Thunderstorms, heavy downpours, traffic jams, internet speeds at a crawl—these are just some of the “misfortunes” this editor had to deal with on a wild Day 2 of the 7th Congress of the Asia-Pacific Glaucoma Society (APGC 2024). But Filipinos are known for smiling despite adversaries. No matter how horrible the situation is, a Filipino would always find a way to smile (and laugh!) about the problem. It’s more fun in the Philippines! was actually the country’s tourism tagline at some point, and despite an advancing tropical storm, Day 2 at APGC 2024 was still chock full of ophthalmic fun.
The 4th edition of the Asia-Pacific Glaucoma Guideline (APGG4) kicked off Day 2 of the APGC 2024 in Manila, when it was launched during the first session. The APGG4, with crucial updates in glaucoma management, is intended to elevate glaucoma care standards in the Asia-Pacific region. General (and young!) ophthalmologists packed the symposium, even enduring long queues to get a copy of these precious guidelines. Check out the full article of our coverage here.
The spotlight on MIGS, interventional glaucoma, and eye drops
Prostaglandin-associated periorbitopathy syndrome (PAPS) is one topic that grabbed a lot of podium time today. The long-term use of prostaglandin analogues (PGAs), a widely-used and preferred first-line treatment for glaucoma and elevated intraocular pressure (IOP), leads to the syndrome, which is starting to take off as PGAs enter heavier clinical use.
As emphasized by experts at APGC 2024, PAPS is not only a cosmetic concern.It may cause problems in the long-term management of glaucoma, including treatment adherence, ophthalmic surgery outcomes and reliable IOP measurements. But fret not, there are new therapeutic approaches that may address this previously unmet clinical need—dealing with PAPS is one of the important updates in the new APGG4.
One emerging therapeutic solution is omidenepag isopropyl (OMDI; Eybelis, Santen Pharmaceutical Co., Ltd., Osaka, Japan), a novel, non-prostaglandin, selective EP2 receptor agonist which provides a unique pharmacological mechanism of action. OMDI appears to provide IOP reductions comparable to PGAs, but without PAPS-related undesirable side effects.2
Throughout the day, there were a lot of discussions around glaucoma progression and other hot topics in glaucoma management, including MIGS controversies and modifications in glaucoma drainage implantation. From medical to surgical management, the spectrum is as wide as the ophthalmic mind can imagine, with each aspect offering a different perspective in treating glaucoma patients.
Glaucoma management comprises a very comprehensive approach, this much is true. This silent thief of sight needs to be detected as early as possible, and for management to be effective, treatment adherence is crucial. With eye drops and their historically poor adherence rates, interventional glaucoma strategies are on the rise. This new approach offers adjunct solutions and innumerable combinations of treatment when traditional approaches are no longer effective.
The debate format has reigned supreme at APGC, and competing glaucoma management strategies proved to be fertile ground for it at another one of our Day Two highlight symposia. In this session, glaucoma luminaries from around the world sparred over SLT, post-trabeculectomy needling, retinal nerve fiber layer optical coherence tomography and more—with drops’ precarious place in the future of glaucoma treatment framing many of the rousing discussions. Check that out here, you won’t want to miss it.
Sidebar convos with glaucoma greats
As per usual, we were filming throughout the day, and I took this opportunity to chat up as many of our esteemed interviewees in between takes.
A rhetorical question from the wise stood out to me: “Bottomline, what do our patients need?” asked Prof. Makoto Aihara (Japan), when I got to interview him on Day 2 of APGC 2024. It all boils down to the patients, he emphasized. “The patients come first, you see,” he added.
Indeed, in the vast sea of an ever-evolving glaucoma armamentarium, the bottom line is what patients need and addressing that to provide the best outcomes.
And then there is glaucoma imaging! Advancements in OCT, floor effect pushback and more have made everything a whole lot more exciting (or complicated!)—whichever way you’d like to look at it.
The ophthalmic industry today has more than ever to offer with imaging. Eye care practitioners looking to upgrade their clinical practices, face a very confusing decision indeed on which imaging system to use. But Prof. Dr. med. Jost Jonas (Germany), a comprehensive ophthalmologist and clinical scientist, made it sound so simple.
“The more we see, the more we can detect glaucoma early,” he shared, when explaining the benefits of early detection and what would be the best suitable imaging technology to look for. And with detecting glaucoma early being a point of emphasis leading up to the crazy, current-day constellation of screening tools—and despite the confounding multitude of options available now—glaucoma physicians today are in a better position than they have ever been to manage this nefarious, sight-robbing ailment.
Editor’s Note: Reporting for this event took place during the 7th Congress of the Asia-Pacific Glaucoma Society (APGC 2024), held from May 24-26, 2024 in Manila, Philippines.
References
- Sakata R, Chang PY, Sung KR, et al. Prostaglandin-associated periorbitopathy syndrome (PAPS): Addressing an unmet clinical need. Semin Ophthalmol. 2022;37(4):447-454.
- Kuo HT, Yeh CY, Hsu AY, Ho JH, Lin CJ, Tsai YY. Clinical Efficacy of Omidenepag Isopropyl for Primary Open-Angle Glaucoma, Normal Tension Glaucoma, or Ocular Hypertension: A Meta-Analysis. J Ocul Pharmacol Ther. 2023;39(10):705-715.
