lower patients’ IOP.
Most recently, the FDA approved Allergan’s minimally invasive Xen Gel Stent. The stent is a soft, permanent implant that shunts fluid from the anterior chamber to the subconjunctival space. It is placed just under the conjunctiva, which is a clear membrane that covers the white of the eye. Approximately 6-mm long, the length of an eyelash, and the width of a human hair, the stent comes preloaded in a disposable Xen injector and is implanted through a small, self-sealing corneal incision.
The Xen Gel Stent surgery is an outpatient procedure – your doctor will schedule follow-up appointments to review your progress and determine your need for eye drops. The stent is designed to lower high eye pressure in open-angle glaucoma patients where previous surgical treatment has failed and/or medications alone are insufficient. The procedure should not be used in patients who have angle-closure glaucoma where the drainage angle of the eye has not been surgically opened.
The Xen Gel Stent is now available in the United States.
SOME DO's AND DON'Ts FOR SUMMER ACTIVITIES
Maintaining an active lifestyle with a daily routine of exercise is a good prescription for anyone, including people with glaucoma.
There is evidence that aerobic exercise (e.g. brisk walking, running, biking) performed on a regular basis can lower IOP. Exercise may also improve blood flow to the retina and optic nerve. If you need an incentive, remember once the aerobic exercise stops, your IOP will return to its earlier level. But before embarking on a new exercise regime, always discuss the pros and cons with your doctors.
There are some caveats. Upside down yoga positions, such as handstands or shoulder stands, scuba diving and other activities where you invert your body should be avoided, because they can raise IOP. Exercises in which you inhale and hold your breath are also not recommended.
Be sure your sunglasses filter out 100 percent of UV light. And always wear protective glasses when doing yard work or playing contact sports. Wear goggles when swimming – large goggles that don’t press too hard on the orbit of the eye are recommended. It’s especially important for individuals who have had trabeculectomy surgery to wear wrap-around goggles when swimming or kayaking as infection in post-trabeculectomy eyes can be serious. Best to stick with sea water or a pool – fresh lake water has more infectious capabilities. If you suspect the water quality, don’t take a chance. Let caution be the rule.
When patients with pigmentary dispersion syndrome or pigmentary glaucoma jog or participate in other jarring ball sports, they may develop an exercise-induced release of pigment from the iris and possibly an associated spike in IOP. These patients need to check with their ophthalmologist, who may want to evaluate them before and after such exercise.