Four articles. Four minutes. | Issue #24
Diagnostics: Higher average home IOP excess above individualized target was associated with faster visual field loss
Surgery: DMEK's apparent glaucoma advantage over DSAEK remained uncertain in direct comparisons
Medication: Sepetaprost was noninferior to latanoprost for mean diurnal IOP reduction at 4 weeks
Epidemiology: Diabetes was linked to higher risk of hospital-recorded probable primary angle-closure glaucoma
In-office and remote intraocular pressure metrics associated with visual field progression in treated open-angle glaucoma
Methods
In 150 eyes of 94 patients with treated open-angle glaucoma at two academic centers, investigators retrospectively related 7–10 days of iCare HOME recordings and longitudinal office IOP measurements to visual field mean deviation slopes over a mean follow-up of six years. Threshold-based measures included average IOP excess, calculated only from above-target readings; individualized targets were available for 142 eyes.
Results
Greater average home IOP excess above the individualized target was associated with faster field loss (uncorrected P=0.003) and remained significant after Bonferroni correction. Associations for daily-average excess and total excess, which combines frequency and magnitude, did not survive correction. Standard IOP metrics and office threshold-based measures showed no significant associations.
Conclusion
Average home IOP excess above an individualized target was associated with progression in treated open-angle glaucoma. Prospective validation is needed to establish its predictive usefulness.
Our Angle
In a treated glaucoma eye with confirmed progression despite office IOPs near target, the first questions are whether the progression is real, whether the target remains appropriate, and whether medication adherence or intermittent pressure elevations are being missed. Home tonometry may be most useful in this selected scenario rather than as routine monitoring for every stable patient. This study suggests that the magnitude of excursions above an individualized target may carry information that a single office pressure does not.
The important caveat is that target IOP is itself a moving, clinician-defined variable. Here it was taken from the record closest to home monitoring and may already have been lowered because progression had been recognized, creating treatment-to-target bias. A 7–10-day snapshot may also poorly represent years of IOP exposure, and the analyses did not adjust for baseline damage, age, medication regimen, prior surgery, or adherence. For now, I would reserve home tonometry for unexplained progression, suspected diurnal fluctuation, or discordance between office IOP and structural or functional change. Prospective studies still need to show that home-derived IOP burden predicts future progression and, more importantly, that acting on it preserves vision.
Surgery
Incidence of De Novo Glaucoma and Ocular Hypertension After DMEK vs DSAEK: A Systematic Review and Meta-Analysis.
Design: Systematic review and meta-analysis
Journal: American Journal of Ophthalmology, September 2026
Authors: Sadek et al.
Descemet membrane endothelial keratoplasty (DMEK) had lower pooled rates of glaucoma and ocular hypertension than Descemet stripping automated endothelial keratoplasty (DSAEK), although a causal advantage remains uncertain. Across 33 studies of 5,235 adult eyes without preexisting glaucoma or ocular hypertension, pooled rates from separate procedure cohorts were 3% versus 11% for glaucoma, 9% versus 34% for ocular hypertension, and 6% versus 20% for starting or increasing medication. Follow-up averaged 35 versus 68 months; after accounting for observation time, the ocular hypertension difference remained statistically clear, but the glaucoma difference did not. Direct comparisons, analyses requiring optic nerve or visual field changes, and glaucoma surgery outcomes were inconclusive. Greater steroid exposure was associated with ocular hypertension, and most evidence was observational; variable definitions and randomized trials limited to ultrathin or microthin DSAEK leave low to very low certainty.
Medication
Efficacy and safety of sepetaprost in patients with primary open-angle glaucoma or ocular hypertension: results from the randomised, phase 3 ANGEL-J1 study.
Design: Phase 3 investigator-masked randomized noninferiority trial
Journal: Japanese Journal of Ophthalmology, June 2026
Authors: Inatani et al.
Sepetaprost met ANGEL-J1's noninferiority criteria versus latanoprost for daytime IOP lowering, with more conjunctival hyperemia. In this investigator-masked Japanese trial, 325 adults with primary open-angle glaucoma or ocular hypertension received once-daily sepetaprost 0.002% or latanoprost 0.005%; week-4 mean diurnal IOP fell 5.77 versus 6.10 mmHg with a 1.5 mmHg noninferiority margin. Noninferiority persisted through 3 months without demonstrated superiority, although fewer sepetaprost recipients achieved at least 20% IOP reduction or IOP of 18 mmHg or less at week 4. Those responder differences were not statistically clear at month 3, while drug-related hyperemia occurred in 29.6% versus 8.6% and was mostly mild. Three months of daytime testing at a mean baseline IOP of 23.2 mmHg after washout leaves nighttime control, longer-term outcomes, and efficacy at lower starting pressures uncertain.
Epidemiology
Risk factors of primary angle-closure glaucoma: An exposome-wide association study in the China Kadoorie Biobank.
Design: Prospective cohort with nested case-control exposure selection
Journal: Asia-Pacific Journal of Ophthalmology, September 2026
Authors: Shao et al.
The China Kadoorie Biobank linked metabolic and lifestyle factors to probable primary angle-closure glaucoma, although the hospital-record definition was broad. Among 499,102 adults aged 30 to 79, 3,266 cases were recorded over a median 15.7 years, and 26 of 117 exposures remained associated after correction for multiple testing. Older age, female sex, postmenopausal status, diabetes, higher glucose, larger waist circumference, and higher pulse pressure were associated with higher risk; higher body mass index was associated with lower risk, whereas hypertension and systolic or diastolic pressure were not clearly associated. Daily intake of dairy products or preserved vegetables and peptic ulcer history were associated with higher risk; physical activity and tea consumption were associated with lower risk. Sensitivity analyses restricted to definite PACG were broadly consistent, but cases included glaucoma suspect and unspecified diagnoses and baseline eye examinations were unavailable; residual confounding and using the same cohort for discovery and validation limit causal interpretation.
SpyGlass Pharma acquires Advanced Vision Science for approximately $13 million, bringing IOL production in-house for its investigational bimatoprost-delivery system for open-angle glaucoma and ocular hypertension.
FDA approves non-diffractive spiral IOLs for presbyopia correction after cataract surgery, with spherical and toric models now commercially available in the United States.
CMS and partner agencies finalize Transparency in Coverage rules requiring clearer insurer pricing files, with telephone cost estimates required for plan years beginning on or after January 1, 2027.
The DAYBREAK sponsor reports phase 3 vision non-inferiority versus aflibercept for an investigational intravitreal anti-VEGF therapy in wet AMD, with 54% of recipients reaching 24-week dosing at one year.
Indocyanine green, now essential for choroidal imaging, was originally developed in the 1950s by:
A. A pharmaceutical company for liver function testing
B. A photographic film company for near-infrared photography
C. A military contractor for night-vision equipment
D. A textile manufacturer for fabric dyeing
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 EXPLANATION
Indocyanine green, now essential for choroidal imaging, was originally developed in the 1950s by:
B. A photographic film company for near-infrared photography
ICG was developed in Kodak's research laboratories for near-infrared photography before it acquired medical uses. Its optical behavior later made it useful for circulation measurements and angiography.
The choroidal application is therefore one chapter in a broader imaging history. Near-infrared light penetrates ocular pigment better than visible wavelengths used with fluorescein, helping reveal choroidal vascular patterns. An industrial dye became valuable because a property useful for photography also solved a clinical visibility problem.