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Moderator
Scott E. LaBorwit, MD, ABO
Panelists
Dilru C Amarasekera, MD, ABO; Lisa K. Feulner, MD, PhD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Lital Smadar, MD
Co-Authors
Guy Ben Simon (MD), Noa Kapelushnik (MD), Alon Skaat (MD), Reut Singer (MD), Daphna Landau (MD), Mordechai Rosner (MD), Ofira Zloto (MD)
Purpose
Involutional ectropion is the most common type of ectropion, affecting older adults due to eyelid laxity. The potential role of eye drop use in contributing to lower eyelid laxity remains unclear. This study aimed to evaluate the association between eye drop therapy and eyelid laxity, distinguishing between mechanical and pharmacological effects.
Methods
We conducted a clinical cross-sectional study including adult participants, divided into three groups: (1) patients with glaucoma using chronic topical anti-glaucoma medication, (2) patients with dry eye using only preservative-free artificial tears, and (3) participants not using any eye drops. All subjects underwent slit-lamp examination and standardized horizontal lower eyelid laxity testing using the eyelid distraction test. Punctate epithelial erosions (PEE) were graded on a scale from 0-4. Statistical analysis was performed using ANOVA with post hoc comparisons.
Results
Seventy patients (mean age 65; 33 women) were included: 20 with glaucoma using anti-glaucoma drops, 20 with dry eye using preservative-free artificial tears, and 30 controls not using eye drops. Lower eyelid laxity was highest in the dry eye group (5.00 mm), followed by the glaucoma group (3.13 mm) and controls (1.98 mm; p < 0.001). PEEs were more common in both treatment groups (mean score 1.60) than in controls (0.07; p < 0.001).
Conclusion
Chronic eye drop use is associated with increased lower eyelid laxity, especially in dry eye patients. Findings suggest mechanical manipulation may outweigh medication toxicity. Patients should be advised not to pull down the eyelid during instillation. Larger studies are needed for confirmation.
Presenting Author
Zarmeena Vendal, MD
Purpose
To evaluate how intraocular pressure (IOP) is affected when either netarsudil 0.02% or brimonidine 0.1% is added to latanoprost 0.005% monotherapy in normal tension glaucoma (NTG) patients.
Methods
This was a randomized, multicenter, investigator-masked, prospective study with two arms. A total of 100 eyes of 100 subjects were targeted. Subjects were randomized to receive either netarsudil 0.02% or brimonidine 0.1% in addition to their current latanoprost 0.005% monotherapy. The primary outcome measure was mean diurnal IOP after 6 weeks of treatment. Secondary outcome measures were mean IOP at each time point (8am, 12pm, and 4pm) after 6 weeks of treatment between groups and percentage of diurnal IOP reduction of both groups after 6 weeks of treatment compared to baseline.
Results
To date, 42 subjects in the netarsudil group and 42 in the brimonidine group (84 total) have completed the study. Diurnal IOP after 6 weeks was reduced by 1.6 mmHg in the netarsudil group from baseline, compared to 0.9 mmHg in the brimonidine group. This corresponded to a 10.8% and 4.9% reduction in IOP in the netarsudil and brimonidine groups compared to baseline, respectively. After 6 weeks, IOP at 8am, 12pm, and 4pm were reduced by 2.0, 1.4, and 1.2 mmHg, respectively in the netersudil group, and 0.9, 0.9, and 0.9 mmHg, respectively in the brimonidine group.
Conclusion
Interim results suggest higher IOP reduction in NTG patients currently on latanoprost 0.005% when netarsudil 0.02% is added vs when brimonidine 0.1% is added.
Presenting Author
Jasmin Kaur, BSc
Co-Authors
Savak Teymoorian (MD, MBA)
Purpose
To evaluate real-world 12-month outcomes following standalone intracameral travoprost implant (iDose TR) in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) who had undergone prior selective laser trabeculoplasty (SLT) and/or bimatoprost intracameral implant injection.
Methods
This retrospective, non-randomized, unmasked study included 65 consecutive cases of standalone iDose TR implantation by a single U.S. glaucoma surgeon. All patients had OAG or OHT and a history of prior SLT and/or bimatoprost implant injection. Intraocular pressure (IOP), medication burden, visual field mean deviation (VF MD) and adverse events were evaluated at baseline (BL) and up to 12 months (M12) post-implantation. Efficacy data were analyzed for the 55 cases that did not have a secondary surgical intervention (SSI), while safety data were documented for all patients. The SSIs included iStent or iStent infinite in 8 eyes and iStent plus cyclophotocoagulation in 2 eyes.
Results
In the 55 cases without a SSI, mean+SD IOP decreased from 19.9+4.1 mmHg at BL to 13.6+2.5 at M12 (p<0.001). There were no significant differences in 12M IOP reductions (mean+SD) between mild (-5.8+3.5 mmHg, n=24), moderate (-5.3+3.3 mmHg, n=16) and severe OAG (- 7.6+5.5 mmHg, n=12) (P=0.2980). IOP reductions (mean+SD) in eyes with prior SLT (-6.5+4.9 mmHg, n=34) were no different than those without prior SLT (-5.9+1.9 mmHg, n=21) (p=0.5286). At M12, 89% of eyes were on zero topical medications. Mean+SD change from BL in VF MD was -0.38+2.31 at M12 (n=46, p=0.2694). Adverse events were infrequent; suspected retinal edema in 2 eyes, no device-related complications.
Conclusion
At 12 months post-iDose TR, eyes without SSI had a 31.5% IOP reduction and 89% were drop- free. IOP lowering was consistent across glaucoma severities. Prior SLT did not reduce efficacy, with similar outcomes in SLT-treated and SLT-na�ve eyes. iDose TR was well-tolerated with infrequent adverse events and stable visual fields at 12 months.
Presenting Author
Gagan K Sawhney, MD
Co-Authors
Ashna Talwar (PhD), Abhishek Nair (MS, PhD), Teresa Brevetti (MD), Elizabeth Donckels (MSc), Tigwa Davis (PhD), Yecheng Huang (MS)
Purpose
Latanoprostene bunod (LBN) 0.024% ophthalmic solution is indicated for reducing intraocular pressure in patients with open-angle glaucoma (OAG). Concomitant dry eye disease (DED) could impact adherence to glaucoma medications worsening the condition. This study identified LBN prescription adherence patterns among patients with and without DED.
Methods
100% Medicare FFS Parts A/B/D claims were used to identify OAG patients ?65 years with and without incident DED with an LBN prescription between January 2017-June 2020. Index date was the earliest DED diagnosis or treatment during the 6-month period following OAG identification. Patients receiving LBN after the index date were followed over a 12-month follow up period. Adherence was assessed using Proportion of Days Covered (PDC) until end of days supply, with ?0.8 indicating adherence. Patients were excluded if they had any other forms of glaucoma, a DED procedure, or pre-index diagnosis or prescription for DED. Statistical significance was set at p<0.05.ED.
Results
912 patients on LBN were identified after applying all the selection criteria. Most patients were females (55%), White (79%) with mean (SD) age of 77.3 (8.1). The mean (SD) PDC for LBN was 0.73 (0.24) and of these 45.1% patients had adherence of ?0.8. Around 44.5% (n=406) patients discontinued LBN with a minimum gap of 60 days after end of their LBN prescription. Of those, 62.1% (n=252) restarted LBN following discontinuation. LBN patients without DED (n=718) had a mean (SD) PDC of 0.73 (0.24) which was not statistically different than LBN patients with comorbid DED (n=194) which had a mean (SD) PDC of 0.75 (0.24).
Conclusion
Average adherence to LBN was ~75%, with about half of patients meeting the ?80% adherence threshold. Adherence rates were similar between patients with and without comorbid DED. Nearly two-thirds of patients who discontinued eventually restarted therapy. Together, these findings highlight LBN's durability, tolerability, and real-world utility.
Presenting Author
Jason Bacharach, MD
Purpose
This retrospective case series study aimed to document eye care practitioners’ (ECPs’) real-world experience using Vyzulta (latanoprostene bunod; LB), including satisfaction, utilization patterns, and patient (pt) outcomes. This interim sub-analysis reports ECP satisfaction and utilization patterns.
Methods
This sub-analysis of a retrospective, multicenter, cross-sectional study includes survey responses from ≥30 ECPs from Brazil, Canada, Hong Kong, Mexico, South Africa, South Korea, Taiwan, Thailand, Tunisia, Turkey, Ukraine, the UAE, and the USA. ECPs were currently licensed optometrists or ophthalmologists with ≥3 years’ experience treating pts, and who had prescribed LB on-label (reduction of intraocular pressure in pts with open-angle glaucoma or ocular hypertension) to ≥10 pts in the last 12 months. ECPs completed a retrospective user-experience survey about their experience with LB. Key outcomes included clinical practice setting, LB utilization patterns, and ECP satisfaction with LB.
Results
Five ECPs with ≥11 years’ experience from five practices (mostly medium-sized [11–50 ECPs]) in the USA completed the survey. In the last year, on average ECPs prescribed LB as monotherapy and in combination to 184 and 186 pts, respectively; 38% of pts were diagnosed with primary OAG and 31% with normal-tension glaucoma. Mean ECP-reported effectiveness of LB (scale: 0, very poor effectiveness; 10, very good effectiveness) was 9.2 in pts with no prior treatment and 8.0 in pts with failed IOP-lowering drops and failed selective laser trabeculotomy and/or minimally invasive glaucoma surgery. Mean ECP-reported overall satisfaction with LB (scale: 0, very dissatisfied; 10, very satisfied) was 9.2.
Conclusion
The findings of this ECP-experience survey provide insights into real-world ECP utilization patterns and satisfaction with LB. ECPs reported very high effectiveness and overall satisfaction with this treatment.
Presenting Author
Noa Geffen, MD
Purpose
Visual field testing is essential in the diagnosis and follow-up of glaucoma. Transitioning visual field assessments to a home setting could enhance accessibility, enable earlier detection of progression, improve patient convenience, and increase testing frequency.
Methods
An observational, multicenter, open-label clinical trial. The study included glaucoma suspects, ocular hypertension and glaucoma patients, aged 18 years and older, who were able to sign an informed consent and follow the study requirements. The performance of Humphrey Field Analyzer (HFA) was compared to the Peripherex Visual Field Test (PRX-VFT), a home-based application, which utilizes eye tracking within a brief, gamified software interface. Subjects were required to have access to a personal computer with a webcam and internet connectivity. Exclusion criteria included presence of any other ocular or CNC diseases that would contribute to visual field loss, or to eye movement disorders.
Results
190 PRX tests were conducted on 36 eyes of 19 participants who provided reliable, corresponding HFA data. The cohort included 58% females, with a mean age of 61.5 years (SD 11.9; range 26–78). Test–retest reliability was strong (intraclass correlation coefficient, 0.76). The PRX-VFT demonstrated excellent sensitivity (96%) and negative predictive value (98%) for detecting abnormal visual fields, along with good specificity (79%) and positive predictive value (66%) for confirming normal fields. Participants reported that the PRX-VFT was easier and more enjoyable to use compared with HFA.
Conclusion
In-home PRX-VFT is a novel and feasible technology. The study demonstrated strong agreement with standard in-office HFA testing, establishing its validity. This approach has the potential to improve patient care delivery while minimizing incremental costs to both patients and the healthcare system
Presenting Author
Thomas J Berdahl, None
Co-Authors
Brian Shafer (MD), John Berdahl (MD), Natalia Morales (MD), Daniel Terveen (MD)
Purpose
To evaluate agreement between intracranial pressure (ICP) predicted from spontaneous retinal venous pulsation (SVP) thresholds and ICP measured by lumbar puncture (LP).
Methods
A prospective, single-center study was conducted in adults scheduled for clinically indicated LP. Within 24 hours of LP, participants underwent noninvasive modulation of intraocular pressure (IOP) using sealed negative-pressure goggles (Ocular Pressure Adjusting Pump). Negative pressure was gradually increased until SVPs were extinguished. For each eye, in both the upright and left lateral decubitus positions, masked examiners measured IOP at the last presence and the first absence of SVP at the optic disc. Predicted ICP was defined as the midpoint between these two IOP values, and agreement with LP-measured ICP was evaluated using Bland-Altman analysis using 80% limits of agreement (LoA).
Results
Fifteen subjects (30 eyes) were enrolled; 4 subjects lacked SVP, all of whom had ICP greater than intraocular pressure, while 11 subjects exhibited venous pulsations that could be extinguished with negative pressure and were therefore included in the quantitative agreement analysis. In the upright position, predicted ICP (12.7 ± 3.2 mmHg) closely matched measured ICP (12.9 ± 3.8 mmHg; bias ?0.18 mmHg, 80% LoA ±6.0 mmHg). In the LLD position, predicted ICP (17.5 ± 3.1 mmHg) exceeded measured ICP (12.9 ± 3.8 mmHg; bias +4.66 mmHg, 80% LoA ±8.2 mmHg).
Conclusion
Predictions of ICP based on venous pulsation disappearance agreed well with LP obtained ICP when subjects were upright, supporting the physiological link between SVP thresholds and the translaminar pressure gradient.
Presenting Author
Jackson P. Dorsett,
Co-Authors
Natalia Morales (MD), John Berdahl (MD), Thomas Berdahl (None)
Purpose
To estimate intracranial pressure (ICP) non-invasively by observing changes in spontaneous venous pulsations (SVPs), central retinal vein (CRV) diameter, and intraocular pressure (IOP) under variable tilt positions and applied ocular pressure.
Methods
Prospective, observational, non-randomized study of 30 healthy adults with or without glaucoma at a single site. Participants with intracranial, retinal, hypertensive, or pulmonary disease were excluded. Using a tilt table, participants were positioned at five angles (+90°, +45°, 0°, -45°, -90°). At each tilt, SVP visibility, CRV diameter, and IOP were recorded with ocular imaging and tonometry. The process was repeated with the ocular pressure adjusting pump (OPAP) while non-invasively modulating IOP in 3-mmHg increments (-20 to +20 mmHg). The primary endpoint is the OPAP level at which SVP transitions (appearance/disappearance), serving as an indirect estimate of ICP across postures.
Results
We anticipate that OPAP-modulated IOP levels correlating with SVP and CRV changes will reflect posture-related ICP shifts. Specifically, lower OPAP values will be required to suppress SVPs in upright postures (lower ICP), while higher OPAP values will restore SVPs in head-down positions (higher ICP).
Conclusion
This study evaluates a novel, non-invasive method for estimating ICP using tilt table testing and ocular pressure modulation. If validated, the approach may provide a safe and practical alternative to invasive ICP monitoring, with potential applications in glaucoma and neurology.
Presenting Author
Ibrahim Abboud, BSc
Co-Authors
Abdelrahman Elhusseiny (MD, MSc), Amin Zakkour Khudari (PharmD)
Purpose
To investigate whether ?2-agonists, compared with beta-blockers (BB), reduce the risk of developing Glaucoma Suspect (GS), Open-Angle Glaucoma (OAG), Primary Open-Angle Glaucoma (POAG), and Low-Tension Glaucoma (LTG) in hypertensive patients using a U.S. national cohort.
Methods
This retrospective cohort study used the TriNetX database. Patients ?40 years with hypertension who were prescribed ?2-agonists or BBs were included if they had ?4 prescriptions of the assessed drug and ?3 ophthalmology visits within five years. Patients with exposure to the alternate study drug or other antihypertensives were excluded. Outcomes were new-onset GS (H40.0), OAG (H40.1), POAG (H40.11), and LTG (H40.12) at 1, 3, and 5 years. Propensity score matching (PSM) was applied to balance demographics, comorbidities, medications, and procedures. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs).
Results
After matching (n=2,190). ?2-agonists users had a lower incidence of GS (5.2% vs. 7.2% at 1y; 6.8% vs. 8.9% at 3y; 7.8% vs. 10.3% at 5y; all p<0.01), OAG (0.9% vs. 2.1%; 1.4% vs. 3.5%; 1.6% vs. 3.8%; all p<0.01), and POAG (0.6% vs. 1.5%; 1.00% vs. 2.6%; 1.1% vs. 3%; all p<0.01) relative to BB. LTG incidence was similar between cohorts. In Cox models, ?2-agonists use had a reduced risk of GS (aHR 0.62 [95% CI, 0.54-0.71] at 1y; 0.63 [0.56-0.72] at 3y; 0.65 [0.58-0.74] at 5y; p<0.001), OAG (0.19 [0.14-0.26]; 0.22 [0.16-0.28]; 0.22 [0.17-0.29]; p<0.001), POAG (0.17 [0.12-0.24]; 0.19 [0.13-0.26]; 0.18 [0.13-0.25]; p<0.001), and LTG (0.37 [0.18-0.79]; 0.39 [0.20-0.76]; 0.40 [0.21-0.75]; p<0.01).
Conclusion
?2-agonists were associated with a reduced risk of development of GS, OAG, POAG, and LTG compared to BB, independent of confounders.
Presenting Author
Kamoliddinbekzod R. Yusupov, MS
Co-Authors
Mokhiryam Alieva (MD), Jamshid Mamatov (MD)
Purpose
To evaluate the relationship between the implantation of large or thick intraocular lenses (IOLs) in hypermetropic patients and the subsequent development of secondary angle-closure glaucoma (ACG), and to identify preventive strategies for minimizing this risk.
Methods
A review of clinical literature, case studies, and surgical outcomes was conducted focusing on hypermetropic patients undergoing cataract or refractive lens surgery. Parameters such as axial length, anterior chamber depth (ACD), lens thickness, and postoperative intraocular pressure (IOP) were analyzed. The anatomical and biomechanical effects of IOL size and positioning on the anterior chamber configuration and aqueous humor dynamics were evaluated using anterior segment imaging studies and biometric data.
Results
Hypermetropic eyes with short axial length and shallow anterior chambers are prone to angle crowding. Implantation of large or thick high-power intraocular lenses (IOLs) can further decrease anterior chamber depth by pushing the iris-lens diaphragm forward, narrowing the iridocorneal angle and obstructing aqueous outflow, leading to secondary angle-closure glaucoma. Careful preoperative biometry, anterior segment OCT assessment, selection of thinner IOLs, and prophylactic peripheral iridotomy in high-risk patients help prevent this postoperative complication.
Conclusion
The use of large intraocular lenses in hypermetropic eyes can precipitate secondary angle-closure glaucoma through anatomical angle crowding and reduced aqueous drainage. Careful preoperative assessment, individualized IOL selection, and appropriate preventive interventions are essential to ensure patient safety and preserve visual function.
