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Precision medicine to prevent glaucoma-related blindness

Moroi, Sayoko E.a; Reed, David M.a; Sanders, David S.a,b,c; Almazroa, Ahmeda,d; Kagemann, Lawrencee,f,g; Shah, Neilh; Shekhawat, Nakula; Richards, Julia E.a,i

Current Opinion in Ophthalmology: May 2019 - Volume 30 - Issue 3 - p 187–198
doi: 10.1097/ICU.0000000000000564
TRANSLATIONAL RESEARCH: Edited by Jason Hsu and Sunir J. Garg

Purpose of review Approximately 10% of patients become blind despite using evidence-based guidelines developed from clinical trials and epidemiology studies. Our purpose is to review opportunities to decrease glaucoma-related blindness using the emerging principles of precision medicine.

Recent findings The current review focuses on three topics: first, candidate biomarkers for angle-based surgeries, second, head-mounted display (HMD) technology for vision and testing, and third, glaucoma risk alleles discovered by genome-wide association studies. First, in angle-based surgeries, tracers injected into the anterior chamber or Schlemm's canal have allowed visualization of aqueous veins. We describe an innovative use of optical coherence tomography angiography to visualize aqueous veins in a case with 6-year successful outcome following catheter-based trabeculotomy. Second, HMD technology can augment perceived vision and can be used for perimetry testing. Third, developing genetic risk scores that characterize patients who are at highest risk for blindness is a priority. Such biomarker risk scores will integrate genome-wide association study-based risk alleles for glaucoma along with well known demographic and clinical risk factors.

Summary As we gain more knowledge, precision medicine will enable clinicians to decrease glaucoma-related blindness by providing more timely interventions to those patients who are at highest risk for progression to blindness.

Video abstract

aDepartment of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan

bDepartment of Ophthalmology, Casey Eye Institute, Oregon Health & Science University

cDevers Eye Institute, Legacy Health System, Portland, Oregon, USA

dCurrently at King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Science, Ministry of National Guard, Riyadh, Saudi Arabia

eDepartment of Ophthalmology, NYU School of Medicine, New York City, New York

fDivision of Ophthalmic and Ear, Nose and Throat Devices, Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring

gDepartment of Ophthalmology, University of Maryland School of Medicine, Baltimore, Maryland

hDepartment of Ophthalmology, Loyola University Medical Center, Maywood, Illinois

iDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA

Correspondence to Sayoko E. Moroi, MD, PhD, Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan, 1000 Wall St., Ann Arbor, MI 48105, USA. Tel: +1 734 763 3732; fax: +1 734 615 0542; e-mail:

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