News Flashes IGR 21-2

Is VR really capable of delivering clinically meaningful insights?

Promotion of lymphatic pathways could improve native aqueous humor outflow or outflow after glaucoma surgery

The prominent cell 'type' of the conventional pathway is the trabecular meshwork (TM) cell, displaying at least two different morphologies (TM vs. juxtacanalicular, JCT)

Due to their extensive connectivity, separation of these outflow cells by dissection is extremely difficult

It is now clear that generation and regulation of IOP likely involves a complex interplay between many cell types in the outflow pathway

A key finding of the study is the conservation of gene expression across humans and macaques, with a surprising note that lymphatic markers are reduced in primates as compared to pigs and mice

Given the fact that monkeys slept in a standing position, it is interesting and unexpected to find more significant elevation of CSFp than IOP, thus a significant lowering of TLPD during sleeping hours. The result matches the increase of CSFp reported in humans who slept in the supine position

For glaucoma patients, a deficient CSFp elevation during sleep may also contribute to the pathogenesis of glaucomatous optic neuropathy

Apolipoprotein A-I binding protein (AIBP) may play a critical role in suppressing Muller glial activation and protecting RGCs against glia-driven neuroinflammation and mitochondrial dysfunction in glaucomatous neurodegeneration

While these data are consistent with lack of harm from the transplant, any benefit of treatment has yet to be shown

Autophagy is a lysosome-mediated degradation system. Physiological levels of autophagy are essential for the maintenance of cellular homeostasis, and it is rapidly upregulated during various stress conditions

Corneal strain based systems cannot be calibrated to true IOP and so do not measure IOP directly

IOP peaks triggered by the WDT may reveal instability of IOP inconsistent with controlled glaucoma, in a similar fashion as a cardio stress test may reveal coronary ischemia not seen in physiologic states

Measurement of single-day IOP variation can poorly characterize the short-term IOP variation5 On the other hand, IOP peak and mean during WDT are quite reproducible in different days and months

On the other hand, one might hypothesize that considering eyes progressing so markedly as to be detected by the AGIS method may not provide a realistic assessment of sensitivity to subtle change. Similarly, eyes having visual fields that are so unvarying that they are found to be stable in a PoPLR analysis may be presenting a test of specificity that is unrealistically undemanding

The real value in this study is mainly to underscore that the formulae we have established to predict peak 24-hour IOP from office-visit data are not applicable to all patients in a typical glaucoma clinic

Reliability parameters may be the least reliable metrics produced by the Humphrey perimeter,3,4,5 leading to the conclusion that perimetric test results should seldom be discarded solely on the basis of reliability parameters

The field of glaucoma has seen numerous laser and surgical procedures come and go despite early results which appeared favorable, but when analyzed on a more extended basis, turned out to be not as effective or safe as originally thought

Results may not be permanent after a single ten-day course of treatment and that repeating the ACS would be necessary

As is often the case with strong science, the experiments raise at least as many questions as they answer

We should be cautious in attributing any improvements in axon counts and some measures of visual function in glaucoma models to regeneration rather than survival and delayed recovery

Therefore, these data require replication with the addition of numerous critical controls

The presented approach to treat age-related neurodegenerative diseases still requires adjustments before being brought to the clinic

Clinically, it will be important to determine the abundance of injured-but-not-yetdead RGCs that might be amenable to such a strategy and to figure

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