Four articles. Four minutes. | Issue #3
Diagnostics: Macular OCT may help detect glaucoma progression once optic nerve RNFL is floored
Surgery: Tubes and trabeculectomy carry higher endothelial keratoplasty risk than MIGS
Epidemiology: Prior heart attack and low untreated BP, but not longer sleep and alcohol consumption, linked to 12-year OAG incidence
Nutrition: Oral Nicotinamide improved retinal electrophysiology in treated NTG patients
Comparing the Utility of Retinal Nerve Fiber Layer and Ganglion Cell Inner Plexiform Layer OCT Changes to Detect Glaucoma Progression
Methods
This retrospective longitudinal study included 2,464 eyes from 1,605 patients followed at the Wilmer Eye Institute with at least ≥ 5 VF tests paired with OCT scans. Investigators compared circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thinning rates across glaucoma suspects and mild, moderate, and advanced glaucoma, then modeled their association with event- or trend-based visual field (VF) progression.
Results
Eyes with VF progression had faster global cpRNFL and mGCIPL thinning than nonprogressing eyes (P<0.001). Overall associations with VF progression were similar, but differed by disease stage: cpRNFL thinning was more strongly associated with progression in suspects, while mGCIPL thinning was more strongly associated with progression in moderate and advanced glaucoma.
Conclusion
cpRNFL and mGCIPL OCT appear to play complementary roles in glaucoma monitoring. cpRNFL may be more useful in early disease, while mGCIPL may better track progression in later glaucoma when cpRNFL approaches the measurement floor.
Our Angle
This study suggests that macular ganglion cell OCT becomes increasingly important as optic nerve RNFL measurements lose sensitivity in later-stage glaucoma. The clearest application is in moderate to advanced glaucoma, where ganglion cell analysis may provide additional structural evidence of progression especially when VFs are unreliable. Because this was a single-center study in treated patients that relied on global OCT and 24-2 VF progression metrics, the findings should complement but not replace careful scan interpretation and clinical judgment.
Surgery
Corneal Endothelial Keratoplasty After Glaucoma Treatment: An American Academy of Ophthalmology IRIS® Registry Analysis.
Design: IRIS Registry retrospective cohort study
Journal: Ophthalmology Glaucoma, February 2026
Authors: Bal et al.
In this IRIS Registry analysis of 7.8 million glaucoma-spectrum patients, endothelial keratoplasty was rare overall (0.13%), with higher risk after tube shunt surgery and trabeculectomy compared with untreated eyes (adjusted hazard ratio [aHR] 6.63 and 3.06, respectively), but no increased risk after MIGS or laser trabeculoplasty (aHR 0.80 and 0.70, respectively). These findings suggest that although prior studies have demonstrated subclinical endothelial cell loss after MIGS, contemporary minimally invasive and laser-based glaucoma interventions may not translate into higher rates of clinically meaningful corneal decompensation, particularly in higher-risk eyes. Major limitations include the retrospective registry-based design and substantial potential for confounding by indication, as eyes undergoing tubes or trabeculectomy likely had more severe glaucoma and more complex ocular comorbidities.
Epidemiology
Baseline risk factors for the development of open-angle glaucoma in a 12-year glaucoma incidence study: the Thessaloniki Eye Study.
Design: 12-year population-based prospective cohort study
Journal: British Journal of Ophthalmology, April 2026
Authors: Ntonti et al.
In the 12-year Thessaloniki Eye Study, 43 of 826 participants without baseline glaucoma developed open-angle glaucoma, with higher risk associated with pseudoexfoliation (PXF), higher baseline IOP, larger cup-to-disc ratio, family history of glaucoma, prior heart attack, and lower untreated blood pressure, while longer sleep duration and alcohol consumption were associated with lower risk. The study reinforces the importance of closer long-term surveillance of patients with PXF and vascular risk factors, although interpretation is limited by the small number of incident glaucoma cases, self-reported lifestyle data, and the predominantly older Greek population.
Nutrition
Effects of nicotinamide supplementation in normal-tension glaucoma: a crossover placebo-controlled randomised clinical trial.
Design: double-masked crossover placebo-controlled randomized clinical trial
Journal: British Journal of Ophthalmology, April 2026
Authors: Ha et al.
In this randomized crossover trial of 53 patients with treated normal-tension glaucoma, 12 weeks of oral nicotinamide (vitamin B3) improved electrophysiologic measures of inner retinal function after 12 weeks versus placebo, although no significant changes were seen in standard visual field indices. The findings support ongoing interest in nicotinamide as a potential adjunctive neuroprotective therapy in glaucoma, but interpretation is limited by the short follow-up, small sample size, exclusion of many patients due to unreliable ERG testing, and lack of demonstrated short-term visual field benefit.
Implantable IOP sensors are gaining long-term evidence that 24-hour IOP peaks and variability may better capture RNFL thinning risk than mean office IOP.
An intravitreal injection of a synthetic opsin-like protein shows sustained 3-year functional benefit in advanced retinitis pigmentosa, including gains from light perception to hand motion.
AI-assisted screening may help identify psychological distress in glaucoma patients while reducing staff screening burden.
CMS is pushing electronic prior authorization into EHR workflows, creating a path to reduce payer paperwork and authorization delays by 2027.
Charles Kelman reportedly conceived phacoemulsification after being inspired by:
A. a cardiac catheter
B. a dermatology laser
C. a neurosurgical drill
D. a dentistry probe
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: D