Graduation Date

Summer 8-14-2020

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Carol B Toris

Second Advisor

Lani Zimmerman

Third Advisor

Wallace Thoreson

Fourth Advisor

Jane Meza

Abstract

Glaucoma laser and incisional surgical treatments are associated with a known risk of complications. The ability to better predict treatment outcomes and individualize treatment recommendations can enhance the benefit to risk ratio of a treatment option. The work presented in this dissertation explores the interplay of biometrics, race and aqueous humor dynamics and their influence on treatment outcomes. In the first chapter, we demonstrate that pre-operative aqueous humor dynamics (higher aqueous flow, lower outflow facility and lower uveoscleral outflow) are predictive of greater intraocular pressure lowering after selective laser trabeculoplasty. The second chapter describes significant race-based differences in aqueous humor dynamics and biometrics between a Chinese and Caucasian study set, each compromised of two different age groups. Overall, Chinese subjects had a higher intraocular pressure, higher aqueous flow, lower uveoscleral outflow, higher outflow facility, lower anterior chamber volume and higher central corneal thickness as compared to Caucasian subjects. The final chapter demonstrates that the intraocular pressure lowering effects of a trabecular bypass procedure (iStent) are much less apparent in non-Caucasian patients and in patients with higher axial lengths. Cataract surgery done without iStent, had greater success in eyes with flatter keratometry, deeper anterior chamber and shorter axial lengths. This work thereby identifies significant interplay between race, biometrics and aqueous humor dynamics and describes their influence on glaucoma treatment outcomes.

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