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.

EMPOWER - Contact Lens Success in Modern Optometric Clinics

Jacob Lang, OD, FAAO, Dipl ABO; Jaclyn Garlich, OD, FAAO; and Melissa Barnett, OD, FAAO, FSLS, FBCLA

Eyetube

In the first EMPOWER podcast episode of 2026, Dr. Jacob Lang leads a conversation with Dr. Jaclyn Garlich and Dr. Melissa Barnett on the evolving role of contact lens technology in modern optometric practice. The discussion highlights strategies for fitting daily lenses, managing dry eye and presbyopia in contact lens patients, and setting realistic expectations to support long-term patient success.

Ocular Releases Phase 3 Data for Wet AMD Candidate Axpaxli

Eyetube

Ocular Therapeutix releases its long-awaited SOL-1 phase 3 data for wet AMD drug candidate Axpaxli; Nordic Pharma expands the availability of its novel dry eye therapy Lacrifill; and Alcon launches the only multifocal toric contact lens featuring Water Gradient Technology. Learn more about your ad choices. Visit megaphone.fm/adchoices