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Aqueous outflow imaging techniques and what they tell us about intraocular pressure regulation.

Accepted version
Peer-reviewed

Type

Article

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Authors

Khatib, Tasneem Z 
Meyer, Paul AR 
McCluskey, Peter 
Martin, Keith R 

Abstract

Recent advances in the medical and surgical management of open-angle glaucoma have increased the number of treatment options available. Several new intraocular pressure (IOP)-lowering treatments target the conventional aqueous outflow (AO) system. However, success rates are variable and outcomes in individual patients are often difficult to predict. Variable treatment responses remain unexplained and highlight deficiencies in our current understanding of AO regulation and IOP homeostasis. Imaging is often relied upon to confirm diagnoses and monitor treatment responses in other ocular and systemic pathologies. As yet no suitable AO imaging tool has been developed to fulfil this role in glaucoma. A variety of imaging techniques have been used to study the AO tracts of humans and animals in ex vivo and in vivo eyes. In this review, results from novel imaging techniques that assess aqueous drainage through the episcleral venous system are considered and we argue these provide new insights into AO regulation. We suggest that the ability to objectively measure AO responses to interventions would be a significant clinical advance, and we have demonstrated that this can be achieved with direct visualisation of aqueous drainage. We predict that the evolution of AO imaging technology will continue to reveal critical components of AO and IOP regulation, and that personalised IOP-lowering treatment in glaucoma care may well become a reality in the near future.

Description

Keywords

Animals, Aqueous Humor, Glaucoma, Open-Angle, Humans, Intraocular Pressure, Tonometry, Ocular, Trabecular Meshwork

Journal Title

Eye (Lond)

Conference Name

Journal ISSN

0950-222X
1476-5454

Volume Title

35

Publisher

Springer Science and Business Media LLC

Rights

All rights reserved
Sponsorship
1. A core support grant from the Wellcome Trust and MRC to the Wellcome Trust – Medical Research Council Cambridge Stem Cell Institute 2. Haemoglobin Video Imaging facilities funded by Sydney Eye Hospital Foundation, Carl Zeiss Meditec, and Glaukos Corporation