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Message March, 2022 NEWSLETTERDoctor, I Have A Question About MIGSLiving with Glaucoma : Kumsar MahadevaProtecting Your Eyes in WinterDriving
Newsletter March, 2022MESSAGE FROM THE PRESIDENTDear Readers,Next week, March 6 to 12, is World Glaucoma Week, a global initiative of the World Glaucoma Association (WGA) to raise awareness of glaucoma. We share the goal of the observance - to alert everyone to have regular eye examinations in order to detect glaucoma as early as possible. We strive to be an important resource to help patients better manage their glaucoma, and to educate everyone about eye health. We understand the global urgency of the message as we work to better understand the disease and help advance glaucoma strategies for diagnosing, treating and eventually nding a cure.Join us on Tuesday, March 15 at 5 pm, when Louis R. Pasquale, MD will speak about one major advance, “Using Articial Intelligence to Disentangle Glaucoma Pathogenesis”. Among his distinguished credentials, Dr. Pasquale is the Shelley and Steven Einhorn Distinguished Professor of Ophthalmology at Mount Sinai Hospital in New York City.. As you all know, it is our mission to support cutting-edge research that helps us to better understand the disease of glaucoma. Looking ahead, I hope you’ll save the date of Monday, April 4 at 5 pm, when Dr. Adriana Di Polo will report on results of her important study funded by TGF in a webinar she’s calling “Glaucoma: Seeing the Light at the End of the (nano) Tunnel.” Dr. Di Polo will present new ndings from her laboratory at the University of Montreal that demonstrate the critical role that pericytes play in vascular dysfunction in glaucoma and shed light on a new path for vision restoration.As always, we thank our friends and supporters who make our research and educational programs possible. And we thank you for being a reader of our newsletter.Elena Sturman
Doctor, I Have a Question.What Is the Role of MIGS Procedures in a Doctor’s Arsenal of Treatment Options?Question answered by:Robert D. Fechtner, MDChair, Department of Ophthalmology and Visual Sciences, SUNY Upstate Medical University, Syracuse, NYThere is a real role for minimally invasive glaucoma surgeries (MIGS), but we have to have realistic expectations going in. Every glaucoma procedure has an ecacy side and a safety side and there’s a continuum of surgeries that range from being highly eective pressure reducers that carry many more safety risks, to those that are very safe but provide modest pressure reduction.The great advantage of MIGS as compared to traditional surgery like a trabeculectomy or a drainage implant is safety. MIGS don’t have nearly the frequency or severity of complications as, for example, a trab, but in the long term they don’t appear to have the ecacy of the procedures that have a greater complication prole.Here’s how MIGS work to lower intraocular pressure. Some, like the iStent and Hydrus, target the trabecular meshwork (TM), which is the conventional aqueous humor outow path but which is often blocked in glaucoma. Both the iStent and Hydrus lower IOP by creating a bypass through the trabecular meshwork (TM) allowing aqueous to go directly into the Schlemm’s Canal. Another strategy is to incise the trabecular meshwork with a blade or with a lament threaded into Schlemm’s canal (Sight Sciences Omni 360) or remove a segment of the trabecular meshwork with a device such as Kahook Dual Blade. There are outow pathways beyond the TM. There is a strategy of instilling viscoelastic through the TM into Schlemm’s canal to dilate the outow pathways. The Sight Sciences Omni 360 is designed to do this in addition to TM incision.Both the iStent and Hydrus – like some other MIGS devices – were tested and approved by the FDA for implantation only in combination with cataract surgery. While there’s no reason these devices wouldn’t work as stand-alone procedures, they would not be covered by insurance as they would be “o-label” procedures. Only the Xen Gel Stent, a dierent category MIGS device, which diverts the uid from inside the eye to the subconjunctiva space, (more like what a trabeculectomy does) is a device approved in the United States for implantation alone or with cataract surgery.
Newsletter March, 2022Patients with mild or moderate glaucoma can have condence about any of these devices as they all seem to be roughly similar in lowering IOP. For whom would they be recommended?Let’s say, for example, that you have mild glaucoma with a little bit of damage but you are controlling your pressure very well with two eye drops. When we do your cataract surgery, which by itself often lowers IOP, we can do an additional MIGS procedure for you that may further help your pressure control or may get you o one or two drops – at least for a while.Or, we could just do the cataract surgery and you’ll likely be on the same two drops afterwards.It makes sense to me to oer a MIGS procedure if I can help you get better pressure control or reduce the burden of eye drops – to me that’s a victory. It may seem like a small victory, but for glaucoma we celebrate any victory. MIGS procedures and devices, however, will not replace a trabeculectomy or a glaucoma drainage implant when that’s what you need. DRIVING WITH GLAUCOMAEven if glaucoma may not have dramatically changed your vision acuity, drivers with glaucoma need to be especially alert when behind the wheel. Especially older drivers.Warning signs that driving may be dangerous include: loss of peripheral vision (making it dicult to see and react in time to avoid obstacles like other cars and pedestrians coming from the side); blurred vision (making it harder to distinguish clear images and see movement such as passing cars or someone crossing the street); increased light sensitivity, (making it more dicult for your eyes to adjust from headlight glare at night); and close calls (because of a failure to notice obstacles in the road).Glare is a common vision problem associated with glaucoma and driving at night, when the glare from oncoming headlights can be particularly problematic. Many glaucoma patients choose to avoid night driving due to the headlight glare that makes is dicult to see well.Just after sunrise and just before sunset when the sun can shine directly into drivers’ eyes are other times when glare can be blinding.Especially if you’re an older driver, it’s important to assess your ability to drive safely: have your visual eld and contrast sensitivity evaluated regularly.
If you choose to continue to drive, be sure to:-- Select proper glasses for both day and night driving. Darkened or polarized lenses can be helpful in blocking glare in daytime. But when driving at night, do not wear tinted glasses --the eyes need to adapt to darker natural conditions. -- If you wear glasses, keep them clean. And avoid wide-temple frames which can interfere with side vision.-- When you buy a car, choose a clear windshield and keep your windshield clean, inside and out. People often forget the importance of wiping o the inside of the windshield, which is easily smudged. Check your windshield for pitting and cracks. -- Maintain and clean o your headlights, which can get coated with road grime.-- Make sure your windshield wipers are in good condition and change them as needed.-- When driving into the sun, utilize your sun visor – it can help to block out the sun. Avoid storing papers or other items on the dashboard. Leave more following room – when the sun is in your eyes it can be hard to see what the car ahead of you is doing. Here are two resources that can help you evaluate your driving skills:American Association of Retired PersonsDriver Safety Programhttp://www.aarp.org/families/driver_safety/800-424-3410 AAA Foundation for Trac SafetyDrivers 65 Plus: Test Your Own Performance.Available as a brochure and other information is available athttps://seniordriving.aaa.com/
Newsletter March, 2022LIVING WITH GLAUCOMA : Meet Kumar Mahadeva Kumar Mahadeva, a TGF Board Member since 2014, was born and raised in Sri Lanka. Following the example of his parents, he went to England to attend college. He had intended to return to Sri Lanka after college. But because the country was at the cusp of a civil war, he instead came to the U.S. to attend Harvard Business School. I had always hoped to return to Sri Lanka but I’m glad that I stayed in the U.S.,” he says. Indeed. As the founder of Cognizant Technology Solutions (CTSH) in 1993, and its rst Chairman and CEO , Kumar was the driving force behind one of the fastest-growing technology services companies in the world. Cognizant has grown into a leader in its industry and is in the S&P 500 and Nasdaq 100.“Cognizant leveraged talent in India to deliver large software projects to clients worldwide, a pioneering concept at the time. Although remote work has now become routine, the infrastructure for it did not exist back in 1993. The internet was not what it is today and we had to build our own networks, Software platforms and Videoconferencing systems to integrate widely dispersed teams. In the end we got the model working very well. There is a tremendous shortage of talent in technology and the US benets from having access to a global talent pool.“I got involved with The Glaucoma Foundation because I was a glaucoma patient myself. I was diagnosed around 2003 but was not prescribed any treatment. Fortunately I sought a second opinion from my current doctor who said my pressures were far too high and so I learned about the risks of glaucoma creeping up on you when you don’t even realize it, and also how dierent it can be depending on how you are treated and cared for. “I do drops and had one surgery – other than that, things have gone well. Up to this point glaucoma hasn’t changed my day-to-day life.“Given my personal interest in glaucoma, I looked up organizations I could contribute to and became a regular contributor to the Foundation. Then they reached out and asked me if I wanted to join the Board. “For me the Foundation is both an opportunity to contribute to something that is meaningful to me and also a tremendous learning opportunity. I am particularly interested in some of the more fundamental aspects of glaucoma –research into the causes of glaucoma that can eventually lead to a full cure rather than just management of the disease. “So, more recently, when the Foundation was looking for funding for several research projects, I agreed to support a very fundamental piece of work on blood ow to the eyes and the neurons and pericytes which control that blood ow but which in glaucoma patients are not working so well. Now the research team on this project at the University of Montreal has unveiled mechanisms underlying these defects. Their ndings have just been published in the Proceedings of the National Academy of Sciences USA.
“My interest in nding a cure is heightened as glaucoma is hereditary and such research might benet my young son and others of his generation. “I’m active in several other organizations whose work interests me personally, such as the Cure Alzheimer’s Fund where I recently joined the board of trustees. My father had Alzheimer’s disease which prompted my interest in the disease.“What do I do for fun? My 20-month-old son is certainly entertaining. I’ve always been a technology nerd, so I do a lot of things in that area. We also enjoy a culturally full life in New York and Miami Beach.”ARE YOU PROTECTING YOUR EYES? Winter is not over yet. And it can wreak havoc on your eyes. Fortunately, following a few cold weather eye tips can help keep your eyes safe.Heaters and dry wind can aggravate dry eyes during the winter months. Dry eye syndrome, particularly common among older adults, is mostly caused by a deciency in the tear glands, and a common preservative in many glaucoma medications can worsen the symptoms. The main treatment for relief is the use of lubricating articial tears, available as over the counter eye drops, to replace natural tears and also provide an articial protective coating for the eye. Leave at least fteen minutes between applications of the eye drops used to treat glaucoma and the articial tears to keep from washing the glaucoma drop out of the eye. Generally, the articial tear should be used after the glaucoma eye drops. There are two categories of articial tears:• Eyedrops with preservatives often come in multidose bottles and contain preservatives that discourage growth of bacteria once the bottle has been opened. The preservatives may irritate your eyes, especially if you have moderate or severe dry eyes.• Preservative-free eyedrops have fewer additives and are generally recommended if you apply articial tears more than four times a day, or if you have moderate or severe dry eyes. Preservative-free eyedrops may come in single-dose vials.For more severe cases, a thicker gel or ointment can be used at night or a prescriptive eye drop is available. Using a humidier in your home may also be helpful. If you haven’t experienced some relief with these eorts, make an appointment with an eye doctor who can suggest other treatments.It’s important to wear sunglasses in the winter to protect your eyes from dry, cold conditions and from the sunlight that reects o of snow and ice. When shopping for sunglasses, remember to look for a pair that blocks 100 percent of the sun’s rays for best results.If you participate in sports like ice skating, skiing and snowboarding, consider wearing special goggles that can provide even more protection for your eyes. It’s also a good idea to wear a hat to help deect the sun’s rays, and if possible, to avoid skiing or hiking behind other people to help cut down on the amount of snow and debris that can y into your face.
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