Four articles. Four minutes. | Issue #8
Genetics: Polygenic risk score stratifies lifetime glaucoma risk and treatment burden
Diagnostics: OHTS Trial analysis supports repeating inconsistent Goldmann IOP readings before acting on a single measurement
Health Systems: Drive-time mapping exposes rural gaps in glaucoma specialist access
Medication: Kitchen or bathroom eyedrop storage linked to better glaucoma adherence
Polygenic risk impacts lifetime risk and prognosis of glaucoma
Methods
This FinnGen registry-biobank cohort included 402,739 Finnish European individuals, including 21,609 with glaucoma diagnosed after age 40. Investigators benchmarked 14 published glaucoma polygenic risk scores (PRSs), selected the best-performing PRS, and assessed lifetime glaucoma risk, family history, glaucoma subtype risk, and 20-year treatment outcomes.
Results
The Truong PRS had the strongest association with glaucoma, with a hazard ratio of 3.32 for individuals at or above the 90th percentile versus the 20th to 80th percentiles (p<2e-16). Estimated lifetime glaucoma risk by age 85 ranged from 2.5% below the 1st PRS percentile to 45.3% at or above the 99th percentile, and the PRS contributed independently of family history. Among glaucoma cases, the highest PRS decile had higher 20-year medication escalation (60.6% vs 38.4%), laser therapy (39.8% vs 22.9%), and incisional surgery (15.8% vs 9.5%) than the lowest decile.
Conclusion
Among Finnish European individuals in FinnGen, glaucoma PRS provided risk information beyond family history and was associated with greater registry-defined treatment intensity among diagnosed patients. The study supports PRS as a potential risk-counseling and screening tool, but not yet as a basis for individual treatment targets without prospective validation in more diverse populations.
Our Angle
This study adds to the growing body of evidence that genetics may eventually help us move from population-based glaucoma screening to a more personalized risk-based approach. What is particularly compelling is that polygenic risk was associated not only with developing glaucoma, but also with markers of disease severity and treatment burden after diagnosis. For glaucoma specialists, this raises the possibility that genetic risk information could one day help identify patients who warrant earlier surveillance, more frequent monitoring, or a lower threshold for intervention. The findings also suggest that PRS may provide information that family history alone cannot capture, and that the combination of both may offer the most complete assessment of inherited risk. At the same time, the study highlights how far we still have to go before PRS is ready for routine clinical use. The score was developed and validated in a relatively homogeneous European population, and it was not combined with the clinical and imaging factors that currently drive real-world decision-making. For now, PRS appears best viewed as a promising adjunct to traditional risk assessment, but one that may become increasingly relevant as precision medicine enters glaucoma care.
Diagnostics
Intraocular Pressure Measurement Variability in the Ocular Hypertension Treatment Study.
Design: Post hoc analysis of a multicenter randomized clinical trial
Journal: Ophthalmology Glaucoma, June 2026
Authors: Shukla et al.
In this post hoc Ocular Hypertension Treatment Study analysis, 1,636 participants contributed 145,236 standardized Goldmann applanation tonometry (GAT) over 15 years, and the first 2 readings were within 2 mm Hg in 96.2% of eye-visits. A third reading was needed in only 3.8% of eye-visits but lowered the final recorded IOP in 63.4% of those cases, while higher IOP, greater baseline visual field pattern standard deviation, and prior measurement variability predicted the need for repeat measurements, characteristics known to be risk factors for the development of POAG. Limitations include the inability to distinguish measurement error from physiologic IOP fluctuation and the use of a highly standardized clinical trial protocol that may not fully reflect real-world practice.
Health Systems
Geographic Distribution and Drive Times to Glaucoma Specialists in the United States: A National Geospatial Access Analysis and Drive-Time Study.
Design: Cross-sectional geospatial access analysis
Journal: Ophthalmology Glaucoma, April 2026
Authors: Wang et al.
This national geospatial analysis estimated county-level drive times from population centroids to the nearest American Glaucoma Society specialist across the contiguous United States. Median drive times were shortest in the Northeast (40 minutes) and metropolitan cores (14 minutes) and longest in the West (1.85 hours), small-town cores (1.16 hours), and rural counties (1.02 hours), with wide intrastate variation, reaching more than 4 hours in some states such as North Dakota. The findings point toward teleophthalmology, shared-care referral, and workforce planning, but estimates were based on county centroids and modeled travel times rather than actual patient travel, and the analysis was limited to AGS members and did not account for wait times, public transportation, referral patterns, or access to comprehensive ophthalmologists providing glaucoma care.
Medication
The Impact of Medication Storage Location on Glaucoma Eyedrop Adherence: A Home-Based Assessment Using Electronic Monitoring.
Design: Prospective cross-sectional home-monitoring study
Journal: American Journal of Ophthalmology, February 2026
Authors: Chen et al.
Among 93 adults aged 60 or older with bilateral glaucomatous field loss, 1 week of electronic eyedrop monitoring (MEMS caps) found that 15.3% of prescribed dose opportunities were missed. The strongest environmental predictor of adherence was storage location. Kitchen or bathroom storage was associated with better adherence than bedroom storage, while lighting, clutter, contrast, time spent in the storage room, and frequency of visits to that room were not associated with adherence. Evening doses were nearly twice as likely to be missed as morning doses, and lower adherence was also associated with Black race, lower educational attainment, and more complex dosing regimens. These findings support asking patients where and when they use their drops and linking dosing to a visible daily routine, although the small single-week observational design measured adherence rather than IOP or progression.
The American Academy of Ophthalmology partners with OpenEvidence to embed its Preferred Practice Patterns into a widely used medical AI platform, offering ophthalmologists free, cited guidance at the point of care.
The FDA approves Ranluspec, an interchangeable ranibizumab biosimilar offered in both vials and prefilled syringes, expanding lower-cost anti-VEGF options for wet AMD, diabetic macular edema, and retinal vein occlusion.
JAMA Ophthalmology reports a smartphone AI app screened 614 people for ocular surface malignancies with high sensitivity and specificity, supporting earlier detection where specialty access is limited.
Oculis randomizes the first patient in PREDICT-1, a registrational trial of licaminlimab, a topical anti-TNF eye drop, testing whether selecting dry eye patients by a TNFR1 genotype improves symptom relief.
Who invented the direct ophthalmoscope in 1851?
A. Allvar Gullstrand
B. Hermann von Helmholtz
C. Hans Goldmann
D. Charles Schepens
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: B