It was a case of third time lucky for the 2021 Glaucoma New Zealand Symposium: After two postponements over the past year, the Symposium successfully went ahead at Alexandra Park, Auckland, on the 16th of May. Since in-person educational events have been few and far between recently, it was a fantastic opportunity to mix with colleagues and sponsors and enjoy some excellent glaucoma education from diverse speakers. This year, GNZ also allowed delegates to attend remotely (with 35 people live-streaming the event and the 125+ attendees in the room), which prompted positive feedback.
Keynote Speaker Professor Graham Lee MD MBBS FRANZCO
Zooming in on red-eye: Professor Graham Lee, presenting via (almost entirely glitch-free) Zoom from Brisbane, was this year’s keynote speaker. Professor Lee gave a whistle-stop tour of the red-eye in glaucoma. He is fellowship-trained in cornea and glaucoma, he is uniquely qualified to cover this topic. The presentation covered a wide variety of causes and cases of red-eye in glaucoma, ranging from sight-threatening emergencies (acute angle-closure) to mild iatrogenic red eye (this part of the talk also highlighted the broader range of preservative-free medications available for glaucoma treatment in Australia compared with New Zealand). Prof Lee raised the importance of asking about a patient’s nutrition and covered an interesting case of reduced conjunctival healing in a patient suffering from alcoholism.
One of GNZ’s Trustees and resident session chair extraordinaire, Dr. Sam Kain, was tasked with chairing the day’s rapid-fire sessions. As usual, he provided some light relief in humorous introductions for all speakers. The first of these sessions was entitled ‘Clinical Pearls for Glaucoma Management: Mastering the Basics.’ Dr. Hussain Patel spoke on the epidemiology of glaucoma, focusing on his research in this field in Aotearoa/New Zealand. Dr. Patel’s retrospective review of ADHB clinical records showed that Māori and Pacific patients were under-represented in primary open-angle patient clinic numbers. That non-glaucomatous optic neuropathy should always be considered for patients in these ethnic groups.
The ABC of OTC: Determining visual field progression in glaucoma is always a challenging task. Dr. Keli Matheos highlighted reasons for this, including a large number of non-repeatable visual field defects and the fact that many of us are likely to be under-testing our patients. Dr. Graham Reeves’ presentation covered a literal and entertaining alphabet of OCT in glaucoma. Somewhat disappointingly, he could not come up with OCT-themed words starting with K, U, and W (I’ve racked my brains for these, too). Although their talks were technology-based, both Dr. Matheos and Dr. Reeves honed in on the continued importance of clinical disc interpretation as an integral part of every glaucoma assessment. At the GNZ Symposium, Dr. Alex Buller was gifted the un-sexy but extremely important topic of compliance (also commonly referred to as adherence) in glaucoma. Dr. Buller summarised several high-level studies to highlight the importance of adherence to topical medication regimens and a long list of reasons patients may stray from their instructions.
Holistic Approach to Glaucoma Care: The day’s second session, ‘Holistic Approach to Glaucoma Care,’ included topics across the full glaucoma spectrum. One of the highlights of this session was Professor Jennifer Craig’s presentation on the intersection of dry eye and glaucoma. Professor Craig outlined why preserving the ocular surface is key in glaucoma patients, particularly those with existing dry eye disease, and in younger patients who may have decades of therapy. New Zealand’s lack of subsidised preservative-free glaucoma medications was again mentioned. I hope that more of these unit dose eye drops will be available for our patients in the future. Other methods that can help reduce the burden on the ocular surface in glaucoma patients include using preparations with lower toxicity preservatives, reducing the number of instilled doses, and considering laser or surgical treatments for some patients.
Lifting weights, lighting IOP: Dr. Geraint Phillips provided an overview of research from the University of Auckland, a collaboration between Optometry, Ophthalmology, and Sports Science, looking at how resistance training affects IOP. Their study found that resistance training caused spikes in IOP (to above 60 mmHg in some participants!), but IOP returned to normal quickly post-lift. This provided some food for thought around advising glaucoma patients on lifestyle factors. It has already been established that aerobic exercise lowers IOP, encouraging us to take time away from the couch over the upcoming winter months.
Primary Angle Closure: Following lunch, the delegates settled back into their seats for various angle-closure presentations. Professor Lee returned to our screens to provide an update on the management of primary angle-closure, including interpretation of the EAGLE and ZAP studies. He also reminded the audience to interpret the ZAP study cautiously as the study was undertaken in a Chinese population, and the results will not be generalizable to New Zealand’s demographics. Professor Helen Danesh-Meyer reminded the audience of an oft-neglected technique in managing acute angle-closure: corneal indentation. This can be done to force aqueous humour into the peripheral angle and effectively break the acute attack, allowing some symptomatic relief for the patient while they wait for definitive treatment.
Case Studies and the Gordon Sanderson Scholarship: The Symposium continued its tradition of holding a case-presentation session, with speakers from both optometry and ophthalmology, covering glaucoma diagnoses and glaucoma mimics. Dr. Jesse Gale covered a fascinating case of a congenital conduit to the retrolaminar space and used clinical methods to investigate corneal biomechanics (surprisingly, they were not affected). Richard Johnson had the most scandalous diagnosis, with an unusual case of topless disc syndrome (superior segmental optic nerve hypoplasia).
The day concluded with the Gordon Sanderson Scholarship presentation. The scholarship, named for Associate Professor Gordon Sanderson, one of the founding trustees of GNZ and a titan of eye care in New Zealand, has been awarded every year since Gordon passed away in 2017. The 2019/2020 recipient, Blair Lowry, received the scholarship to investigate the demographic factors surrounding acute angle closure in New Zealand. He summarised 65 cases that were presented to ADHB over two years. It is great to see the scholarship being put towards research that will help future generations of eye health professionals.
Overall, it was a fantastic day of glaucoma education (even if it did mean giving up a Sunday). Special thanks to all excellent speakers and the sponsors, AFT Pharmaceuticals, Allergan, Designs for Vision, Device Technologies, Glaukos, Humanware, Medix21, OIC, and Tristel for their generous support of the event.
Author: Dr. Hannah Kersten is a therapeutic optometrist interested in glaucoma and neuro-ophthalmic disorders. A trustee of GNZ, she currently holds clinical and research roles at Eye Institute in Auckland.