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Top-Ten from the AGS Meeting
March 2003, San Francisco, USA
Cynthia Mattox
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W. Lee. M. Alward described two families from their large database that have autosomal dominant NTG. One of these families had the same E50K mutation previously reported in the optineurin gene; the other family did not have any defects in the entire optineurin gene. This huge family had ten affected individuals in at least four generations, all with IOPs under 20.
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Darrell WuDunn described some elegant experiments that revealed the interesting interactions of mechanical stretch (producing a stress response), interleukin-1a, and NF-kappa B activation in trabecular meshwork cells. (NF-kappa B activates ELAM.)
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With sophisticated animated graphics and in vivo video, Murray Johnstone demonstrated the pulsatile flow of aqueous in tubules in Schlemm's canal and into episcleral veins. He emphasized the dynamic and compliant nature of the trabecular meshwork as opposed to a static sieve-like system.
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D.S. Friedman presented the staggering statistics of the increased prevalence of glaucoma that will become apparent as the proportion of elderly Americans increases in the coming decades. Using the primary data from large population-based studies in the USA, Australia, and Europe, an estimated 3.4 million Americans will have glaucoma in 2020, compared to the estimated 2.2 million in 2000.
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F.S. Mikelberg presented data that dispute the theory that Helicobacter Pylori infection is somehow connected with open angle glaucoma. A large number of patients and controls were tested for IgG seropositivity to H. pylori but there was no significant difference between the groups.
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Joseph Caprioli described how the drug Tepranone, geranylgeranylacetone (GGA), which is used in Japan to treat gastric ulcers by protecting the gastric mucosa, may be neuroprotective for retina ganglion cells. GGA was found to increase heat shock protein 72, and thereby ameliorate the loss of RGCs in a rat model of glaucoma in which IOP was elevated.
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The three Mini Symposia were well-received.
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The Business of Glaucoma included presentations by Paul P. Lee on AGS and community practice patterns in caring for glaucoma patients. Recall systems, documenting handout materials, informed refusal, and expectations for compliance were a few of the simple things that Paul Weber reminded us could be performed in order to avoid malpractice suits. As always, Bill Ritch provided us with the current status on Medicare reimbursement issues, while Steven Fleisher eased our minds about the upcoming HIPPAA regulations.
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In Evidence-Based Medicine, Anne Coleman, Don Minckler, Michael Kass, and Paul Lee reviewed the ways in which we can use our literature to provide better care for patients. Linda Zangwill reviewed the sensitivity/specificity data for the various NFL/optic nerve imaging devices. Richard Parrish and Roy Wilson elegantly described concepts such as 'likelihood ratio' that can help with clinical decision-making. Henry Jampel encouraged interested AGS members to become involved in producing a Cochrane review.
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In the Video Surgical Mini-Symposium, Drs Katz, Parrish, Liebmann, Cioffi, Singh, Tello, Wise, Cohen, Cantor, Myers, Wilson, Crandall, Johnstone, Lesser, Stiles, and Samuelson all presented brief videos of their surgical techniques for conjunctival closure, releasable sutures, and complex cataract and glaucoma surgery.
