How Can Genetic Assessments Affect Glaucoma Surgical Decision-Making?

Improving care for patients whose family history is consistent with an autosomal dominant form of the disease.

Erin A. Boese, MD

Glaucoma Today

Key Takeaways Gene-guided surgery may be most beneficial for patients with glaucoma caused by a single genetic mutation. Surgeries specific to the trabecular meshwork, especially gonioscopy-assisted transluminal trabeculotomy, are uniquely effective for the treatment of myocilin-associated juvenile open-angle glaucoma. The presence of a mutation in optineurin, TANK-binding kinase 1, or methyltransferase-like 23 in a patient with normal-tension glaucoma could warrant consideration of trabeculectomy to reduce IOP into the single digits and arrest disease progression. A 9-year-old girl, dwarfed by the exam chair, sat in my clinic. Each of her eyes had an IOP higher than 40 mm Hg on maximum tolerated medical therapy, but fortunately, they had no measurable glaucomatous damage. Although it was the patient’s first visit to the clinic, I knew her family well. She carried the same autosomal dominant mutation in the myocilin (MYOC) gene as dozens of her family members. Despite the temptation to offer her a trabeculectomy (the procedure recommended to everyone else in her family), I felt confident performing gonioscopy-assisted transluminal trabeculotomy (GATT). This MIGS procedure bypasses the trabecular meshwork (TM), which is the tissue I knew to be affected in her disease. Following GATT, not only was the patient’s IOP at a normal level, but she was able to discontinue all of her glaucoma medications.1 What is most noteworthy in this scenario is not the surgical procedure but its remarkable efficacy—an effect supported by the specific pathophysiology of the patient’s disease.

The Intersection of Dry Eye and Allergies

Jackie Garlich, OD, FAAO; Jessilin Quint, OD, FAAO; and Mila Ioussifova, OD, CNS, FAAO, FOWNS

Eyetube

Co-hosts Jackie Garlich, OD, FAAO, and Jessilin Quint, OD, FAAO, invite Mila Ioussifova, OD, CNS, FAAO, FOWNS, back on the To the Point podcast to talk about in-office allergy testing. Dr. Ioussifova has built her dry eye and ocular allergy treatment armamentarium over the course of 13 years in practice. She notes that combined, dry eye and ocular allergy can be part of a vicious cycle if the underlying dysregulated immune system isn’t addressed—this is where immunotherapy comes in. Dr. Ioussifova covers her in-office pretesting protocol and the billing and reimbursement behind it.

FDA Approves Label Supplement for iDose TR

Eyetube

The FDA approves a key label supplement for Glaukos’ iDoseTR; Nidek announces the European launch of a new open-field refraction system; and there have been several leadership changes announced during the first month of 2026. Learn more about your ad choices. Visit megaphone.fm/adchoices