Four articles. Four minutes. | Issue #6
Diagnostics: Nasal iridotrabecular contact on AS-OCT was associated with PACS to PAC progression
Medication: Lower medication adherence linked to more invasive surgery
Surgery: Severe glaucoma, PXG, and LTG were associated with better goniotomy outcomes
Epidemiology: Patients with end-stage renal disease on hemodialysis had higher 5-year risk of requiring glaucoma treatments
Iris Trabecular Contact on OCT in Angle Closure Progression.
Methods
In this analysis of 825 untreated primary angle-closure suspect (PACS) eyes followed for 6 years in the Zhongshan Angle Closure Prevention (ZAP) trial, investigators graded anterior-segment OCT (AS-OCT) images for iridotrabecular contact (ITC) and assessed 72-month progression to primary angle closure (PAC), defined as IOP >24 mm Hg, peripheral anterior synechiae, or acute angle closure.
Results
Progression occurred in 34 of 825 eyes (4.1%). Nasal ITC presence was associated with nearly a 5-fold higher progression risk. Longer nasal and superior ITC were also associated with increased risk, whereas gonioscopy grades and overall extent of angle closure were not predictive.
Conclusion
Among untreated PACS eyes in the ZAP trial, nasal ITC presence and longer nasal or superior ITC on AS-OCT were associated with higher 72-month progression risk. These findings suggest qualitative AS-OCT assessment may help identify higher-risk PACS eyes, although the low progression event count (34 eyes), inclusion of only untreated Chinese PACS patients, and post hoc nature of the analysis limit generalizability.
Our Angle
This study highlights a practical application of anterior segment OCT beyond documenting narrow angles: risk stratification. As most clinicians already obtain AS-OCT images in angle closure patients, simply noting the presence and extent of nasal ITC may provide additional prognostic information without the need for specialized software or complex biometric measurements. The findings are also a reminder that gonioscopy alone may not capture all aspects of angle closure risk. However, the absolute risk of progression remained low: only 34 of 825 eyes progressed over 6 years, and the study was limited to untreated Chinese PACS patients. For now, we view ITC as an additional factor that may help identify patients who warrant closer observation or more detailed discussion about prophylactic treatment rather than as a standalone indication for intervention.
Medication
The Association between a Pharmacy-Based Estimate of Medication Adherence and Surgical and Laser Treatments in Glaucoma Patients.
Design: Retrospective cohort study
Journal: Ophthalmology Glaucoma, March 2026
Authors: Peng et al.
In this retrospective study of 4480 glaucoma and glaucoma suspect eyes, poorer medication adherence, measured by proportion of days covered (PDC), was common, with a mean PDC of only 56.1%. Every 10% decrease in adherence was associated with a 5% higher likelihood of laser treatment, 7% higher likelihood of MIGS, and 15% higher likelihood of traditional surgery. These findings support that medication adherence may be an important marker of future treatment escalation, although the retrospective design, reliance on pharmacy refill data rather than actual drop use, and inability to account for all factors influencing surgical decision making limit causal interpretation.
Surgery
Factors Associated with Goniotomy Outcomes in the United States: An IRIS® Registry Analysis.
Design: IRIS Registry retrospective clinical cohort study
Journal: Ophthalmology Glaucoma, February 2026
Authors: Joo et al.
In this IRIS Registry analysis of 48,098 adult eyes undergoing goniotomy, 52% achieved at least 20% IOP reduction by 6 months. Mean IOP also fell over 36 months after both phaco-goniotomy and standalone goniotomy, with higher baseline IOP, severe glaucoma, pseudoexfoliation glaucoma, and low-tension glaucoma associated with better short-term success and lower long-term failure risk. These findings suggest that goniotomy outcomes may be more favorable in some patients not traditionally prioritized for MIGS, although registry coding, missing medication, visual field, OCT, and angle anatomy data, inability to distinguish surgical techniques or extent of treatment, and potential selection bias related to follow-up duration and surgeon case selection limit interpretation.
Epidemiology
Increased Risk of Intraocular Pressure-Lowering Treatment in End-Stage Renal Disease Patients Undergoing Hemodialysis.
Design: TriNetX retrospective cohort study
Journal: Ophthalmology Glaucoma, May 2026
Authors: Lim et al.
Among adults with end-stage renal disease on hemodialysis, 5-year receipt of new IOP-lowering medication or surgery remained higher than in matched controls after comorbidity matching (HR 1.36). The largest relative associations were seen for cyclodestruction (HR 3.72) and glaucoma drainage devices (HR 2.09). These findings support closer ophthalmic surveillance and care coordination for dialysis patients, although interpretation is limited by the treatment-based endpoint, EHR coding, surveillance bias, residual confounding, and missing eye-level severity.
Bascom Palmer appoints Pradeep Ramulu, MD, PhD, as Chair of Ophthalmology beginning August 2026, succeeding Eduardo C. Alfonso, MD.
Outlook Therapeutics resubmits a Class 1 Biologics License Application for bevacizumab-vikg, restarting a 60-day FDA review for neovascular AMD.
Oculis reports that phase 3 trials of its topical dexamethasone eye drops missed 52-week vision endpoints in DME despite OCT thickness reductions.
TearSolutions begins a 54-patient phase 2 study of Lacripep, a lacritin-derived topical peptide, for neurotrophic keratitis after FDA orphan drug and fast track designations.
Which landmark glaucomatous optic nerve finding did Albrecht von Graefe describe in 1855?
A. Disc pallor
B. Disc edema
C. Disc excavation
D. Disc hemorrhage
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: C