The edition · Ophthalmology
Which glaucoma fields progress, and reining in antibiotic eye drops
Plus perfusion pressure as a factor beyond intraocular pressure, the corneal toxicity of HER2 antibody-drug conjugates, and a reminder on diabetic retinopathy screening.
The edition in brief
Today's ophthalmology edition opens on glaucoma risk stratification. A 10-year multicentre study of 127 eyes found that baseline central (10-2) visual field patterns predicted long-term central progression: inferior defects and both-hemifield involvement carried roughly three- to four-fold higher progression risk, marking eyes that need closer central field surveillance. A cross-sectional Indian study of 75 eyes with open-angle glaucoma found lower ocular perfusion pressure tracked with greater severity even though intraocular pressure did not, and that patients on antihypertensives had lower perfusion pressure despite similar clinic blood pressure. A prospective study documented ocular surface toxicity in 86% of patients on HER2-targeted antibody-drug conjugates, with a dose- and time-dependent vortex keratopathy and corneal nerve loss that was partially reversible. A clinic pearl reaffirms diabetic retinopathy screening intervals. The practice-changer is a stewardship one: an India-focused model urges culture-guided therapy for serious ocular infections and restraint with broad-spectrum and prolonged topical antimicrobials, to curb the multidrug resistance now seen in keratitis and endophthalmitis.
Baseline central field pattern predicts which glaucoma eyes progress
Use the baseline 10-2 central field pattern to stratify risk: inferior or both-hemifield defects mark eyes needing closer central field surveillance and a lower threshold to escalate.
Low ocular perfusion pressure tracked with glaucoma severity, beyond IOP
In glaucoma that worsens despite controlled intraocular pressure, consider ocular perfusion pressure — ask about antihypertensive use and overnight blood-pressure dipping.
HER2 antibody-drug conjugates commonly damage the ocular surface
Expect and monitor for ocular surface toxicity in patients on HER2 antibody-drug conjugates; manage with lubrication and oncology liaison rather than reflexive drug cessation.
Hold the line on diabetic retinopathy screening intervals
Keep to the diabetic retinopathy screening schedule — from diagnosis in type 2, within five years in type 1, then yearly — and refer sight-threatening disease promptly.
Bring antimicrobial stewardship to the red eye
Apply antimicrobial stewardship to ocular infections: culture-guided, time-limited therapy and restraint with broad-spectrum and prolonged topical antimicrobials.
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