Gillman, Kevin (2022) Towards personalised Glaucoma management identification of specific factors influencing Glaucoma treatment outcomes. (PhD thesis), Kingston University, .
Abstract
Glaucoma is a group of neurodegenerative diseases resulting in irreversible vision loss through retinal ganglion cell death. A number of treatment options are currently used to treat glaucoma, ranging from pharmaceutical therapies and localized laser treatments, to surgical filtration procedures and a wide variety of novel Minimally Invasive Glaucoma Surgery (MIGS) procedures. All of these options aim at reducing the rate of retinal ganglion cell apoptosis through the lowering of intraocular pressure (IOP). Yet, two significant limitations impact the choice of glaucoma treatments in clinical practice, and are addressed successively in this thesis. First, while all glaucoma treatments currently target IOP to slow or halt disease progression, a growing body of evidence suggests that static in-clinic tonometry does not provide an accurate representation of IOP. Indeed, the dynamic nature of IOP as well as its out-of-office variations were shown to have a direct impact on glaucoma progression (Article 1). Besides, a number of intrinsic and extrinsic may have influence IOP, causing immediate, short-term and long-term pressure fluctuations (Article 2-4). Second, while the number of therapeutic options for glaucoma is growing with the addition of new MIGS techniques every year, there is, to date, no clear consensus guiding treatment choice. Yet, glaucoma is a multifactorial disease and recent literature abounds with suggestions that specific clinical or demographic characteristics may influence the outcomes of medical or surgical treatments (Article 5-8). Although this implies that tailoring treatment options to individual patients’ characteristics may be beneficial, interstudy heterogeneity have so far impaired study comparability and generalisation. Thus, specific clinical recommendations guiding personalized therapeutic choices remain scarce.
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