2022 MAY : simplebooklet.com

Newsletter May 2022MESSAGE FROM THE PRESIDENTDear Readers,In recent months, Articial Intelligence (AI) has been on the front burner at The Glaucoma Foundation. In March, Dr. Louis R. Pasquale presented our rst webinar on the subject “Using Articial Intelligence to Disentangle Glaucoma Pathogenesis.” As an NIH Principal Investigator, Dr. Pasquale’s research focuses on the discovery of primary prevention strategies in the open-angle glaucomas. He has been a co-investigator on many research projects to assess the use of articial intelligence and machine learning algorithms in glaucoma. You can read about his talk in this issue and watch the recorded webinar anytime by visiting our website under the EVENTS tab.Today, doctors have no way to predict how each patient’s glaucoma will evolve, which complicates decisions about treatment and when/if surgery might be indicated. In December, TGF awarded a $250,000 grant to Dr. Linda M. Zangwill and her team at the University of California, San Diego, to develop an AI algorithm capable of forecasting the progression of a person’s glaucoma. We hope that this research will eventually provide physicians with crucial information and lead to timely, targeted interventions and better outcomes.As her lab works on the project, we have invited Dr. Zangwill to talk to us about the opportunities for providing real-time AI support to clinicians treating glaucoma patients, as well as the challenges in implementing appropriate AI systems in clinical practice. You can read more about Dr. Zangwill and register here to join us live at 5:00 pm (EDT) on June 8th for “Harnessing Articial Intelligence to Improve Glaucoma Management: Challenges & Opportunities.” Earlier this spring, Professor Adriana di Polo at the University of Montreal presented a webinar on the newest discoveries of her study into the critical role that pericytes (the ensheathing cells that wrap around capillary walls) play in vascular dysfunction in glaucoma. She uses excellent visual aids to explain how ‘nanotubes’ that connect pericytes are damaged in glaucoma, leading to neurovascular decits. This study, the researchers say, paves the way for the development of therapeutic approaches to restore neurovascular health in glaucoma. We will continue to follow Dr. Di Polo’s research and encourage you to watch her very interesting talk.

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We are especially grateful to Santen, Inc. - Tara Mathiesen RN, BSN, Associate Director of Patient & Professional Partnerships, and Dr. Najam Sharif, BSc (Jnt Hons), PhD, DSc, FARVO, FBPhS, Vice President for Global Alliances & External Research (GAER) and Global Ophthalmology R&D - for providing funding for these webinars. Santen is a global leader in ophthalmological research and the development, production, and marketing of related pharmaceuticals and medical devices. With Santen’s support, our webinars have been viewed by thousands of people in the U.S. and abroad, strengthening a valuable educational link between TGF and a broad audience of researchers, physicians and patientsWe are also very fortunate to have a partner in AbbVie pharmaceuticals. AbbVie invests billions of dollars in research to discover, develop and deliver new medicines, targeting diseases with signicant unmet need where they can improve the standard of care with innovative new therapies. We thank them and Priscilla Schwab, their Senior Medical Education Manager for Global Grants and Charitable Donations, for making a generous donation to the Foundation in April to assist us in all aspects of our work. As always, we are grateful to you and all of our readers for your abiding interest in The Glaucoma Foundation, and for supporting us in our mission to improve the lives of people with glaucoma.Please stay in touch. info@glaucomafoundation.orgElena Sturman

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Newsletter May 2022Using AI to Disentangle Glaucoma PathogenesisFor glaucoma researchers, clinicians and patients alike, the advancement of articial intelligence (AI) is an exciting aspect of ophthalmology. It’s generally believed there’s a tremendous amount AI can do in the eld of glaucoma. While much of the focus has been on using AI to diagnose the disease, in March Dr. Louis Pasquale presented a TGF Webinar on a dierent aspect -- using AI to understand what’s causing glaucoma in the rst place. Dr. Pasquale is the Shelley and Steven Einhorn Distinguished Professor of Ophthalmology and Site Chair of the Department of Ophthalmology at Mount Sinai Hospital in New York, and Vice Chair of Translational Ophthalmology Research at Mount Sinai Healthcare System.His focus was on primary open angle glaucoma (POAG), the most common form of glaucoma, which aects some 53 million worldwide. As he explained, in POAG, progression of the disease plays out over decades and there is a preclinical asymptomatic phase of the disease. While we don’t know what is going on in that phase, we suspect that there are biochemical changes that trigger the glaucomatous process. But, he stressed, we need to know what’s going on if we are to develop strategies for disease prevention. Figuring out what triggers this process has been at the heart of Dr. Pasquale’s research career. Dr. Pasquale has had access to data at Harvard from a very large cohort of 270,000 nurses and health care professionals who have been followed since 1980, with detailed follow-ups every two years. From 1989 to 1993, 100,000 of them donated blood – DNA and plasma were extracted and frozen waiting for the day when technology would allow researchers to leverage the data to better understand what’s going on in POAG. That time has come, says Pasquale. In 2010 that DNA was contributed to a global eort to resolve the genetic architecture of POAG. Results published in 2021 found over 120 genetic loci that are associated with glaucoma. (That number has since increased.) The name of the game is to learn how these genes are contributing to the pathogenesis of POAG. AI was used to determine dierent patterns of visual eld loss which develop in early onset POAG, nding 14 dierent patterns. Archetype analysis conrmed that in a subset of cases, visual eld damage starts at the center of vision, not as peripheral loss, as was commonly thought. Characteristic of this subset, in addition to the paracentral visual eld loss pattern, is that there is early visual disability and the disease tends to progress more rapidly. Dr. Pasquale also shared information on recent work in the eld of metabolomics – the systemic study of unique chemical proles associated with disease. The hypothesis is that there is a unique chemical prole signature associated with POAG that could be detected even before the disease manifests itself.

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Living with Glaucoma : Meet Joe RosenJoe Rosen, one of TGF’s newest board members, has had a long and successful career in the healthcare eld. Trained as a CPA, he started a business that collected human blood plasma for further manufacturing into albumin, gamma globulin, antihemophilic factor and other products with medical uses. Joe focused on the business side of the company, which grew to become the largest independent collector in the industry – at one point with collection sites in 26 states.Yet he admits he knew very little about glaucoma until it impacted his life personally. That was over 10 years ago, when his wife was diagnosed. Today, while he still works part-time, Joe is a caregiver and major support for his wife and is a supporter of glaucoma research initiatives.It was during a routine eye examination at a local ophthalmologist in New Jersey that Mrs. Rosen learned she had the rst signs of glaucoma and should see a specialist. “When you rst hear the word ‘glaucoma’, and you know nothing about it other than you could go blind, it’s a shock!” Joe recalls. “It was distressing to both of us.“We went to see Dr. Robert Ritch and there was an immediate level of comfort. Whether we believed it or not, he said ‘you will not go blind – I will take care of you.’ Our anxiety level went down – he was someone we trusted.” Over the years, Mrs. Rosen has had laser treatment, surgery, and she is dutiful about her eye drops. “I’ve heard that compliance with taking medications is an ongoing challenge for the profession, but my wife is the most methodical and diligent patient in terms of how she instills her eye drops,” Joe explains. “She’s watched ‘how-to’ videos and in all these years, I can’t remember her ever missing one of her drops – even when we were traveling worldwide. If you asked her about that, her response would be: ‘What do you expect – these are my eyes. I will do whatever I can to follow exactly what the doctor says.’“When it comes to taking visual eld tests, she hates them. The anxiety is immense, as is waiting for the doctor to say ‘there hasn’t been any change.’ I imagine most patients would feel the same way. She participated in several of Dr. Ritch’s research trials, including one that concerned an alternative to the visual eld test.“Since joining the TGF Board I have become more involved as I want to understand what someone with glaucoma goes through. I listen to the Webinars we present. I think they are very good. Even if you don’t grasp all the science being presented, you learn what’s going on --new treatments, research, diagnostics. Education is a great benet to patients – I think that’s so important. “I continue to try to be as supportive and understanding as I can be.” Joe has been on the Boards of several not-for-prot organizations as well as Boards of private and public companies in the healthcare sector. “I was happy to join the Board of the Glaucoma Foundation, an organization that was nancially sound and structured for the benet of the glaucoma patients it serves.”

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Newsletter May 2022Doctor, I have a Question.If I have heart disease or problems with my blood vessels,should I be worried about my risk for glaucoma?Question answered by:Alon Harris, MS, PhD, FARVOProfessor of Ophthalmology, Vice Chair of International Research and Academic Aairs, Director of Ophthalmic Vascular Diagnostic & Research Program at Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York Glaucoma is a common eye disease aecting millions of persons worldwide, and today it is the leading cause of irreversible blindness in African Americans. The risk for glaucoma increases with age, and other factors and medical conditions may further increase the odds for its onset and progression. Intraocular pressure is the only currently approved therapeutic pathway. However, in many patients lowering eye pressure does not prevent the disease or stop its progression, and vascular health has been demonstrated for many years to be a contributory factor in many individuals. Glaucoma is a multi-factorial disease inclusive of intraocular pressure and vascular decits such as poor blood supply to the optic nerve and low blood pressure.The cells within your eye responsible for vision, the retinal ganglion cells, require constant blood ow and nourishment to maintain their health and provide vision. Lower biomarkers of blood ow and metabolism have been identied within eyes of glaucoma patients, either alone or in combination with elevated eye pressure. Specically, vascular deciencies have been identied in the blood vessels supplying the eye and within retinal, choroidal, and optic nerve tissues. However, the extent to which vascular disease may elevate your risk for glaucoma is uncertain and highly individual in nature. The pressure within your eye in combination with your vascular health, unique anatomy, demographics and other conditions such as diabetes will ultimately determine your overall risk for the onset and progression of glaucoma. Importantly, being of African descent signicantly elevates your risk for glaucoma. Persons of African descent experience approximately a threefold increase in glaucoma compared to those of European descent, having both earlier onset and faster disease progression. The mechanisms behind these signicant disparities are not well understood or adequately addressed in current practice, but may be in part due to the signicantly higher levels of systemic vascular disease observed within African

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American communities. Persons of African descent have signicantly higher levels of diabetes, high blood pressure, and heart disease as well as glaucoma. In my laboratories we previously identied lower biomarkers of blood ow and metabolism in the retina and blood vessels supplying the eye in glaucoma patients of African descent, and further identied how these decits were associated with their disease progression. Our recent studies point to an urgent need for larger prospective trials with African descent endpoints as the primary outcomes to conrm these ndings. In summary, cardiovascular disease and blood vessel health have indeed been linked to glaucoma, especially within persons of African descent. However, the extent to which vascular health may inuence your risk for glaucoma or its progression is currently dicult to determine. The vascular imaging equipment required to visualize these tissues are expensive, require specic training, and produce complex data with high individual variability. To overcome these limitations my teams are currently working on using mathematical modeling and articial intelligence applications to enhance the ability to use these vascular data in determining glaucoma risk and designing best approaches for improved patient outcomes.It’s Allergy SeasonSome studies show that pollen seasons are getting longer and more intense across the country. Several over the counter and prescription medications can help with allergy symptoms.We’ve all read labels on over-the-counter cold and allergy medications that say ‘do not take if you have glaucoma.’ It really depends on which type of glaucoma you have. Antihistamines and decongestants generally have no eect on open-angle glaucoma — the most common form of the disease. But people with closed-angle glaucoma, also called narrow-angle glaucoma or angle-closure glaucoma, should avoid or use them with caution. That is because one of the side eects can be the enlargement (dilation) of the pupil which in rare instances can cause an acute glaucoma attack in individuals whose anterior chamber angles are anatomically narrow. It may take some trial and error to nd the best medication regimen. Patients should talk to their doctor about options.And here are two general anti-pollen tips. Pollen tends to be highest between early morning and mid-morning, as well as on hot, dry, windy days. Plan your exercise or errands accordingly. If you are prone to allergy symptoms and have to go out in the morning, or do yardwork – wear a high quality N95 mask which will help lter out pollen.

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Newsletter May 2022Eyecare Tips for Summer Traveling • Start your trip with new rells of your glaucoma medications. Pack a sucient supply of each medication, and talk to your doctor in advance about extra prescriptions, just to be safe. • Make a list of all medications you normally use, noting each prescription dosage, the medication’s trade name as well as the generic name. Generic names are especially important if you are traveling out of the country, where drug makers may use dierent names from those in the US • Pack your medications in their original pharmacy containers rather than in pill cases or other unlabeled bottles.• Never pack medications in checked baggage when ying - they can be lost or stolen. Put them in your carry-on bag and always keep that with you. If you are traveling by car, do not store medications in the trunk.• While the TSA does not require medications to be packed in a one-quart bag or in 3-ounce containers, all meds must still be separated from other items (removed from purse, suitcase, etc.).• Store all medications in a dark, cool area – for example, among or inside clothing.• If you’re crossing time zones, ask your doctor how you should take your medication. Many doctors recommend adapting your schedule to the local time at your destination, and not worrying about a missed dose due to time change. This can simplify your regimen during your stay as well as on your return.• Set an alarm on your cellular phone, watch or travel alarm clock to remind you when to take your daily doses. If you're taking day trips, don't forget to bring your medications with you. Set up reminders, like a sticky note you keep with your wallet. • Traveling on a plane will not aect your eye pressure (IOP) – it is a controlled atmosphere and compensates for changes in altitude. But open medication bottles carefully when you’re rst back on the ground.• The air on airplanes is very dry. If you wear contact lenses, frequently apply rewetting solution.• Be safe rather than sorry. If you wear prescription eyeglasses, take an extra pair with you.Bon Voyage! .

2022 MAY

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