Four articles. Four minutes. | Issue #7
Medication: Home tonometry reveals wide variation in prostaglandin analog washout times
Diagnostics: Higher POAG polygenic risk scores were linked to faster VF loss and greater treatment burden
Health Systems: Per-visit conversion risk could guide glaucoma suspect follow-up intervals
Epidemiology: Obstructive sleep apnea was linked to higher 10-year glaucoma risk
Remote tonometry identifies significant variability in the timing of IOP response to topical medication change
Methods
20 patients (34 eyes) with primary open-angle glaucoma or ocular hypertension on prostaglandin analog (PGA) monotherapy used a rebound home tonometer multiple times daily while undergoing PGA washout and restart. Fifteen patients completed all three periods, and investigators modeled the time to 90% of maximum IOP change (T90%) after washout and after restart.
Results
Median time to reach T90% after stopping PGAs was 18.5 days, compared with just 2.2 days after restarting therapy. Notably, washout times varied substantially between patients, with nearly 30% of eyes projected to require more than the standard 4 week washout period used in many clinical trials, whereas 19 of 22 restart eyes plateaued within 7 days.
Conclusion
These findings suggest that a fixed washout duration may not accurately capture the true IOP response in all patients, although interpretation is limited by the small, selected, single-site cohort without verifying medication adherence. These findings however support performing medication washout under remote tonometry guidance for more individualized assessment of medication washout and treatment effects.
Our Angle
This study challenges the assumption that a standard 4-week PGA washout is appropriate for every patient. As glaucoma specialists increasingly rely on washout IOPs when evaluating treatment response, planning interventions, or conducting clinical trials, these data suggest that some patients may be assessed too early while others may spend longer than necessary with elevated IOP. The findings also highlight a potentially underappreciated role for home tonometry: not just identifying peak IOPs, but helping personalize the timing of clinical decision-making. While the study is too small to change current practice, it provides support for remote tonometry’s important role in clinical trial design in improving the accuracy of treatment-effect estimates, enhancing the safety of medication washout protocols through real-time monitoring, and potentially reducing the sample sizes needed to detect meaningful differences in IOP-lowering efficacy.
Diagnostics
Primary Open Angle Glaucoma Polygenic Risk Score is Associated with Disease Progression.
Design: Longitudinal multi-biobank cohort study
Journal: Ophthalmology Glaucoma, June 2026
Authors: Bineshfar et al.
In 2 biobank cohorts totaling 950 people with open-angle glaucoma followed for a median of 6.5 years, each standard-deviation increase in a cross-ancestry POAG polygenic risk score was associated with 22% higher odds of visual field progression and greater treatment burden. In the Mass General Brigham cohort, a higher score also predicted earlier glaucoma procedures, and the link persisted in eyes with normal or only mild baseline damage. These findings suggest a polygenic risk score may eventually help identify which patients warrant closer surveillance even in mild disease, although a small mean deviation effect, a cohort that was 65.5% of European descent, and the observational design limit conclusions about clinical thresholds or added value beyond examination and imaging.
Health Systems
Risk-Stratified Monitoring of Open Angle Glaucoma Suspects Based on Diagnostic Conversion Risk.
Design: Claims-based retrospective cohort study
Journal: American Journal of Ophthalmology, June 2026
Authors: Yoo et al.
Among 83,305 newly diagnosed open-angle glaucoma suspects in US claims data, 20.6% received a POAG diagnosis within 5 years, with annual conversion of 9.4% in the first year and 5.3% thereafter. Conversion rates ranged widely by demographic profile, from 2.0% per year in untreated patients younger than 50 to 16.7% in treated patients older than 70. This risk gradient supports tailoring follow-up intervals to individual conversion risk, although claims-coded diagnoses do not confirm structural or functional conversion, treatment may instead mark clinician concern, and the modeled 6.1-year interval for the lowest-risk group is not validated guidance.
Epidemiology
Positive Airway Pressure and Long-Term Glaucoma Risk in Obstructive Sleep Apnea: A Real-World Cohort Study.
Design: Retrospective electronic health record cohort study
Journal: Ophthalmology Glaucoma, June 2026
Authors: Nishida et al.
Among more than 12 million adults evaluated for obstructive sleep apnea (OSA) in a real-world electronic health record database and followed for a mean of 5.2 years, incident glaucoma was higher with OSA than in sleep-tested controls. Incidence rose from 1.74 per 1,000 person-years in controls to 2.38 in OSA without a positive airway pressure (PAP) device record and 3.39 in OSA with one, corresponding to adjusted hazards of 1.27 and 2.10 versus controls. The steeper risk in the PAP-recorded group most likely reflects more severe sleep apnea rather than any effect of the device itself. These findings support closer ophthalmic surveillance for patients evaluated or treated for OSA, although code-based exposure and outcomes, unmeasured OSA severity and adherence, and confounding by indication limit interpretation.
FDA clears a SPECTRALIS software update with 250-kHz OCT angiography, enhanced eye tracking, and green autofluorescence imaging for commercial release in the second half of 2026.
The TECNIS PureSee IOL launches across the United States after FDA approval, adding a refractive EDOF option with improved intermediate vision and monofocal-comparable distance acuity.
The phase 3 Orunea trial begins testing cenegermin-bkbj, a recombinant human nerve growth factor eye drop, in about 150 adults with persistent corneal epithelial defects.
Alkeus begins a 230-participant phase 3 study of oral gildeuretinol, a deuterated vitamin A therapy designed to reduce toxic vitamin A dimers, for advanced Stargardt disease.
Which ancient legal code promised a physician ten shekels in money if he performed eye surgery and saved the eye?
A. Hippocratic Corpus
B. Sushruta Samhita
C. Code of Hammurabi
D. De Re Medica
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 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: C