G360 2024: Rehashing glaucoma treatments with Dr Michael Chaglasian

Michael Chaglasian, OD, FAAO highlights key talking points on his talk, "Facts and Fiction for Glaucoma Testing," as well as hopeful developments in glaucoma treatment with Optometry Times. Chaglasian gave his talk during this year's Glaucoma 360 event, which wrapped up on February 10 in San Francisco, California.

Editor's note: This transcript has been lightly edited for clarity.

Michael Chaglasian, OD, FAAO:

Hi, I'm Michael Chaglasian. I'm an associate professor at the Illinois College of Optometry. I practice seeing glaucoma patients at the Illinois Eye Institute in Chicago, Illinois.

I'm here at the Glaucoma 360 meeting in San Francisco; always a great kickoff meeting for me in the early part of the calendar year to start thinking about things all glaucoma since that's really where my passion is. At this meeting, I have a small talk on facts and fiction for glaucoma testing. So I'm going to be talking about several of the key things that people often get mixed up on in the diagnosis and assessment of their patients who might have glaucoma. We're going to talk about intraocular pressure (IOP) measurement, visual fields, and [optical coherence tomography, or] OCT.

So lots of new information and maybe a little bit rehashing of information that we know but needs to put into place better at this Glaucoma 360 meeting, particularly in the realm of IOP measurement. You know, we've known for a long time that we don't have a full picture of our patients' intraocular pressure. We measure it 2 to 5 times a year in our office, and we don't know what's going on in between. There have been many studies over the years of identifying that pressure is highest at night while patients are sleeping, and the way that IOP varies between eyes and days and weeks. There are devices now where patients can measure their eye pressure at home on one of those devices, the eye care home tonometer, and it really helps the practitioner. It's a device I've used in my practice to get a better picture of the patient's diurnal high pressure curve. That factors into how we set target pressures, how low our pressure needs to be in glaucoma care and whether or not the patient is having IOP spikes that is increasing the risk of future progression.

Looking forward to in the field of glaucoma, this will be a little bit 2024: [artificial intelligence, or] AI. Seriously, though, today my talk, "Facts and Fiction for Glaucoma Testing," is about helping optometrists read and interpret their visual field reports and their OCT reports. There are many foibles and failures in how that's done: it's a different devices and different reports, and it's a little bit of a mixed bag. So I do believe that an AI type of algorithm that would help us read a report, give us the high level intuitive interpretation of it, associate it with the correlating visual field reports [would be beneficial], so we have that structure and function thing that we always talk about in glaucoma, as well as perhaps AI utilization and analysis of at-home high pressure readings for our patients, where we would have hundreds of pressure readings. That would really turn things around, I think, for glaucoma.

At this Glaucoma 360 meeting, there's always talk about new treatments and new procedures. Quite honestly, there's not too much in the near-term horizon for new pharmacological treatments for glaucoma. There's a host of new surgical procedures, you know, that's always there, so these mixed devices, they continue to evolve. Although, recently there's been some pushback about the full efficacy of mixed procedures and there was some issues that happened at the end of 2023 for reimbursement purposes and coverage purposes for [microinvasive glaucoma surgery, or] MIGS so that got talked about at the meeting. So all of that factors in together of, "How am I going to take care of my glaucoma patient in 2024 and beyond?" Perhaps like good many years, it's a lot of the same and a little bit of moving forward with a better understanding of where our analysis as clinicians needs to be focused.