Four articles. Four minutes. | Issue #11
Diagnostics: Routine 10-2 VF adds limited value, but improves detection of rapid central progression in select glaucoma patients
Genetics: Genome-wide study identifies new genetic variants linked to steroid-induced ocular hypertension
Medication: Tirzepatide linked to lower 2-year POAG risk than GLP-1 receptor agonists in older adults with diabetes
Epidemiology: Disc hemorrhage and lower IOP reduction linked to fast Asian NTG progression
Value of 10-2 Visual Field Testing for Detecting Progression in Patients with Glaucoma.
Methods
This prospective longitudinal study compared serial 10-2 and 24-2 Humphrey visual field testing in 96 treated open-angle glaucoma eyes and 56 healthy controls followed for a median of 4.5 years. Participants underwent paired 24-2 and 10-2 testing every 4 months, and investigators compared central 12 locations of the 24-2 with the full 10-2 using global, quadrant, and pointwise total deviation slope analyses while matching specificity between the two tests.
Results
The 10-2 and 24-2 performed similarly for detecting progression using global and sectoral analyses. However, the 10-2 identified more eyes with rapid focal progression when stricter pointwise criteria (≤–1.25 dB/year) were applied, particularly in patients with worse baseline central visual field loss. At 90% specificity, 53% of progressing eyes were detected by both tests, while 28% were identified only by the 10-2 and 19% only by the 24-2. Major limitations include restriction to patients with early glaucoma, exclusion of highly myopic eyes, and comparison with the traditional 24-2 rather than the newer 24-2C strategy.
Conclusion
Routine serial 10-2 testing provided little additional benefit over the 24-2 for most patients with early glaucoma, but it improved detection of progression in eyes with preferential central visual field loss and faster localized deterioration. These findings support selective rather than universal use of the 10-2 during glaucoma follow-up.
Our Angle
This is one of the strongest prospective comparisons of serial 10-2 and 24-2 testing because it addresses several limitations of prior studies. The inclusion of a healthy control cohort allowed the investigators to control for false-positive progression and compare performance at matched specificity.
Perhaps the most clinically relevant finding is that routine 10-2 testing is unlikely to improve progression detection in the average patient with early glaucoma. Instead, the study supports a risk-stratified strategy. The greatest benefit of the 10-2 was observed in eyes with established central visual field damage and faster focal deterioration. For these individuals, the denser sampling of the macula likely captures progression that the relatively sparse central points of the 24-2 may miss.
Several limitations deserve consideration. The study included only patients with early glaucoma and excluded highly myopic eyes, limiting generalizability to advanced disease and myopic glaucoma. Additionally, comparisons were made against the traditional 24-2, not the newer 24-2C, which incorporates 10 additional central test locations and may narrow the performance gap. Future longitudinal studies comparing 24-2C versus 10-2 are likely to be more clinically relevant.
Genetics
Genome-Wide Association Study for Glucocorticoid-Induced Ocular Hypertension.
Design: Pharmacogenetic genome-wide association and whole exome sequencing study
Journal: Ophthalmology Science, May 2026
Authors: Lama et al.
Among 1118 patients exposed to glucocorticoids, investigators identified common variants in the UBE2E3 locus associated with a smaller steroid-induced IOP rise, and demonstrated that the gene is highly expressed in aqueous outflow tissues, including Schlemm canal and trabecular meshwork. These findings strengthen the evidence that genetic factors influence susceptibility to steroid-induced ocular hypertension, but modest effect sizes, limited ancestral diversity, and the need for larger functional validation preclude clinical implementation at this time.
Medication
Association of Tirzepatide versus Glucagon-Like Peptide-1 Receptor Agonists with Incident Glaucoma in Patients with Type 2 Diabetes: A Retrospective Cohort Study.
Design: Retrospective propensity-matched cohort study (TriNetX)
Journal: Ophthalmology Science, May 2026
Authors: Pan et al.
In 51,540 propensity-matched adults 60 years or older with type 2 diabetes, tirzepatide was associated with a 35% lower risk of 2-year incident POAG diagnoses than GLP-1 receptor agonists (HR 0.65; 95% CI, 0.44-0.96). The authors propose that dual activation of GIP and GLP-1 pathways may provide greater neuroprotective and IOP-lowering effects than GLP-1 agonism alone. However, the absolute event rates were low in both groups (0.16% vs 0.27%), and the retrospective database lacked clinical data such as IOP, OCT, visual fields, adherence, or care-access detail. These findings support further prospective studies but are not sufficient to recommend tirzepatide over GLP-1 receptor agonists solely for glaucoma prevention.
Epidemiology
Fast progressors in Asian normal-tension glaucoma: 10 years and beyond in a longitudinal cohort.
Design: Longitudinal retrospective cohort study
Journal: British Journal of Ophthalmology, July 2026
Authors: Lee et al.
In 274 medically treated Asian (Korean) NTG eyes followed for a mean of 13 years, 10.9% experienced rapid visual field deterioration (at least 1 dB/year mean deviation loss). Fast progressors had more disc hemorrhage (36.6% vs 13.9%) and less percentage IOP reduction (10% vs 29%), while baseline IOP was similar across groups. Baseline thinner ganglion cell-inner plexiform layer thickness also identified patients at greater risk. The results support closer follow-up and lower individualized targets for higher-risk NTG, but the single-center retrospective cohort and limited number of fast-progressors limit broader application.
CMS proposes a 2.4% Medicare payment increase for ambulatory surgery centers in 2027, while aggregate payments for ophthalmic procedures are projected to fall 1%.
Emmecell receives FDA RMAT designation for EO2002, an investigational corneal endothelial cell therapy delivered by magnetic injection as a possible alternative to corneal transplantation.
Alcon and RxSight enter a collaboration worth up to $200 million to develop adjustable presbyopia-correcting IOLs that surgeons could fine-tune with light after cataract surgery.
Glaukos completes phase 2 enrollment for GLK-321, an investigational physostigmine eyelid cream for Demodex blepharitis delivered through its drop-free iLution platform.
Which pioneer performed the first successful full-thickness corneal transplant in 1905?
A. Harold Ridley
B. Eduard Konrad Zirm
C. Robert Machemer
D. Charles Schepens
See answer at bottom of newsletter.
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The Open Angle is a weekly glaucoma research digest for busy eye care professionals.
Four papers worth knowing, in under four minutes.
Edited by Jella An, MD, MBA and Jason Dossantos, MD.
The Open Angle is an educational editorial product. It is not medical advice. Readers should review original sources before changing practice.
Trivia Answer: B