From the Guidelines
To support the health of the trabecular meshwork and manage its dysfunction, focus on reducing intraocular pressure (IOP) through medication, lifestyle changes, and possibly surgical interventions, as evidenced by the most recent study in 2021 1.
Key Interventions
- First-line medications include prostaglandin analogs like latanoprost (0.005%, one drop daily in the affected eye at bedtime), which increase uveoscleral outflow and reduce IOP by 25-35% 1.
- Beta-blockers such as timolol (0.25-0.5%, one drop twice daily) decrease aqueous humor production.
- Alpha-2 agonists like brimonidine (0.1-0.2%, one drop two to three times daily) reduce aqueous production and increase outflow.
- Carbonic anhydrase inhibitors such as dorzolamide (2%, one drop three times daily) also decrease aqueous humor production.
Lifestyle Modifications
- Regular exercise
- Maintaining healthy blood pressure
- Avoiding smoking
- Limiting caffeine intake
- Staying well-hydrated
Surgical Interventions
- For patients with advanced trabecular meshwork dysfunction, minimally invasive glaucoma surgeries (MIGS) like iStent or Hydrus implantation can bypass the damaged meshwork.
- Laser trabeculoplasty (SLT or ALT) can also stimulate the trabecular meshwork to function better, with effects lasting 1-5 years, as supported by a study in 2016 1.
Patient Education and Support
- Educating patients about their condition, treatment options, and the importance of adherence to medication regimens is crucial, as highlighted in a study from 2021 1.
- Patients should be encouraged to alert their ophthalmologists to any changes or barriers to self-management.
- Referral to an ophthalmologist with special training or experience in managing glaucoma should be considered if the diagnosis or management is in question, or if the condition is refractory to treatment.
From the Research
Trabecular Meshwork Anatomy and Physiology
The trabecular meshwork is a complex, fenestrated, three-dimensional structure composed of trabecular meshwork cells (TMC) interdigitated into a multilayered organization within the extracellular matrix (ECM) 2. It is located within the iridocorneal angle and is the main pathway for drainage of aqueous humor (AH) out of the eye. The trabecular meshwork plays a critical role in modulating intraocular pressure (IOP) through regulation of aqueous humor outflow.
Supporting the Health of the Trabecular Meshwork
To support the health of the trabecular meshwork, it is essential to understand the mechanisms that regulate its function. The extracellular matrix (ECM) in the trabecular meshwork is crucial for maintaining the integrity of the tissue and regulating the outflow of aqueous humor 3. Additionally, the Na-K-Cl cotransport system is a primary regulator of trabecular meshwork cell volume and appears to be coordinated with net efflux pathways to maintain steady-state volume 4.
Managing Trabecular Meshwork Dysfunction
Trabecular meshwork dysfunction is responsible for the elevation of intraocular pressure (IOP) in glaucoma patients 2. The dysfunction can be caused by various factors, including ultrastructural changes in the ECM, mutations in ECM genes, and increased stiffness of the trabecular meshwork 3. To manage trabecular meshwork dysfunction, it is essential to target the underlying mechanisms, such as:
- Regulating the extracellular matrix (ECM) to maintain the integrity of the trabecular meshwork 3
- Modulating the Na-K-Cl cotransport system to regulate trabecular meshwork cell volume 4, 5
- Reducing the deposition of fibrous granular material and increasing the content of hyaluronic acid in the trabecular meshwork 6
Key Factors in Trabecular Meshwork Function
Some key factors that influence trabecular meshwork function include: