Four articles. Four minutes. | Issue #2
Surgery: Pigmentary glaucoma fails SLT and MIGS more often than POAG
Medication: Topical steroids are no better than placebo after LPI
Diagnostics: Frontloading visual field testing detects fast progression sooner
Epidemiology: PDE-5 inhibitor use linked to lower OAG risk in men
Comparison of glaucoma surgery incidence and outcomes in pigmentary and primary open-angle glaucoma: IRIS Registry analysis.
Methods
This IRIS Registry cohort compared 49,171 pigmentary glaucoma (PG) eyes with 2,546,775 POAG eyes, assessing procedure incidence and propensity-matched outcomes after laser trabeculoplasty (LTP), MIGS, filtering surgery, and cyclophotocoagulation.
Results
PG eyes had higher 4-year procedure incidence than POAG eyes (22.2% vs 19.5%, P<0.001), including more LTP, filtering or cyclodestructive procedures (P<0.001). Failure at 1 year was also higher in PG after LTP (60.7% vs 58.2%) and MIGS (66.7% vs 60.8%; both P<0.001). Among PG eyes, severe disease was more common in non-Hispanic Black and Asian patients.
Conclusion
PG eyes were more likely than POAG eyes to require procedural glaucoma treatment and had higher 1-year failure after LTP and MIGS. Severe PG was also more common among non-Hispanic Black and Asian patients.
Our Angle
This study suggests that eyes with pigmentary glaucoma carry a higher procedural burden than POAG, with less durable outcomes after LTP and MIGS. In practice, this supports closer post-procedure surveillance and earlier discussion of filtering surgery when IOP remains uncontrolled, especially when considering additional laser or angle-based treatment. Given the limits of ICD-coded registry data, these findings should inform follow-up and counseling after LTP or MIGS in eyes with PG, while prospective studies are needed before lowering the threshold for filtering surgery.
Medication
Evaluating The Need For Anti-Inflammatory Medication Post Laser Peripheral Iridotomy.
Design: Prospective randomized double-masked placebo-controlled fellow-eye trial
Journal: Ophthalmology Glaucoma, May 2026
Authors: Leshno et al.
In a prospective, randomized, double-masked, placebo-controlled trial of 28 PACS patients (56 eyes) undergoing bilateral elective LPI, topical prednisolone acetate 1% 4 times daily for 4 days showed no clear advantage over artificial tears for anterior chamber inflammation, symptoms, IOP, or iridotomy patency. These findings suggest routine steroids after high-powered (4.5-6mJ) pulsed (2-6 shots) LPI may be unnecessary, though the small single-center sample warrants confirmation in larger multicenter studies.
Diagnostics
A staged approach to the number and frequency of visual field testing for detecting glaucoma progression.
Design: Computer simulation study
Journal: Ophthalmology Glaucoma, May 2026
Authors: Phu et al.
In a 100,000-subject computer simulation of visual field testing over 30 years, a frontloading strategy starting with 3 VF tests per visit every 3 months detected catastrophic and fast progressors sooner than most fixed schedules. The most efficient testing model for detecting fast progression appeared to be 2 VF tests per visit at 3- or 6-month intervals with downtitration after 30–36 months, though the findings remain simulation-based and need real-world validation.
Epidemiology
Association Between PDE-5 Inhibitor Therapy and the Hazard of Open-Angle Glaucoma.
Design: Multicenter retrospective electronic health record cohort study
Journal: American Journal of Ophthalmology, April 2026
Authors: Elhusseiny et al.
In men aged 40 years and older with erectile dysfunction, chronic PDE-5 inhibitor use was associated with a lower hazard of developing open-angle glaucoma over 1 to 3 years of follow-up. These findings raise the possibility of a protective association, possibly mediated through vascular and nitric oxide–related pathways, though prospective studies are needed before any clinical recommendations can be drawn.
Bayer Pharmaceuticals agrees to pay up to $2.45B for a phase 2 endothelin receptor antagonist implant for glaucoma and diabetic retinopathy.
CMS and FDA launch a pathway that could shorten Medicare coverage delays for breakthrough devices.
X-linked retinoschisis gene therapy advances to phase 3 after interim data show foveal schisis closure.
A new anti–IL-6 (Vamikibart) intravitreal injection shows mixed results for DME but clearer benefit for uveitic macular edema.
Which plant-derived agent is historically credited with introducing the first pharmacologic concept of lowering intraocular pressure?
A. Pilocarpine, from jaborandi leaves
B. Physostigmine, from Calabar beans
C. Atropine, from belladonna plants
D. Scopolamine, from henbane plants
See answer at bottom of newsletter
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The Open Angle is a weekly glaucoma research newsletter 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