In a recent Medical Journal of Australia podcast, host Sally Block spoke with Dr. Helen Doe, an ophthalmic surgeon, and Dr. Aparna Raniga, a glaucoma and cataract specialist, both from Macquarie University Hospital. They discussed the latest in glaucoma and age-related macular degeneration (AMD), two of the leading causes of irreversible vision loss. Their insights highlighted the importance of early detection, advances in diagnostic technology, and new treatment strategies designed to preserve both sight and quality of life.*

Early Detection Matters

Dr. Doe explained that AMD often begins silently, with early changes such as drusen (tiny deposits under the retina) detected during routine eye exams. Many patients don’t notice vision problems until the disease has already advanced.

Dr. Raniga emphasized that glaucoma is known as the “silent thief of sight” because it rarely causes pain or obvious symptoms until significant vision has been lost. She noted that patients often arrive at her clinic saying, “I don’t know why I’m here—I can see fine.” That’s exactly the challenge: glaucoma may not cause noticeable issues until 30–40% of peripheral vision is gone.

Both specialists agreed that regular eye exams are the cornerstone of prevention, as vision loss from these diseases is often permanent.

Understanding the Conditions

Dr. Doe outlined the classifications of AMD:

• Early and intermediate stages are marked by drusen deposits.
• Late AMD may be wet (caused by abnormal blood vessels bleeding under the retina) or dry (resulting in the gradual atrophy of retinal cells).
• She also highlighted a variant called polypoidal choroidal vasculopathy (PCV), more common in Asian patients, which can mimic AMD but requires careful diagnosis.

Dr. Raniga explained that glaucoma is an umbrella term describing damage to the optic nerve. She broke it down into open-angle (fluid drainage angle is open but not working) and angle-closure (the drainage angle is blocked, leading to sudden pressure spikes). She also distinguished between primary glaucoma, which occurs without another cause, and secondary glaucoma, which may follow other eye issues like uveitis, retinal surgery, or cataract complications.

Diagnostic Tools

Dr. Doe described how tools like fundus imaging, OCT (optical coherence tomography), and OCT angiography have revolutionized retinal care. OCT, in particular, provides detailed cross-sectional images of the retina, helping doctors distinguish between wet and dry AMD and track disease progression over time.

Dr. Raniga shared that she also relies heavily on OCT and visual field testing to monitor glaucoma progression. She explained that glaucoma is about accelerated nerve fiber loss compared to normal aging, and computer-based tools like guided progression analysis help catch deterioration before patients notice functional problems.

Treatment Advances in AMD

Dr. Doe highlighted several important developments:

• Supplements: She explained that the large AREDS and AREDS2 trials proved a specific mix of vitamins (C, E, zinc, copper, lutein, and zeaxanthin) can cut the risk of progression to advanced AMD by up to 25%.
• Anti-VEGF injections: Drugs like Lucentis, Eylea, and Faricimab are now standard for wet AMD, reducing bleeding and fluid and often preserving vision. She reassured listeners that most patients tolerate injections well, describing the procedure as quick and generally painless.
• Dry AMD treatments: For the first time, complement inhibitors such as pegcetacoplan have been approved, offering new hope for slowing vision loss from geographic atrophy.
• Emerging therapies: Dr. Doe also mentioned future approaches such as implantable drug reservoirs, gene therapy, and stem cell treatments, which may further reduce treatment burden.

Treatment Advances in Glaucoma

Dr. Raniga explained that glaucoma management has shifted dramatically over the past decade. In the past, treatment meant “drops until surgery,” but now patients benefit from earlier, less invasive options:

• Preservative-free drops: She said these are increasingly used first because they lower eye pressure without causing the redness, irritation, or blurred vision that older drops often produced.
• Selective Laser Trabeculoplasty (SLT): Once used late in treatment, SLT is now backed by the LiGHT study as a safe and effective first-line option. Dr. Raniga emphasized that SLT can control eye pressure as well as drops, is more cost-effective, and reduces the need for daily medications.
• Cataract surgery with MIGS: She described how combining cataract surgery with minimally invasive glaucoma surgery (MIGS) devices, like iStent, Hydrus, and the newer Miniject, has significantly lowered the global rates of traditional trabeculectomy surgery.
• Advanced cases: Referring to the TAG study, Dr. Raniga stressed that patients with advanced glaucoma often do better when surgery is offered earlier rather than after exhausting other treatments. This proactive approach can help preserve the vision patients still have.

Lifestyle and Complementary Approaches

While medical and surgical care are essential, both specialists also touched on supportive measures:

• Dr. Raniga noted that Vitamin B3 is being studied in Australia for its potential to slow glaucoma progression, while Ginkgo biloba and other supplements are being researched with mixed results.
• She mentioned that exercise and meditation may reduce oxidative stress and support overall health, though strong evidence in glaucoma patients is still lacking.
• Practical adjustments matter too: she advised avoiding tight swim goggles that can raise eye pressure, reducing time spent playing wind instruments, and managing systemic conditions like hypertension, diabetes, or sleep apnea that may contribute to eye disease.

What It Means for You

The experts emphasized that these advances translate into more options and improved outcomes for patients.

• Dr. Doe encouraged patients with AMD to ask about supplements, anti-VEGF injections, and whether they may qualify for new treatments like complement inhibitors.
• Dr. Raniga urged people with glaucoma to be proactive: ask about preservative-free drops, SLT, or MIGS if you’re diagnosed, and don’t wait until vision loss is obvious.

For both conditions, early diagnosis remains the key. Treatments can preserve vision and quality of life, but only if started before significant damage occurs.

Bottomline

Glaucoma and AMD are no longer conditions where patients must “wait and see.” As Dr. Raniga explained, today’s care is about early, proactive intervention to slow progression and maintain independence. And as Dr. Doe reminded listeners, even for conditions once considered untreatable, new therapies are emerging.

*The Medical Journal of Australia (September 22, 2025). “MJA Podcasts 2025. Episode 17: Advances in glaucoma and age-related macular disease” https://www.mja.com.au/podcast/223/6/mja-podcasts-2025-episode-17-advances-glaucoma-and-age-related-macular-disease

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