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eye to eye newsNovember, 2022The Glaucoma Foundation | Page OneDear Readers,The fall season is in full swing at the Foundaon. On October 22, we held our rst medical symposium oering connuing educaon credit to ophthalmologists and optometrists across the country. Eighty eye-care professionals joined us at the Harvard Club in New York City for a half day of presentaons by experts from Harvard, Duke, Columbia, UC San Diego, University of Iowa, SUNY, Mount Sinai, and Johns Hopkins. Another 350 aended the symposium on Zoom.Titled The Future is Now: Translang New Informaon into Clinical Pracce, the program explored new and developing science related to glaucoma and its impact on clinical care. The enre symposium can be viewed on YouTube, accessible on our website, and we will be spotlighng some of the talks in our newsleers, beginning in this issue with Dr. Thomas Johnson’s work on renal ganglion cell transplantaon. We would like to thank our partners AbbVie, Santen, Alcon, Glaukos, Heidelberg Engineering, Qlaris Bio, New World Medical, Ora, and Zeiss Meditec for supporng this special project. We have just awarded three new supplemental glaucoma fellowships to doctors from Columbia, Mount Sinai, and the Kresge Eye Instute at Wayne State University. And, this month, our scienc advisory board will be reviewing a record number of research grant applicaons, assessing which projects are ready for funding. In our next newsleer, we will tell you about the fellows, and the science we will be supporng in 2023. During this special season of Thanksgiving, I want you to know how grateful we are for you, our friends and supporters, who care about our mission and make our research and educaonal iniaves possible. The Foundaon and I wish you and your loved ones a happy and healthy holiday season.Please remember us on Giving Tuesday, November 29th. You are vital to our work! With all best wishes,Elena Sturman, President and CEO
The Glaucoma Foundation | Page TwoUnl two years ago, Hillary Golden, a Louisianan living in Denver, didn’t know a lot about eyes, and even less about glaucoma. But what a dierence two years can make! Today, as a 53-year-old with severe glaucoma, her life is steeped in learning as much as she can and spreading the word about glaucoma, specically about normal-tension glaucoma (NTG). “I have been in medical sales my enre career,” Hillary explains – “from selling CT scan equipment to medical soware.” She was training oral surgeons on computer guided surgery in 2020 when elecve surgeries were halted due to the Covid pandemic. She was furloughed for four months. It was during that period at home that she noced a stye on her eyelid and decided to get it checked out. “I had the me, so I agreed to do a more comprehensive eye exam. The assistant dilated my eyes. Then the doctor came in and looked in my eye and says ‘hmmm, I don’t like the look of your nerve.’ At this point, I knew nothing about eyes. They seemed more concerned about the nerve than about my stye. I remember that at about 11:45 she said: ‘I think you might have glaucoma.’ “I came back for a visual eld test and OCT imaging test which conrmed that I had severe glaucoma – they said it was normal-tension glaucoma. A few days later I saw a glaucoma specialist who started me on eye drops. That was the beginning of a whole learning process. I wanted to research the heck out of it – what is normal tension, what does it mean? I thought only old people got glaucoma!” Normal-tension glaucoma is a form of glaucoma in which the opc nerve is damaged even when the pressure does not exceed the normal range. “Because I was miserable on the drops, they said we could try SLT laser surgery, but that did not work. I had lost 40 percent of my visual eld in both eyes at my diagnosis. The loss is in the upper nasal quadrant, so thankfully, I can sll see and can drive. “In 2021 I was traveling again, working for Allergan, selling a medical device for glaucoma. I got more involved with my eyes – I was talking to glaucoma doctors all day for work. This past February I changed jobs moving to Sight Sciences –working with the Omni MIGS surgical Living With Glaucomaeye to eye news
The Glaucoma Foundation | Page Threesystem for glaucoma. The reason I love my job is because I want to help other people through the doctors I call on every day. I also want people to know that normal-tension glaucoma (NTG) is dierent.I personally mentor a couple of glaucoma paents and I am in several glaucoma support groups where I answer quesons the best I can and give support to whoever needs it. In the U.S. normal-tension glaucoma accounts for about 30 percent of all glaucoma cases. “I’ve done a lot of research on my own. There’s a prominent doctor in Switzerland who has done research on the role of vascular dysregulaon in NTG and he’s been helping me. I also have a doctor in Denver and one in South Dakota. I’ve tried to seek out the gurus of normal tension…I have to try everything.“I have a home tonometer – I think this is going to be the norm – measuring IOP three or four mes a year in the doctor’s oce just isn’t oen enough. It’s super important for my pressures to be super low – they need to be 9 or 10. I have a tech background. But not everyone is tech savvy – more doctors need to have a technician to help paents set up their tonometers.“I’ve also become a cered health coach. I know it’s going to help that I eat well and take care of myself in other ways, but it’s frustrang. I’ve lost so much vision and I sit in the waing room with all these other paents who are 20 years older than me, and my eyes are worse than theirs. It’s stressful thinking about what my eyes will look like in 20 years. Losing vision is a scary thing -- I’m doing everything I can to preserve what I have le.”thank you for your supportYour donation matters.Since it’s founding in 1984, The Glaucoma Foundation has never wavered from its principle mission: to fund cutting edge glaucoma research and to educate the public about glaucoma, its diagnosis, and its treatment. e support of individuals like you has provided us with the resources to deliver on this mission. Please give online or with the enclosed envelope.eye to eye news
The Glaucoma Foundation | Page Foureye to eye news Did you know that people with obstrucve sleep apnea syndrome (OSAS) are more likely to develop glaucoma than those who do not have this sleep disorder? According to some studies, people suering from OSAS, which is characterized by episodes of paused and shallow breathing during sleep, are up to ten mes more likely to develop glaucoma.While intraocular pressure (IOP) can rise during nighme, this does not appear to be the primary link between sleep apnea and glaucoma as glaucoma progression occurs in some paents despite very low IOP. Worsening of the opc nerve in conjuncon with low IOP may indicate normal-tension glaucoma (NTG), also known as low-tension glaucoma, and may also signal the presence of underlying sleep apnea. Recent studies suggest that certain types of glaucoma may result from insucient blood supply to the opc nerve. These studies show that there is decreased ocular blood ow in sleep apnea, and that normal-tension glaucoma is more prevalent in paents with sleep apnea. NTG is characterized by progressive opc nerve damage and visual eld loss with IOP levels that are usually considered to be within the normal range. Because sleep apnea can cause worsening of glaucoma, it is parcularly important to recognize its presence and to treat it appropriately. Another sleep-related queson is whether sleep posion is related to glaucoma progression. Research shows that IOP is higher when sleeping in the supine posion (lying face up, horizontally) than other sleep posions, leading to recommendaons that sleeping with the head elevated 20 to 30 degrees may lessen the eect of the supine posion. Some studies indicate that sleeping on the same side of the body as the eye with the greater visual eld loss could also be a factor that contributes to glaucoma progression. Glaucoma and Sleepeye to eye newsEndace is supporng us again, this year through their Circumnavigate the Endace World Challenge! With this challenge, any acvity (walking the dog, swimming, hiking, riding a bike, etc.) will help support glaucoma research. Right now, the Endace team is halfway towards their goal of accumulang 5,469 miles by Dec 2nd. The company will donate $1 to TGF for every mile they earn. Thank you to Endace and the parcipants! Keep up the hard work! If you would like to start your own fundraiser to support TGF, visit our website for more info.supports TGF
The Glaucoma Foundation | Page FiveDOCTOR, I HAVE A QUESTIONThomas V. Johnson, III, MD, PhD, Shelley & Allan Holt Rising Professor, Wilmer Eye Instute, Johns Hopkins Medicine When might opc nerve regeneraon and vision restoraon be a reality for glaucoma paents? Over the past 10 years we have been working hard on the long road to nd cures for glaucoma paents who have already sustained severe and permanent damage to their opc nerve. Our desire is to go beyond what we can do now – which is to preserve vision and prevent future blindness – and to actually restore vision to people who have already lost it. Unfortunately, glaucoma is oen diagnosed late aer vision loss has already begun, and at this me glaucoma vision loss is irreversible. We can do many things to lower eye pressure and for most people this can prevent vision loss from geng worse. Relavely soon we’ll have neuroprotecve therapies that will give us a second method to protect vision but won’t necessarily restore vision. Vision loss in glaucoma is caused by the death of renal ganglion cells (RGCs). RGCs are complex types of nerve cells that play a crucial role in vision. RGCs receive and process visual informaon that begins as light entering the eye and is detected by rods and cones, and then transmit that informaon to the brain via their axons, which are long bers that make up the opc nerve. So, in order to restore vision lost in glaucoma we actually have to replace the renal ganglion cells throughout the enrety of their visual pathway. That’s an incredibly tall order– the Naonal Eye Instute has designated it as an “audacious goal.” First, we need to create RGCs from scratch. Recent scienc advances have enabled RGC producon from human stem cell sources. But once we have created them in a dish, we have to gure out how to transplant them into the eye in a way that allows them not only to survive, but to migrate into the correct part of the rena where they can receive accurate visual informaon about the world around us. And then they need to send an axon that goes all the way to the opc nerve head through the opc nerve and then to one of several centers of the brain that are meant to receive visual input. Once there, they have to create synapses so they are able to deliver rapid signals. Thirty years ago, science would have looked at this list of obstacles and said this is completely impossible, it’s science con. But enough work has been done in the past 10 years that this is connued on next pageeye to eye news
The Glaucoma Foundation | Page SixOPTIC NERVE REGENERATION (CONT.)now sciencally possible. Regarding the major challenge of axon regeneraon, quite a bit of work has actually been done and a number of molecular pathways have been idened that allow surviving RGCs not only to generate RGC axons but to grow axons that in some cases go all the way back to the brain – and actually arrive at structures in the brain that are meant to receive axonal input from RGCs. But relavely less work has been done on the feasibility of connecng the RGCs to the rena to tell us if that is feasible. We know we can coax them to structurally integrate if we disrupt the internal liming membrane (ILM) which is a major barrier. But we sll have a long way to go – funconal integraon is something that we are currently assessing. And neuroprotecon is going to be really important – the survival rate of RGCs following transplantaon needs to be improved. Knowing that there are a huge number of obstacles that sll have to be overcome, we’ve organized a new consorum of more than 200 sciensts worldwide to gure out how to actually put all the pieces of the puzzle together.The goals of the Renal ganglion cell (RGC) Repopulaon, Stem cell Transplantaon, and Opc nerve Regeneraon (RReSTORe) Consorum are to priorize the most crical challenges and quesons related to RGC regeneraon over the next ve years, and to brainstorm approaches to meeng these challenges while fostering opportunies for collaborave scienc invesgaon. What do I tell my paents today? On the one hand, it is dicult to predict the future of opc nerve regeneraon because there are quite a few quesons that we don’t even know how to ask yet; we haven’t goen the experimental systems far enough along to know all of the hurdles that lie ahead. On the other hand, as a clinician/scienst, it is incredibly meaningful that, especially for my younger paents – children and younger adults – I have something that can bring these paents hope. I condently think we’ll at least be doing clinical trials in those people’s lifeme. But one has to be realisc. I am not sure it’s likely to happen in less than 6 to 10 years.eye to eye news
The Glaucoma Foundation | Page SevenNew webinar on TGF’s website: glaucomafoundation.orgHas your eye doctor menoned that you or a loved one has reached their opmal eye glass prescripon? Learn about spectacle- mounted telescopes, nted lenses, and prismac side-vision awareness glasses to help improve limited peripheral eld defects.Hands free magnicaon for low visionTGF Research Grants 2022Guan Xu, PhD, University of MichiganA great number of paents with glaucoma, especially those with exfoliaon glaucoma that progresses fast, require surgical intervenon to avoid blindness. However, the lack of knowledge of how aqueous drainage paths behave when pressure in the eye uctuates is a crical barrier to the accurate predicon of surgical outcomes. The goal of this project is to use an advanced imaging technology, combined with an established mechanical analysis method, to provide us with the knowledge needed for selecng appropriate surgical procedures for desirable outcomes.Dr. Adriana Di Polo, University of Montreal RENEWED GRANTIn 2021, with the support of the Kumar Mahadeva Research Grant, Adriana Di Polo, PhD demonstrated that pericytes (the ensheathing cells that wrap around capillary walls) are key contributors to blood ow decits and neurovascular dysfuncon in glaucoma. She showed that dysregulated calcium inux into pericytes is a major cause of pericyte contracon, capillary constricon, impaired blood ow, and renal ganglion cell loss. A priority in year 2 will be to idenfy the mechanisms leading to massive calcium entry into pericytes, as well as strategies that prevent this detrimental response.eye to eye news
eye to eye newsThis issue is made possible with support from Delta Gamma Foundation - Service for Sight.Black Patients Six Times More Likely to Have Advanced Vision Loss After Glaucoma Diagnosis Than White PatientsA new study from the New York Eye and Ear Inrmary of Mount Sinai shows that Black paents have a dramacally higher risk of advanced vision loss following a new diagnosis of primary open-angle glaucoma when compared to White paents. Louis R. Pasquale, MD, FARVO, senior author of the study, is deputy chairman for Ophthalmology Research at the Icahn School of Medicine at Mount Sinai and director of the NYEE Eye and Vision Research Instute. He co-chairs TGF’s Scienc Advisory Board. “This study has tremendous implicaons for glaucoma screening of Blacks, who we already knew were a populaon at increased risk of glaucoma,” Pasquale says. “Screening earlier in life could signicantly increase the chance of detecng glaucoma and slowing down progression before it reaches one of the advanced paerns shown in our research.”Within the study group of over 200,000 parcipants, 1,946 paents developed glaucoma. Researchers analyzed their earliest record of visual eld loss using archetype analysis, a form of arcial intelligence. The algorithm idened 14 archetypes: four represenng advanced loss paerns, nine of early loss, and one of no visual eld loss.Black paents made up 1.3 percent of the study but had a nearly twofold increased risk of early visual eld loss archetypes, and a sixfold higher risk for advanced eld loss archetypes, when compared to white paents. “African descent is a risk factor for glaucoma blindness, and this work provides insight into why that might be the case,” Pasquale said. “We suspect that the reason why Blacks presented with more advanced paerns of loss compared to whites is that the disease starts one to two decades earlier in the former group compared to the laer group. This emphasizes the importance of early screening strategies in Blacks to idenfy early-onset glaucoma so that visual disability in this populaon is averted.”