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Message MARCH 2024 NEWSLETTERDoctor, I Have A Question with Dr. Nathan RadclieProle of Patient Nancy Tilson-Mallett, MD Dr. Alanna James, TGF-RPB Glaucoma Fellow

Newsletter March, 2024Message From The PresidentDear Readers,2024 marks the 40th anniversary of the founding of The Glaucoma Foundation. What important strides have been made over these decades! Through research, we have improved our understanding of the disease and worked toward achieving the cessation of blindness from glaucoma. We are proud that TGF has played an important role in the advances that have taken place.We are excited to celebrate this milestone at a Gala in New York City on April 18th. And we are thrilled that comedian, talk show host, and producer David Letterman will be on hand to celebrate with us as he accepts TGF’s rst Chairman’s Spotlight Award. We can’t wait!Our next webinar reects the reality that therapies for glaucoma are safer, more eective, and more tailored to the patient’s needs than ever before. On April 23, Dr. John Berdahl will discuss updates in surgical technologies, drugs and new drug delivery, new lasers, and what is just around the corner. Dr. Berdahl is widely regarded as one of the leading cataract surgeons in the US, and one of the few surgeons who is fellowship-trained in cornea, glaucoma, and refractive surgery. He has been involved in numerous FDA-monitored clinical trials on some of the most exciting technologies in ophthalmology. With other exciting projects in the TGF pipeline, we are embarking on the next decade with great enthusiasm and optimism. None of this would have been possible without the support of our friends. We thank you for being a reader of the newsletter and for all you do for TGF. With your ongoing generosity, we look forward to what lies ahead.With all best wishes for a happy and healthy year to come, Elena Sturman

DOCTOR, I HAVE A QUESTIONAs an eye doctor, if you had glaucoma, how would you like to be treated? Question answered by Dr. Nathan M. Radclie, MDAttending Physician, New York Eye Surgery Associates, PLLCClinical Assistant Professor of Ophthalmology, Mt. Sinai School of Medicine One of the things that comes up between glaucoma experts and patients is a disagreement over eyedrops. I think patients, generally, are very comfortable with taking drops for glaucoma, and for the most part with the idea of medical therapy. In many ways that is what eyedrop therapy is.But, there’s a little more to it. The stomach exists to absorb things, like pills, but the eyes aren’t as loving to having chemicals placed in them. And since glaucoma is a chronic disease, and patients may be taking drops a couple of times a day, their eyes begin to have tolerability problems. Patients can develop dry eye…they can develop red eye. It’s this pattern that gradually sneaks up on patients as their eyes become less and less comfortable.Oftentimes, the patient asks the doctor “can I take a dierent drop,” and patients and doctors often fall into a pattern of trying to switch drops to nd just the right one. Sometimes you get lucky but often you don’t. And because I think patients are so comfortable with the idea of drops, when doctors bring up the idea of some alternative therapy, patients become uncomfortable. It may sound to them like the doctor is saying your glaucoma is getting worse. But what the doctor is often just saying is…I’d like to attend to your quality of life, to making your eyes feel, see and look better using either a laser, a sustained delivery medication, or even a procedure. There are safe procedures that now can be done with quick recovery and pretty good results.Here are some surprising points I’d like to make. The rst is that almost every practicing ophthalmologist would start their own therapy with selective laser trabeculoplasty (SLT). This was really proven to be a winner in the Laser in Glaucoma and Ocular Hypertension (LIGHT) Study, which found that SLT helped keep the visual eld loss from progressing and reduced the need for incisional surgery down the road. Nonetheless, while a lot of doctors would choose that for themselves, they let the patient win that argument about how to start their treatment. We’re compassionate, we want the patient to be happy. But patients should know that most doctors wouldn’t choose eyedrops for themselves. I think that’s most important.It’s a fact that most patients who take eyedrops for ten years will have dry eyes. While there are dierent formulations and several preservative-free options, most ophthalmologists and optometrists would agree that most drops have some mechanism that causes the eye to get dry when taken for many years. In addition to laser, there are now two new implants for sustained delivery of medication – Durysta®, which lasts several months, and most recently, the iDose TR, which may last a little longer. That one

Newsletter March, 2024has great safety data but most doctors are only just getting started bringing them into their practice.Micro invasive glaucoma surgery (MIGS) is certainly a fantastic option when you’re having cataract surgery and is now also available as a stand-alone procedure for glaucoma patients who are having side eects or compliance problems with drops.One stent in particular, the Hydrus stent, was shown to help people who are having cataract surgery avoid bigger glaucoma surgeries and visual eld loss over time compared to cataract surgery alone. My takeaway to patients is that it can be normal to feel that eyedrops could be the mainstay of glaucoma therapy, but if we really look at what the literature is telling us, and if you would ask most eye doctors what they would want for their own eyes, you’d be surprised at how many eye doctors believe in moving beyond eye drops early.It’s important to have a conversation with your doctor about side eects and any problems with compliance and also to listen to the doctor and take their recommendations. A lot of patients would probably be happier if they fought back the instinct to lean on the drops and moved on to some of these other wonderful and safe therapies we have.LIVING WITH GLAUCOMAMeet Nancy Tilson-Mallett, MDAdaptability has been one of life’s lessons for Dr. Nancy Tilson-Mallett. At the time of her diagnosis 23 years ago, she was a 46-year-old physician specializing in internal medicine, geriatrics, and hospice and palliative care, a mother, and an artist in Kansas City, Missouri.“I was bumping into things; in my car, I had some side-swiping experiences while driving. The day I was diagnosed I learned that 80 percent of my optic nerves were gone. It was a depressing day in my life.”Dr. Tilson-Mallett soon had a trabeculectomy in her left eye while taking a combination of eye drops in her right eye. A few years later she had a trab in the right eye as well. Her glaucoma has now been stable for several years.“I knew I had lost a lot of vision and I was having a hard time navigating. But it took ve years after my diagnosis before I knew I could do something about it. That was when I went to an occupational therapist who taught me all about dim vision and how to cope with it. It totally changed my life. Unfortunately, I hadn’t gotten that help earlier.“There are things I can no longer do, but I have adapted. I loved sports but can’t see small balls to play with my three grandsons. So now we play soccer and frisbee.

“I was an avid reader. One of the reasons I retired as a physician at age 65 was that after 30 minutes of computer reading my vision would just grey out. And as physicians, we read all the time.“Not driving was the most dicult thing. I can’t drive in the city as my peripheral vision is close to legal blindness. “I think because I’m a visual artist, I use every nerve ber I’ve got. I haven’t seen any studies asking if artists with visual impairments maintain better vision than other patients, but my theory is that they do.“Once I learned that I had glaucoma, I really concentrated on color and objects, and memorizing what I see because I know I might lose it. I try to memorize my rst impression so that’s what I remember without the dimness. And I’m teaching my husband the dierence in colors such as ultramarine blue vs cerulean blue so that he can be more accurate in his descriptions to me. “My passions for the love of nature, color and patterns, biology, and medicine are expressed in my artwork. Even in medical school, I saw the beauty in microscopic images. I’m fascinated with science and art and medical imagery.”Dr. Tilson-Mallett still lectures here and there to medical students on keen observation and seeing. Her Vision Quest presentation depicts her glaucoma journey. “The technical images of my retina and optic nerve were fascinating to me,” she says. “The artwork is my interpretation of these diagnostic studies – mostly silk paintings.”Her art is currently in a show titled “A Physician/Artist’s Visual Journey,” in partnership with Envision University in Wichita, Kansas.As the gallery’s website states: “At the heart of this exhibition is her personal encounter with glaucoma. Fascinated by the technical images of her retina and optic nerve, she translates these diagnostic studies into a series of unique and visually stunning interpretations on canvas.”“I also love doing landscape painting outdoors,” she says, “but I haven’t been able to do that since my mid-fties because the lighting has to be absolutely perfect in terms of brightness. Instead, I’ve learned to do a quick sketch, do a color scheme, and take it back to my studio where there’s perfect lighting. I’ve learned how to pace myself.“I am so grateful that my husband, who is passionate about historic preservation and has restored eight houses, is now transforming the old-fashioned attic of a 130-year-old house into my studio space, with windows on all sides”.

Newsletter March, 2024Meet a 2024 TGF/RPB Research FellowAlanna Elise James, MDOver the last few years, The Glaucoma Foundation (sponsored by Patricia Hill) with Research to Prevent Blindness (RPB) has awarded 14 fellowships in glaucoma to younger doctors from under-represented racial and ethnic minorities who are pursuing substantive glaucoma research across the country. One of them is Alanna Elise James, MD, at the University of Southern California.Dr. James is a rst-generation American, the daughter of Jamaican immigrants. As glaucoma is a condition more prevalent in African-American and Caribbean communities, she felt a strong pull towards the end of her ophthalmology residency to dedicate herself to learning the skills necessary to help more people in these communities in addition to many other patients.“While research in the eld of glaucoma has advanced with technology, there still remain many questions surrounding the development and progression of glaucoma,” she says. “In addition, previous studies have noted racial disparities in not only access to care, but the diagnostic tests and interventions performed.“I am an early-career researcher with a strong interest in advancing our understanding of this disease and patient outcomes in addition to nding ways to reduce the disparities in care. We hope to use this grant to assist in the study of conversion of glaucoma suspects to manifest glaucoma, which we believe will indicate suboptimal resource utilization in glaucoma care. If true, this could drive reallocation of many of those resources towards areas in need. “Currently, my research is focused in a few dierent areas. One project focuses on identifying genetic markers in aqueous uid and blood samples of patients with and without glaucoma. We are also using optical coherence tomography (OCT) to evaluate the anatomy of patients undergoing selective laser trabeculoplasty and laser peripheral iridotomy before and after administration of either 1% or 2% pilocarpine.“Beyond my research, I am dedicated to addressing community and global needs related to eye health. I have a strong interest in global health. While this remains one of my interests, I also recognize the great need for excellent glaucoma care here in our own backyard.“Due to the nature of glaucoma, many patients without readily available access to care present with advanced disease. I am interested in nding solutions to this issue, likely in the area of more eective screening tests and programs and improving access to care, especially in low socioeconomic communities with a high prevalence of glaucoma.“I am excited by the idea of either partnering with or developing screening and educational programs

in high- risk communities. In the future, I envision myself as a leading advocate for eye health and am committed to making a lasting impact by advancing our understanding of disease, improving treatment options, and ensuring that eye care is accessible to all, regardless of their socioeconomic background.” TGF Webinar Program In January, TGF launched a new year of educational programs with an insightful webinar titled I’ve Been Diagnosed with Glaucoma. Now What? This presentation was given by Dr. Constance Okeke, MD, MSCE, prominent cataract surgeon and a pioneer in micro-invasive glaucoma surgery (MIGS). Her talk was tailored to guide individuals navigating a glaucoma diagnosis, oering a comprehensive discussion on pivotal topics. Regarding essential questions to ask your doctor when diagnosed, she suggests: • What kind of glaucoma do I have?• What is my target eye pressure?• What are my treatment options?• How often will I need follow-up?• Are there activities I should avoid?In her empowering session, patients will learn about what makes a successful doctor/patient collaboration, discover impactful lifestyle adjustments, and explore the critical need for emotional and psychological support. See the webinar on our YouTube Channel: https://www.youtube.com/watch?v=sf-fB1ESNHI&t=3s

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