Glaucoma is the second leading cause of irreversible blindness, affecting approximately 67 million people worldwide including more than 2 million Americans. Glaucoma often affects individuals in the prime of their life with devastating personal debilitation. The primary cause of glaucoma is rising intraocular pressure due to increased outflow resistance that is responsible for permanent optic nerve damage and irreversible vision loss.

In a healthy eye, pressure is regulated by a balance between production and outflow of fluid in the front part of the eye, through a strainer-like drainage system called the trabecular meshwork that fails in glaucoma. Although glaucoma has been recognized for nearly 2400 years, the underlying cause of outflow failure remains unsolved despite many advances in modern medicine. Prior research focused on the dysfunction of strainer tissue that protects the drainage system, but surgical treatment to remove it failed to achieve the needed pressure reduction, and new evidence implicates the drainage vessels themselves.

At the University of Pittsburgh, our research focus is on the reduction of this resistance and to expand and regenerate the outflow system, using new tools developed by our scientists and delivering molecules recently discovered to play an essential role in the developing a more effective outflow system.

Loss to Follow Up

One of Andrew Williams’ major areas of focus in the Healthy Vision Lab is understanding and addressing the problem of loss to follow up in glaucoma care. He started examining this topic as a glaucoma fellow at Duke, where he conducted a retrospective analysis of loss to follow up rates over 10 years at their glaucoma service. He found that 1 in 3 of their glaucoma patients became lost from routine care. Concerningly, patients with more advanced disease—who require the closest clinical monitoring—were most likely to drop out of care.

The magnitude of the problem of loss to follow up at a single institution motivated him to examine the extent of this issue for glaucoma patients on a national scale. In 2021, Williams was awarded access to the Intelligent Research in Sight (IRIS) Registry database through a competitive grant from Research to Prevent Blindness and the American Academy of Ophthalmology. This data set includes entries from millions of glaucoma patients across the country. In collaboration with data scientist, Sylvia Lin, PhD, and the Epidemiology Data Center at the University of Pittsburgh Graduate School of Public Health, this project has potential to illuminate risk factors and clinical outcomes of loss to follow up in glaucoma on an unprecedented scale. Ultimately, Williams hopes these insights could inform potential interventions that could keep glaucoma patients in regular care and reduce preventable vision loss.

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