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eye to eyeeye to eye newsApril 2024The Glaucoma Foundation | Page OneMESSAGE FROM THE PRESIDENTDear Friends,TGF commemorates its 40th anniversary this year and is celebrang with a benet gala in New York City honoring two of the Foundaon’s long-serving board members and their spouses. Barry Friedberg & Charloe Moss, and Kenneth & Linda Mortenson will receive TGF’s Kiy Carlisle Hart Award of Merit for Lifeme Achievement. Established in 1998 by the actress and singer, this award is presented to accomplished people with vision loss and the people and organizaons who support them. Producer, actor, writer, comedian and celebrated television host David Leerman will receive TGF’s rst Chairman’s Spotlight Award and will make the gala’s keynote address.Images and video from the evening will be posted on our website at the end of the month.( connued on back page )DOCTOR, I HAVE A QUESTION.As an eye doctor, if you had glaucoma, how would you like to be treated?Queson answered by Dr. Nathan M. Radclie, MD, Aending Physician, New York Eye Surgery Associates, PLLCClinical Asst. Prof. of Ophthalmology, Mt. Sinai School of Medicine.One of the things that comes up between glaucoma experts and paents is a disagreement over eyedrops. I think paents, 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 lile more to it. The stomach exists to absorb things, like ( connued on page 4 )
eye to eye newsLIVING WITH GLAUCOMAMeet Nancy Tilson-Malle, MDAdaptability has been one of life’s lessons for Dr. Nancy Tilson-Malle. At the me of her diagnosis 23 years ago, she was a 46-year-old physician specializing in internal medicine, geriatrics, and hospice and palliave care, a mother, and an arst 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 opc nerves were gone. It was a depressing day in my life.”Dr. Tilson-Malle soon had a trabeculectomy in her le eye while taking a combinaon 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 me navigang. But it took ve years aer my diagnosis before I knew I could do something about it. That was when I went to an occupaonal therapist who taught me all about dim vision and how to cope with it. It totally changed my life. Unfortunately, I hadn’t goen 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 rered as a physician at age 65 was that aer 30 minutes of computer reading my vision would just grey out. And as physicians, we read all the me.“Not driving was the most dicult thing. I can’t drive in the city as my peripheral vision is close to legal blindness. “I think because I’m a visual arst, I use every nerve ber I’ve got. I haven’t seen any studies asking if arsts with visual impairments maintain beer vision than other paents, but my theory is that they do. The Glaucoma Foundation | Page Two
eye to eye newsThe Glaucoma Foundation | Page Threeeye to eye news“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 dierence in colors such as ultramarine blue vs cerulean blue so that he can be more accurate in his descripons to me.“My passions for the love of nature, color and paerns, 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-Malle sll lectures here and there to medical students on keen observaon and seeing. Her Vision Quest presentaon depicts her glaucoma journey. “The technical images of my rena and opc nerve were fascinang to me,” she says. “The artwork is my interpretaon of these diagnosc studies – mostly silk painngs.”Her art is currently in a show tled “A Physician/Arst’s Visual Journey,” in partnership with Envision University in Wichita, Kansas. As the gallery’s website states: “At the heart of this exhibion is her personal encounter with glaucoma. Fascinated by the technical images of her rena and opc nerve, she translates these diagnosc studies into a series of unique and visually stunning interpretaons on canvas.”“I also love doing landscape painng outdoors,” she says, “but I haven’t been able to do that since my mid-ies because the lighng 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 lighng. I’ve learned how to pace myself.“I am so grateful that my husband, who is passionate about historic preservaon and has restored eight houses, is now transforming the old-fashioned ac of a 130-year-old house into my studio space, with windows on all sides”. Learn more about Nancy and her art at hps://www.nancylson-malle.net/
The Glaucoma Foundation | Page Foureye to eye news eye to eye newsHere are some surprising points I’d like to make. The rst is that almost every praccing ophthalmologist would start their own therapy with selecve 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 paent win that argument about how to start their treatment. We’re compassionate, we want the paent to be happy. But paents should know that most doctors wouldn’t choose eyedrops for themselves. I think that’s most important.It’s a fact that most paents who take eyedrops for ten years will have dry eyes. While there are dierent formulaons and several preservave free-opons, most ophthalmologists and optometrists would agree that most drops have some mechanism that causes the eye to get dry when taken for many years. eye to eye newspills, but the eyes aren’t as loving to having chemicals placed in them. And since glaucoma is a chronic disease, and paents may be taking drops a couple of mes a day, their eyes begin to have tolerability problems. Paents can develop dry eye…they can develop red eye. It’s this paern that gradually sneaks up on paents as their eyes become less and less comfortable. Oenmes, the paent asks the doctor “can I take a dierent drop,” and paents and doctors oen fall into a paern of trying to switch drops to nd just the right one. Somemes you get lucky but oen you don’t. And because I think paents are so comfortable with the idea of drops, when doctors bring up the idea of some alternave therapy, paents become uncomfortable. It may sound to them like the doctor is saying your glaucoma is geng worse. But what the doctor is oen just saying is…I’d like to aend to your quality of life, to making your eyes feel, see and look beer using either a laser, a sustained delivery medicaon, or even a procedure. There are safe procedures that now can be done with quick recovery and prey good results.“You’d be surprised at how many eye doctors believe in moving beyond eye drops early.”
eye to eye newsThe Glaucoma Foundation | Page Fiveeye to eye newsMy takeaway to paents 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 conversaon with your doctor about side eects and any problems with compliance and also to listen to the doctor and take their recommendaons. A lot of paents would probably be happier if they fought back the insnct to lean on the drops and moved on to some of these other wonderful and safe therapies we have.In addion to laser, there are now two new implants for sustained delivery of medicaon – Durysta®, which lasts several months, and most recently, the iDose TR, which may last a lile longer. That one has great safety data but most doctors are only just geng started bringing them into their pracce.Micro invasive glaucoma surgery (MIGS) is certainly a fantasc opon when you’re having cataract surgery and is now also available as a stand-alone procedure for glaucoma paents who are having side eects or compliance problems with drops. One stent in parcular, the Hydrus stent, was shown to help people who are having cataract surgery avoid bigger glaucoma surgeries and visual eld loss over me compared to cataract surgery alone.Welcome to the latest edion of touchREVIEWS in Ophthalmology, which includes a range of editorial and review arcles on various insighul topics within the ophthalmology landscape, including macular degeneraon, ocular surface disease and imaging. We are also pleased to introduce the new Editor-in-Chief, Jennifer Loh, MD.
The Glaucoma Foundation | Page Six eye to eye newsMeet a 2024 TGF/RPB Research Fellowunderstanding of this disease and paent outcomes in addion to nding ways to reduce the disparies 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 subopmal resource ulizaon in glaucoma care. If true, this could drive reallocaon of many of those resources towards areas in need. “Currently, my research is focused in a few dierent areas. One project focuses on idenfying genec markers in aqueous uid and blood samples of paents with and without glaucoma. We are also using opcal coherence tomography (OCT) to evaluate the anatomy of paents undergoing selecve laser trabeculoplasty and laser peripheral iridotomy before and aer administraon 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 Over the last few years, The TGF (sponsored by Patricia Hill) /RPB Fellowship has awarded 14 fellowships in glaucoma to younger doctors from under-represented racial and ethnic minories who are pursuing substanve glaucoma research across the country. One of this year’s recipients is Alanna Elise James, MD, at the University of Southern California. Dr. James is a rst-generaon American, the daughter of Jamaican immigrants. As glaucoma is a condion more prevalent in African-American and Caribbean communies, 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 communies in addion to many other paents. “While research in the eld of glaucoma has advanced with technology, there sll remain many quesons surrounding the development and progression of glaucoma,” she says. “In addion, previous studies have noted racial disparies in not only access to care, but the diagnosc tests and intervenons performed. “I am an early-career researcher with a strong interest in advancing our
Would you like to receive newsleers by email? Subscribe on our website: www.glaucomafoundaon.orgCall us (212) 285-0080Or write to us at info@glaucomafoundaon.orgThe Glaucoma Foundation | Page Seven eye to eye newsOver the past two years, MyEyes, LLC has been deeply engaged in understanding the benets and potenal of at-home IOP monitoring. They have been partnering with glaucoma specialists to learn more, as they recognize the transformave potenal of the data this technology provides to paents.My Eyes has provided more than 800 paents with the iCare Home2 tonometer, and TGF has provided support for paents in nancial need whose doctors prescribe its short-term rental. Key use cases for at-home IOP monitoring, backed by recent scienc ndings, and paent reports include:• Catching and identifying max IOPs, often outside the clinic.• Ensuring optimal recovery and understanding IOPs post-op.• Enabling patients to be proactive in their care.• Continual oversight for best outcomes – understanding IOP variability chronically.• Offering exibility for remote care, especially in today’s digital age.Learn about renting the iCareHome2 at MyEyes: https://myeyes.net/ 1-888-959-5563paents without readily available access to care present with advanced disease. I am interested in nding soluons to this issue, likely in the area of more eecve screening tests and programs and improving access to care, especially in low socioeconomic communies with a high prevalence of glaucoma. “I am excited by the idea of either partnering with or developing screening and educaonal programs in high risk-communies. In the future, I envision myself as a leading advocate for eye health and am commied to making a lasng impact by advancing our understanding of disease, improving treatment opons, and ensuring that eye care is accessible to all, regardless of their socioeconomic background.”
eye to eye newsdrug delivery, new lasers, and what is just around the corner. Dr. Berdahl is widely regarded as one of the leading internaonal cataract surgeons. He is one of the very few surgeons in the United States who is also fellowship-trained in cornea, glaucoma, and refracve surgery and he has already performed more than 25,000 eye surgeries around the globe. His published work has primarily focused on the fundamental causes of Glaucoma, Minimally Invasive Glaucoma Surgery, and Asgmasm Management, during and aer cataract surgery. Visit our website under the EVENTS tab to register. On June 8, we will hold our second biennial medical educaon symposium on glaucoma for optometrists and ophthalmologists. The expert speakers will cover a range of topics including diagnosis and monitoring, therapy, and home tonometry. When we held this event in 2022, a majority of parcipants stated that the knowledge they gained would help them to improve their pracce.Thank you for being an Eye-to-Eye reader. Please let us know if there are topics you would like us to address in future issues. Write to us at:info@glaucomafoundaon.orgIn 2021, TGF selected Dr. Linda Zangwill and her team at U.C. San Diego to pursue the development of an algorithm that could be used to predict how a paent’s glaucoma might progress and when surgery could be indictaed.With a two-year grant from the Foundaon, the team has just published their ndings in the journal Bioenginnering. Their summary: Machine learning esmates “achieved high accuracy in predicng surgical intervenons in glaucoma up to 3 years in advance. The model accuracy was consistently high across age and racial subgroups in the test dataset. These results show that [these] approaches can achieve high accuracy in a crical glaucoma predicon task and suggest the potenal for a large impact on paent care.”If you missed our rst webinar of the year, “I’ve Been Diagnosed With Glaucoma-Now What?” I hope you will visit our website and view it. Therapies for glaucoma are safer, more eecve, and more tailored to the paent’s needs than ever before. In our next webinar on April 23, Dr. John Berdahl will discuss updates in surgical technologies, drugs and new MESSAGE FROM THE PRESIDENT (cont.)The Glaucoma Foundation | Page Eight