Four articles. Four minutes. | Issue #17
Epidemiology: Intravitreal injections for AMD linked to more glaucoma diagnoses and surgery in a matched cohort
Surgery: Adjunctive mitomycin C with Ahmed valve implantation showed 74% three-year success in a retrospective series
Diagnostics: Water-drinking IOP stress test detects faster progression despite controlled office IOP within target
Genetics: Whole-genome sequencing identifies a new POAG risk locus in African ancestry individuals
Risk of New Glaucoma Diagnosis and Surgery for Patients with Intravitreal Injections in the TriNetX Database
Methods
This retrospective cohort study used the TriNetX US Collaborative Network to compare patients receiving intravitreal injections for exudative age-related macular degeneration with nonexudative AMD controls. After 1:1 propensity-score matching on demographics and systemic comorbidities, 27,967 pairs were followed for a mean of 4.4 years for incident glaucoma diagnosis and glaucoma surgery.
Results
Patients receiving intravitreal injections were more likely to develop a new glaucoma diagnosis than matched controls (15.1% vs 12.9%, risk ratio 1.17, P < 0.001), an absolute difference of 2.1% (number needed to harm, 47). Glaucoma surgery was nearly twice as frequent after injections (1.6% vs 0.8%, risk ratio 1.84, P < 0.001), with the largest relative increases in drainage device implantation and cyclodestructive procedures.
Conclusion
Intravitreal injections were associated with modestly higher glaucoma diagnosis rates and substantially higher surgery rates in this large matched cohort. The EHR-based design lacked IOP measurements, optic nerve assessments, and lens history, and the ICD-10 glaucoma code also captures ocular hypertension and suspect diagnoses.
Our Angle
Retina patients receiving chronic anti-VEGF are seen often, yet glaucoma surveillance can still become fragmented when care is split between services. The 2.1% absolute increase in new H40 diagnoses is modest, but the near doubling of glaucoma procedures is a signal worth noticing, particularly in patients with established glaucoma, ocular hypertension, rising IOP, or suspicious nerves. In those patients, injection history should be part of the longitudinal pressure and optic nerve assessment and communication between retina and glaucoma services. The TriNetX database lacks IOP, OCT, visual fields, eye-level laterality, reliable cumulative injection counts, and consistent anti-VEGF agent data; and the H40 outcome also includes glaucoma suspects and ocular hypertension. Moreover, wet AMD patients may differ from dry AMD controls in ways matching cannot remove, and more frequent retina visits create surveillance bias. The data do not justify changing anti-VEGF agent or treatment interval based on this study alone. Eye-level and dose-response studies are needed to identify which patients truly benefit from closer glaucoma surveillance.
Surgery
Three-Year Treatment Outcomes of Ahmed Glaucoma Valve Implantation with Adjunctive Intraoperative and Postoperative Mitomycin C
Design: Retrospective case series
Journal: Ophthalmology Glaucoma, August 2026
Authors: Cao B, Kline B, Kao B, et al.
In a retrospective case series of 121 eyes at a single center, Ahmed glaucoma valve implantation with intraoperative subconjunctival mitomycin C followed by two postoperative injections reduced mean IOP from 23.7 to 12.7 mmHg at three years, with glaucoma medications decreasing from 2.9 to 1.3. Cumulative success was 74%, and the 12% complication rate was lower than rates reported in the ABC and AVB tube shunt trials, although one cannot compare an uncontrolled retrospective series to those trials. The study population had lower baseline IOP and was predominantly primary open-angle glaucoma, and the absence of a control arm limits conclusions about the independent contribution of adjunctive MMC.
Diagnostics
IOP Stress Testing Identifies Glaucoma Eyes at Risk of Fast Progression Despite Controlled Office Pressure
Design: Prospective cohort study
Journal: American Journal of Ophthalmology, August 2026
Authors: Malek DA, Medeiros FA
In a prospective cohort of 67 glaucoma eyes, a water drinking test flagged progression risk that routine office tonometry missed. Among 59 eyes whose office IOP fell within severity-specific targets, 22 (37%) exceeded 21 mmHg on the stress test and showed faster visual field mean deviation loss (-0.67 vs +0.16 dB/year) and retinal nerve fiber layer thinning (-0.74 vs -0.18 μm/year). Of 13 fast progressors, 10 (77%) were identified by the stress test while only 3 (23%) had office IOP above their target. The sample was small, single-center, and predominantly early-stage disease.
Genetics
A Whole-Genome Sequence Genome-Wide Association Study in All of Us Identifies a Novel Glaucoma Risk Locus in African Individuals
Design: Ancestry-stratified genome-wide association study
Journal: Ophthalmology Science, September 2026
Authors: Aboobakar IF, Cruz LA, et al.
In an ancestry-stratified genome-wide association study using whole-genome sequencing data from the All of Us Research Program, the European ancestry analysis confirmed known glaucoma risk loci (TMCO1, CDKN2B-AS1, GMDS). A novel variant near CYP2A7 (rs76935404[T], odds ratio 1.35) reached genome-wide significance in individuals of African ancestry when a stringent phenotype definition requiring evidence of glaucoma treatment was applied, and this finding was replicated in an independent African-descent cohort. Both CYP2A7 and the neighboring EGLN2 gene are expressed in ocular tissues relevant to glaucoma, but the causal variant and biological mechanism remain to be established.
FDA classifies a recall of 39,060 bottles of Clear Eyes Maximum Itchy Eye Relief as Class II for lack of sterility assurance, with no adverse events reported.
A first-in-human phase 1b/2a clinical trial began testing a long-acting anti-VEGF antibody fragment designed for six-month dosing in treatment-naive wet AMD.
A sustained-release intravitreal insert for wet AMD missed its primary visual acuity endpoint in the pivotal phase 3 LUGANO trial but achieved a 42% reduction in treatment burden compared with on-label aflibercept.
FDA clears ZEISS CLINIC 360, a cloud and browser-based platform that aggregates diagnostic imaging data from ZEISS and third-party ophthalmic devices, for US launch in early fall 2026.
What prompted the first routine color-vision testing in the 1870s?
A. Astronomical observation errors
B. Railway safety concerns after the Lagerlunda collision
C. Military uniform confusion in battle
D. Incorrect pharmaceutical labeling
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 articles 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