2024 MAY : simplebooklet.com

Newsletter May, 2024Message from the PresidentDear Friends,It’s ocial! TGF is 40 years old, a milestone we just celebrated with 250 supporters and partners at a Gala on April 18th. It was a wonderful occasion that highlighted how far we’ve come in our understanding about glaucoma and progress made in treating the disease. As you’ll read, David Letterman was on hand to deliver keynote remarks and receive TGF’s rst Chairman’s Spotlight Award.Coming up on June 8th is The Glaucoma Foundation’s biennial CME/CE Symposium presented in conjunction with Evolve Medical to provide accredited continuing education for eye care professionals. Titled “Glaucoma – What I Do,” the symposium presentations by distinguished glaucoma professionals will discuss such topics as diagnosis, therapies, the use of AI, and other hot topics. More information at EVOLVEMED.TGF’s ongoing series of webinars, begun during the Covid years, fulll a valuable educational need and our audiences continue to grow. Most recently Dr. John Berdahl, now a member of our Board of Directors, presented a fascinating talk about how far we’ve come in treating glaucoma, and potential breakthroughs ahead. An esteemed glaucoma surgeon, Dr. Berdahl is also an inventor, and one of the potential new directions in glaucoma care is based on his research work. You can learn more by listening to his talk on YouTube: The Glaucoma Foundation - YouTubeThe next webinar, on May 22, will feature Calvin W. Roberts, MD, a Program Manager at the new federal health agency, ARPA-H, who will discuss their new THEA program. The program aims to bring together the expertise of vision scientists from multiple universities and laboratories to restore vision to those who are blind, by transplanting a donor eye. You’ll want to register for this exciting presentation.REGISTER HERE: Webinar Registration - ZoomAs you can see, we’ve actively embarked on our fth decade. We are so grateful to all our friends, among them readers of our newsletter, who make our work possible. We would not be where we are without your support.With gratitude,Elena Sturman

Page 3

David Letterman Helps Fete TGF’s 40th AnniversaryWriter, performer, and producer David Letterman was front and center at TGF’s Gala on April 18that which 250 supporters and friends gathered to celebrate the Foundation’s 40th anniversary. Mr.Letterman received the Foundation’s inaugural Chairman’s Spotlight Award.Said TGF Chairman Gregory K. Harmon, MD, “This new award puts a spotlight on the transformativeeect individuals can have in their chosen eld and their activism and philanthropy on behalf of others.I can’t think of anyone more deserving than our rst recipient, David Letterman.”Accepting the award, Mr. Letterman presented a special new “Top 10 List” about visits to an eye doctor.“The curing and treating of this disease is truly a gift to me and my family,” noted Mr. Letterman, whosemother had glaucoma.The Glaucoma Foundation was founded in 1984 by Dr. Robert Ritch to identify and support innovativeresearch in glaucoma. “Even then,” says TGF President and CEO Elena Sturman, “it was understoodthat research would hold the key to opening doors that could lead to new treatments and eventually acure for this insidious disease.” Ten years later, TGF’s interdisciplinary Annual International ScienticThink Tank was launched, helping to set the course.Eliminating blindness from glaucoma through vital research, education, and collaboration remainsTGF’s core mission. In recent years TGF has developed new initiatives to educate the public and helpglaucoma patients around the world manage their disease. During Covid, TGF began presenting anongoing series of impactful webinars. “We strive to be a valuable resource and to improve the lives ofpeople with glaucoma worldwide,” says Ms. Sturman.With Board Member Dr. Jai Parekh serving as Master of Ceremonies at the Gala, the Kitty Carlisle HartAward of Merit for Lifetime Achievement at the Gala was presented to two longtime Board Membersand their wives -- Barry S. Friedberg & Charlotte Moss, and Kenneth & Linda Mortenson. Ms. Hart, thestage and screen actress, was a devoted friend of the Foundation for many years.Also featured was a presentation by caregivers Jasmyne and Jermayne Hill, whose infant son Jaxonwas diagnosed with primary congenital glaucoma.The Anniversary Gala raised $560,000 in support of the Foundation’s mission to eradicate blindnesscaused by glaucoma. Proceeds will be applied to its research program.For more images and video clips of the gala, visit TGF on our social media sites:• Instagram• Facebook• LinkedIn

Page 4

Newsletter May, 2024DOCTOR, I HAVE A QUESTION.How prevalent is the use of AI in glaucoma clinical practices today? Question answered byFelipe A. Medeiros, MD, PhD Professor of OphthalmologyVice Chair of ResearchBascom Palmer Eye Institute, FL Although there have been a lot of developments in AI, bringing them to real-world glaucoma clinical settings has actually been quite slow. One reason for the complexity in implementing AI in medical practice is the extensive regulatory framework. For instance, considerable research has focused on enhancing optical coherence tomography (OCT) imaging for glaucoma diagnosis using AI, including work conducted in my lab and others. However, beyond developing these AI models, there are additional steps required for clinical integration. To deploy these models on diagnostic devices, companies must conduct comprehensive clinical trials to meet FDA requirements, ensuring the algorithms are both safe and eective.That’s understandable, as regulatory bodies are fullling their oversight responsibilities. However, to date, only a few ophthalmologic AI applications have received approval, and notably, none of these pertain directly to glaucoma.As we continue to rely on traditional methods such as electronic medical records, standard OCT imaging analyses, and long-established visual eld testing techniques, the transformative potential of AI in clinical practice remains largely untapped. Despite signicant advancements and the promising capabilities of AI, the integration into daily medical practice is progressing slowly due to various constraints.One area where AI is being adopted more rapidly is in quality assessment and improvement. Much like AI enhances photo quality on smartphones, it can also enhance the quality of images and tests in devices used for glaucoma assessment. The regulatory requirements for such supportive applications tend to be less stringent than those for direct diagnostic tools, facilitating faster integration into clinical practice.For example, when you acquire an image of your retina with OCT for the purpose of evaluation for glaucoma, you are interested in looking at specic features, like measuring the thickness of the nerve ber layer. The OCT software must then segment the dierent layers of the retina to obtain such thickness measurements. This can be done much better with AI compared to the older algorithms. There is also a lot of work being done in the area of screening, trying to come up with AI that could be

Page 5

made widely available – for example based on simple photographs of the back of the eye to identify glaucoma. While there are commercially available machines approved by the FDA that can be used for screening of diabetic retinopathy, this has proven harder for glaucoma. One of AI’s strengths lies in its ability to identify patterns, particularly useful in interpreting images and visual eld tests for glaucoma management. Typically, a clinician assesses a patient by measuring intraocular pressure, examining the optic nerve, and reviewing OCT and visual eld test results. Integrating all this data to diagnose glaucoma and determine disease progression can be complex. AI can streamline this process by analyzing the data more objectively, enhancing the precision and eciency of glaucoma diagnosis and monitoring.While there is ongoing progress in developing these decision-support systems, and their promise is undeniable, several challenges still need to be overcome before AI can be fully integrated and adopted into clinical practice. The process is underway, but it will take time. THE CHANGING TOOLKIT FOR TREATING GLAUCOMA In April Dr. John Berdahl presented a fascinating webinar talk that took a look back over 100 years of glaucoma treatments and looked forward to what’s in the pipeline.A leading glaucoma surgeon, Dr Berdahl has broadened his skills as an inventor and problem solver. Among his endeavors, he is the founder of Balance Ophthalmics, a company that is developing the rst non-surgical, non-pharmacologic way to lower eye pressure for glaucoma treatment.Dr. Berdahl began his historical review 100 years ago when there was not much one could do to lower eye pressure other than drilling a hole in the eye. He then surveyed major changes that have broadened the toolbox for treating glaucoma, starting with the introduction of Pilocarpine, representing the rst drug class; moving through the years to the introduction of the trabeculectomy – still the most eective, he says, but also the riskiest treatment; shunts that limited the trab risk factor; new drug classes; combination eye drops; and more recently a new wave of drug delivery systems, including the newest iDose.Regarding procedures, 30 years ago the scope of care was greatly expanded with the availability of Selective Laser Trabeculoplasty, or SLT, a treatment Dr. Berdahl thinks should be a rst-line therapy, and the advent of MIGS, which have really changed things, cutting the use of drops and buying patients several years of lower pressures while avoiding the need for more invasive surgeries. Something new is the Belkin Laser, approved for use a few months ago, which builds on the SLT laser, but is a non-invasive, non-contact procedure performed with automated laser technology.All of these newer tools are more patient-friendly, maybe not more eective, but more convenient for patients, with fewer compromises on how the eye looks, and on the comfort of the eye. Dr. Berdahl has been working on a new class of therapy that is neither a drug nor surgery. It is a new device – goggles to be specic – based on his research ndings that glaucoma may be a two-pressure

Page 6

Newsletter May, 2024disease – not just a disease of eye pressure but of the balance between eye pressure (IOP) and cerebrospinal uid (CSF) pressure. If you have a high IOP but low CSF pressure, that dierence causes the optic nerve to cup and bow backwards. CSF pressure was found lower in patients with glaucoma and even lower in patients with normal-tension glaucoma, explaining why so many people who have normal eye pressures still develop glaucoma, said Dr. Berdahl. The goal of the pressurized goggles, which would be worn primarily at night when eye pressure has the tendency to rise, is to balance IOP with CSF pressure. Dr. Berdahl concluded his talk noting that neuroprotection, such an important category in the circle of care, is where exciting research into protecting the optic nerve from damage is ongoing. LIVING WITH GLAUCOMAMeet Natalie CallenderNatalie Callender, from the Chicago suburbs, works as a special education teacher in a therapeutic day school for students who have emotional and behavioral disorders. Now in her mid-30s, this mother of three young boys just received a Master’s Degree in Dierentiated Instruction – which focuses on various ways of delivering instruction to meet the needs of all students, while utilizing diverse methodologies of teaching.It’s an impressive resume, but her journey from childhood to the present day has been remarkably challenging. “In 1991, when I was four years old, my parents noticed that I was not seeing clearly when watching TV. Sitting two feet away from it could not be normal. They didn’t think too much about it until my aunt told my mom she saw a cloud over my eye. So they made an appointment with my pediatrician, who then referred us to an ophthalmologist at what was previously known as Children’s Memorial Hospital in Chicago.My parents took me to the hospital, where I was seen by the head ophthalmologist. The next thing I knew, I was sitting in the patient chair, when a doctor came in and looked in my eyes- then another. Within minutes I had about six or seven dierent ophthalmologists in the practice examining my eyes.This rst hospital visit was terrifying both for me and my parents. After having my pressure taken, eyes dilated, numbing drops inserted, taking a visual eld test, and photos of my eyes, they realized I had cataracts – not one, not two, but three. That meant multiple surgeries for cataract removal and then extracting the lenses from my eyes (lensectomy) because the cataracts were reoccurring. I also had a trabeculectomy and a vitrectomy to remove vitreous humor from my eyes. Next, I was introduced to one of the biggest nightmares of my life – my glasses. One may recognize them as “coke bottles;” those thick, heavy lenses that make your eyes appear magnied and your frames seem oversized.

Page 7

I was entering second grade at this time and that is when the bullying started. This was very hard on me and my family, especially my mom. So, my father began taking me to my monthly appointments. He has been my rock for all these years in person, while my mom and brother supported me on the sidelines.My diagnosis is aphakic (no lenses) uveitis glaucoma, which involves inammation of the eye. Currently, I have no vision in my right eye and my left eye is anywhere from 20/40 to 20/60 depending on the day. Each morning I wake up and am grateful I can see.Throughout my journey, I’ve learned a lot. I’ve learned that there are limitations – like not being able to get my driver’s license; however, I have a wonderful support system. My school is a wonderful place to work and I love my career. I have great co-workers who support me with my vision and accommodate me every single day. A close friend drives me to and from work. It’s really been a blessing to have them and they appreciate my corny jokes.I have three young, amazing, energetic boys (7 1/2, 6, and 2) who are so understanding of what I’m going through. They’ll say, ‘Mom, there’s a curb,’ and grab hold of my hand. My husband is a saint when it comes to running errands and helping with the kids. My parents now live only 10 minutes away as well as my in-laws, who all play a substantial role in my support system.” Does Natalie have any advice to give others?“The best advice is to continue your treatment regimen and stay consistent even if that means setting reminders for yourself. Remember, that is your lifeline to view the world.See that you are meeting your appointments and getting to them when you are expected. Schedule routine check-ups to ensure your vision is not depleting.I feel it is crucial to prioritize your mental health – developing coping skills can minimize stress. Know that there are resources out there –such as support groups. As a glaucoma patient, I have had feelings of sadness and isolation. It’s empowering to know others are impacted too and thriving. This provides me with a sense of peace and hope as it motivates me to prosper and never give up.”“Entrapment “By Natalie Callender Forced into trickery by age ve. Thanking God I am still alive. The cell walls started closing in years past. How long will this nightmare continue to last? “Wait here.” is mostly what I heard. I refused to be nothing short of undeterred. Those fraudulent acts of the thief of sight be known. I will never settle for comfort alone. In isolation with mind, body and soul. Set me free so I can be whole. Perpetrator of this crime-I am not! I would much rather have a voice in declaring my plot. A victim, a survivor, and an exemplary-a glaucoma patient that is all I will ever be. Oh, so you thought I had nothing left? I will see you in prison you vision theft. A dispute with discord has come arise, I will be the forthcomer of my own eyes. At last, I solemnize this sacred bond, of me, my journey and to never despond.

2024 MAY

Page 1

Page 2

Page 3

Page 4

Page 5

Page 6

Page 7

Page 8