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eye to eye newseye to eye March 2023The Glaucoma Foundation | Page Onecon nued on back pageMESSAGE FROM THE PRESIDENTDear Readers,On January 19, in conjunc on with the STEM ins tute at The City College of New York, we launched a new program to reach middle and high school students from communi es in northern Harlem, Washington Heights, and Inwood, where there is a high percentage of people of African American and Hispanic heritage at an increased risk for glaucoma. START WITH THE YOUNG: A GLAUCOMA EDUCATION PILOT PROGRAM was presented on Zoom by Dr. Jose Quiroz. While only 58 percent of the students passed a simple quiz about vision and glaucoma at the outset of the class, we are gra  ed that, one hour later, 81 percent passed the same test. The knowledge they’ve gained about the human eye and the risks of glaucoma is something they can now share with their parents.In addi on to this special program, we con nue to present regular webinars on living with glaucoma, research breakthroughs, diagnos c and treatment op ons, and more. In February, we learned about Flammer Syndrome from Swiss ophthalmologist Dr. NEW WEBINARS

The Glaucoma Foundation | Page TwoAmy Dixon is a visually impaired professional triathlete (swimming, cycling and running). Among her lengthy list of accolades, she’s a 4- me cycling and triathlon na onal champion, and was a member of the Tokyo 2020 US Paralympic Team. Amy began losing her eyesight in college some 25 years ago to a rare form of uvei s, an autoimmune disease, which led to devasta ng forms of glaucoma. She has two percent of her eyesight remaining in one eye only.As if her athle c accomplishments were not enough, in recent years Amy has taken on another voca on with passion – as a pa ent advocate. During the year the Paralympic Games were delayed due to Covid, Amy was extremely ill. Her autoimmune disease came out of remission once again, leading to surgery which ul mately led to embolisms in both lungs. Amy is President of Glaucoma Eyes Interna onal, which includes the online support group Glaucoma Eyes. “Giving back to those who have helped me through 39 surgeries in the last 10 years and to the visually impaired community is hugely important to me,” she says. “We serve about 30,000 pa ents worldwide, not only through the support group. We have a team that addresses individual requests – helping pa ents gain access to physicians, lower cost surgeries and free or lower cost medica ons from our pharmaceu cal partners.” She is also the founder of Camp No Sights No Limits in San Diego, her home base. “It’s the  rst-ever camp dedicated to producing elite-level blind triathletes,” she explains. “In my training journey, I discovered there was no coaching that was speci c to blind athletes who are capable of world class compe  on but needed guides, tandem bikes, skills and resources to get to the top. I wanted to reduce eye to eye newsLIVING WITH GLAUCOMAMeet Amy Dixon PLY

The Glaucoma Foundation | Page Threeeye to eye newsthese barriers and educate new athletes. We’ve had 46 graduates – two campers actually went on to go to the Paralympic Games in Tokyo – a huge accomplishment! Camps are planned for San Diego and in Tennessee this year, along with local clinics throughout the country. “One of the things I’ve found is that there is a great communicaons gap between the paent and the doctors. They might give you general contact info for low vision resources, but there are beer resources out there with all the new adapve technology that can help people to connue working and being contribung members of society. I got frustrated that people didn’t know about the dierent phone apps for blind or visually impaired users and other more costly high-tech aids. So, I talk to doctors and their sta about having these conversaons with their paents. I want to make all that more accessible BEFORE people become low vision and need it desperately.“I work with dierent medical tech and biotech companies advocang for coverage by Medicare and other insurance companies so these advances become more aordable for people with low vision. I also work with the sales force at various pharmaceucal companies, like Allergan and Bausch and Lomb, to teach them how their products are changing lives, to humanize their experiences. I have the pleasure to work with corporaons thank you for your supportYour donaon maers.Since it’s founding in 1984, The Glaucoma Foundation has never wavered from its principle goals to fund cutting edge glaucoma research and to educate the public about glaucoma. Your contribuons provide us with the resources to deliver on our mission. Thank you for giving.to maximize disability inclusion and mental health support in the workplace.“My goal is to make sure that when paents leave their doctor’s oce, they feel empowered; understanding the seriousness of their disease but having all the tools and resources on hand to connue working to manage their disease nancially and medically. I want people to feel seen, heard and important.”

The Glaucoma Foundation | Page FourResearcheye to eye news eye to eye newsRachel Shujuan Chong, MBBS, MMed(Ophth), PhD, at the Singapore Eye Research Ins tute is inves ga ng how myopia, an important glaucoma risk factor, can alter blood vessel structure and func on around the op c nerve.Chiea Chuen Khor, MB, BS, DPhil at the Singapore Eye Research Ins tute will con nue his search to uncover gene c markers that may be useful for iden fying individuals at high risk of exfolia on syndrome related blindness.Raquel L. Lieberman, PhD, at Georgia Ins tute of Technology, is looking for new insights into how LOXL1 contributes to XFS/XFG, as well as new direc ons for therapeu cs.Dieter P. Reinhardt, PhD, at McGill University is the recipient of the 2022 Harriet and Stanley Sloane Grant for Exfolia on Glaucoma Research to analyze the consequences of speci c LOXL1 variants with either protec ve or risk pro les on the func on and development of elas c  bers. In 2022, TGF awarded seven new grants to researchers from labs at Washington University, the University of Pi sburgh, Johns Hopkins University, Singapore Eye Research Ins tute, Georgia Ins tute of Technology, and McGill University. Steven Bassne , PhD, at Washington University’s School of Medicine, is examining whether the levels of a protein called LEFTY2 can be used to diagnose the condi on or predict which pa ents are likely to be a ected most severely. Xi z Chamling, PhD, at Johns Hopkins University School of Medicine, has received the Joe and Marilyn Rosen Grant Award to examine how reac ve astrocytes cause RGC death and hopes to iden fy targets for developing drugs to protect RGCs. Kun-Che Chang, PhD, at the University of Pi sburgh, is working to iden fy a novel therapeu c gene and will apply it to a glaucomatous animal model, providing a deeper understanding of the molecular mechanism of this gene in neuroregenera on therapy.

The Glaucoma Foundation | Page Fiveeye to eye newsThe TGF (sponsored by Patricia Hill) / RPB Fellowships in Glaucoma provide one-year, $10,000 supplemental fellowships targeted to under-represented racial and ethnic minories who are fellows in departments of ophthalmology engaged in substanve glaucoma research. Three new awardees were selected in December.Clara Maria Colon Garcia-Moliner, MDKresge Eye Instute, Wayne State UniversityDuring her residency, Dr. Colon Garcia-Moliner invesgated surgical outcomes of her Instute’s minimally invasive glaucoma surgeries (MIGS), specically looking into the Xen gel stent. In her community at Kresge Eye instute, they found that the success rate for xen gel stents in a predominantly African-American populaon was less than 50%. With the aid of this grant, she aims to further evaluate the mechanism of failure in this type of stent. William Plum, MDColumbia University Aer Dr. Plum’s family emigrated to the US from Brazil when he was nine, his family’s healthcare, of necessity, took place enrely in the community screening and free clinic seng. These experiences movated him to invesgate the eecveness of community-based intervenons, with the aim of improving the detecon and management of glaucoma and other eye diseases in vulnerable populaons. Funding from the Glaucoma Foundaon will allow him to study a queson-based risk assessment at primary care oces as a form of screening for the detecon of glaucoma in the community. The study analysis will be performed at the Mailman School of Public Health at Columbia University. Jose Quiroz, MD, PhDIcahn School of Medicine at Mount SinaiA rst generaon Mexican American, Jose Quiroz received both his MD and PhD in biomedical sciences this year. The focus of his thesis work was developing a viable human anbody treatment for Chikungunya Virus that was derived from human convalescent paents in the Bronx Dominican communies. He aims to use these techniques to beer understand the immune response that leads to uveic glaucoma, specically to demonstrate a proof-of-concept approach to developing a targeted anbody for uveic glaucoma pathologies. If successful, this research would impact sectors of the community which are underrepresented populaons.Fellowships

The Glaucoma Foundation | Page Six eye to eye newsWhat is the Relationship Between Cataracts, Glaucoma and MIGS?Gregory K. Harmon, MDChairman, e Glaucoma FoundationAssociate Professor of Ophthalmology, Weill Medical College of Cornell University/New York Presbyterian HospitalA cataract is a clouding of the eye’s natural lens, allowing less light to pass through and blurring vision. Cataracts aect over 20 million Americans over the age of 40. By age 80, half of all Americans have cataracts. For many, they are an unavoidable part of aging.It is very common for glaucoma and cataracts to coexist. In both condions, the risk increases with age. In addion, there is a risk of developing cataracts or having them progress aer any invasive glaucoma surgery (such as the ltraon surgery known as trabeculectomy). And cataracts, when advanced can trigger angle closure glaucoma in suscepble individuals. But while vision loss from glaucoma is sll irreversible, loss of vision due to cataracts can usually be reversed by surgically removing the cloudy, cataract lens and implanng a clear arcial replacement intraocular lens.When a cataract causes reduced or poor vision, with blur, glare or dimming of sight that interferes with everyday life’s acvies, it is usually me for surgical intervenon. Today, surgeons view cataract surgery as an ideal opportunity to bring a paent’s glaucoma under beer control. They do this by combining cataract surgery with a minimally invasive glaucoma surgery (MIGS) procedure. The FDA’s recent approval of several new MIGS procedures is increasing doctors’ opons. The greatest advantage to the concomitant use of a MIGS procedure with cataract surgery is the signicant reducon of surgical and postoperave risks and complicaons, as compared to tradional glaucoma ltraon surgery (trabeculectomy). By combining cataract surgery with MIGS, it is esmated that 75% of paents will have a signicant lowering of IOP. This reducon is pressure may allow for a reducon in the number of glaucoma medicaons required to control IOP. In the best scenario, glaucoma medicaons could be eliminated, but that depends on the severity of the glaucoma and the number of medicaons being used prior to surgery.Cataract surgery with MIGS is parcularly important in paents with mild to moderate glaucoma. Paents with advanced and severe glaucoma may sll require tradional ltraon surgery or tube shunt surgery because IOP levels typically need to be much lower in these paents. Most importantly, clinical research has shown that by performing a MIGS procedure at the same me as removing the cataract, the surgeon can usually bring the paent’s mild to moderate

The Glaucoma Foundation | Page Sevenglaucoma under beer control, lower the IOP and/or reduce the medicaons required to control the IOP.The advent of MIGS has reduced the necessity of combining cataract and trabeculectomy surgeries, thereby reducing the associated risk of vision threatening complicaons – especially infecons that can occur long aer the trabeculectomy has been performed. Although trabeculectomy surgery is performed far less oen than a decade ago, it can be well suited for paents with glaucoma that is severe and advanced with poor IOP control despite maximal tolerated medicaons or laser treatments. These paents typically need much lower IOP levels which are oen best provided by performing the more tradional glaucoma surgery, trabeculectomy or tube shunt procedures.Special situaons can impact cataract surgery. Paents with exfoliaon syndrome or exfoliaon glaucoma oen have cataracts. It is best to perform the removal of these cataracts earlier rather than later to minimize risk of complicaons. In paents with exfoliaon, the delicate bers that hold the eye’s natural lens in place (zonules) can become weakened and loose. If cataract surgery is delayed in these individuals, allowing the lens to become harder and zonules to become weaker, the eye’s natural lens could fall into the back of the eye during surgery. This surgical complicaon usually requires an addional surgery by a renal specialist to remove the fallen lens. In fact, exfoliaon syndrome is the largest most signicant complicang factor in all of cataract surgery. On the posive side, cataract surgery done in paents with exfoliaon oen lowers the IOP level more than the IOP lowering that results from cataract surgery in the paent who does not have exfoliaon syndrome.The use of a MIGS procedure when performing cataract surgery in paents with exfoliaon syndrome further enhances the IOP lowering eect.Another surgical challenge, especially among exfoliaon paents, is when glaucoma paents have small pupils that do not dilate well. Fortunately, today’s cataract surgeons have many opons to help them temporarily enlarge the paents’ pupils during cataract surgery so that the surgery can be performed more easily and with less risk. Finally, another breakthrough which has made cataract surgery in the presence of glaucoma and/or exfoliaon much safer is the femtosecond laser. Femtosecond laser-assisted cataract surgery is very helpful in paents with exfoliaon syndrome, narrow angles or angle closure glaucoma. eye to eye newsconnued on back page

eye to eye newsMESSAGE FROM THE PRESIDENTcon nued from page 1Josef Flammer and pa ent Hillary Golden.This month, Dr. Thomas V. Johnson III of Johns Hopkins presents “The Promise of Op c Nerve Regenera on.” In April, Professor Alon Harris, an interna onally recognized leader in the  eld of ocular blood fl ow and glaucoma, will discuss the rela onship between the body and the eyes. And TGF’s Glaucoma Ambassador, the ar st Jahkori-Dopwell Hall, is producing the second in a series of videos on glaucoma for TikTok. I’m delighted to announce that Dr. Aakri Shukla, who gave our January webinar on lifestyle and glaucoma, has just been named a member of TGF’s Medical Advisory Board. Lastly, I have the privilege of si ng on a panel at Pharma USA 2023 at the end of this month to discuss bridging the gap between health care providers and pa ents. I look forward to telling you more in our next issue.Wishing you all the best,Elena Sturmanesturman@glaucomafounda on.org212 651 1900This is par cularly true if the cataract is more advanced, requiring more ultrasound energy to break it up. By so ening the cataract lens with the laser before the lens is removed, the risk of complica ons is reduced, making the cataract surgery safer. In exfolia on pa ents, by so ening the cataract lens prior to its removal, stress on the eye’s delicate zonules is reduced and, therefore, the risk of the lens falling into the back of the eye is reduced. In pa ents with narrow angles or angle closure glaucoma, the associated risk of damage to the iris and the cornea are greatly reduced as well.Cataract surgery in pa ents with glaucoma con nues to make great progress! The advent of MIGS procedures is helping cataract surgeons provide their pa ents with safer surgery that provides be er glaucoma control and/or a reduced need for glaucoma medica ons. Many surgeons now feel that combining MIGS procedures with a cataract surgery is an opportunity for be er glaucoma control that should never be missed. By be er controlling glaucoma at the  me of cataract surgery, pa ents may be able to avoid the tradi onal, more risky, invasive glaucoma surgeries. Cataracts, Glaucoma, MIGScontinued from page 7We hope you fi nd this newsle er issue of interest and informa ve. If you’d like to suggest an ar cle for the future, please let us know. We value your readership and your support of all that we do.The Glaucoma Foundation | Page Eight