Before wrapping up the 52nd Annual Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists (RANZCO Virtual 2022), we give you yet another of their by-now-signature Rapid Fire Sessions — each of which provides a veritable treasure trove of ophthalmic goodies on the topics of glaucoma and neuro-ophthalmology.
While we’re far away from Halloween, this grab bag of knowledge goodies is a lot like a bucket of candy and will please the mental palates of eye lovers everywhere. So, we’ve grabbed two pieces here and will dissect them before digestion.
Childhood Glaucoma: QoL Impacts in Adults
In this publication, we discuss glaucoma all the time. After all, it’s one of the most prevalent and pernicious eye diseases worldwide, and its multifactorial basis means there’s no end to what one can learn about it.
One thing that’s a bit new is a discussion of childhood glaucoma and its later effect on the quality of life. This discussion was brought to us by Mr. Lachlan Knight, a Ph.D. candidate at the Orthoptist Flinders University in Australia.
As we know, glaucoma is a chronic condition — but its psychosocial impact is underdiscussed. As Mr. Knight pointed out, there’s limited research regarding quality of life (QoL) in adults with childhood glaucoma. The research there is, however, has suggested lower life satisfaction and lower mental health than those without glaucoma, as well as a limited understanding of the cause of the condition and potential mental health issues. As it stands, there is no childhood glaucoma-specific study to accurately measure QoL from childhood to adulthood.
That’s what Mr. Knight set out to rectify. This resulted in 47 adults in his study, following a number of recurring themes in QoL. “Coping” and “emotional well-being” were the most notable, followed by “ocular health concerns” and “symptoms.”
Issues with coping and emotional well-being far and away dominated the themes, indicating that there are serious long-term psychological impacts of childhood glaucoma. Coping, for example, can include positively adapting to limitations like using visual aids or relying on public transportation. It can also result in maladaptive coping, like ignoring glaucoma care.
Quite notably, the majority — 66% of patients — were concerned about having children because they didn’t want to pass on their glaucoma. Some 60% of those in Mr. Knight’s study sought genetic counseling before having children to ease their mind, as well as make it up.
The upshot here? Childhood glaucoma can have long-term impacts as far as the next generation, and doctors should be aware of the psychosocial implications of glaucoma as well as the physical, and handle maladaptive coping mechanisms in children and young adults before they inflict long-term damage.
HORIZON Study: Five-year Follow-up
Prof. Graham A. Lee from the University of Queensland, Australia, led us through a discussion of the five-year results of the HORIZON clinical trial. For reference, HORIZON was a randomized, multicenter study of the Hydrus® microstent (Ivantis, Irvine, California), a minimally invasive glaucoma surgery (MIGS) option.
Prof. Lee noted that this continuous five-year follow-up compared combined cataract surgery with Hydrus vs. cataract surgery alone, with 80% of patients from the initial study still onboard after five years. Long-term effectiveness was rated by intraocular pressure (IOP) reduction, dependence on medication, failure rates and safety.
And, drum roll… after five years, a combination of cataract surgery with Hydrus reduces IOP as well as medications. Note the “combination” part — the findings here suggest that the combination is, indeed, the key. Those with Hydrus and cataract surgery experienced a lower risk of glaucoma surgery.
Dr. Lee pointed out that this is the first reported clinical benefit associated with a MIGS procedure. Essentially, Hydrus reduces medication non-adherence and the surgical procedure reduces diurnal fluctuations in IOP compared to topical eye drops.
Editor’s Note: A version of this article was first published in Issue 4 of CAKE & PIE POST (52nd RANZCO Brisbane 2022 Edition). The 52nd Annual Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists (RANZCO Brisbane 2022) was held virtually from February 26 to March 1. Reporting for this story took place during the event.
