Talking About Glaucoma (AAC)

Intro:

Welcome back to Talking About Glaucoma, a podcast of indeterminate length and frequency. I’m your host Robert Schertzer, a Glaucoma Specialist from Vancouver, BC Canada. To help produce future shows more frequently, I will no longer include artwork and chapter markings. Hopefully this will get me back on track to publishing new episodes each month this coming year. As always, contact me at [email protected] if you have a glaucoma topic that you would like to discuss with me on a future episode.

In this episode, I talk with Murray Johnstone from Seattle about pulsatile flow through the Trabecular Meshwork and collector channels. We discuss the imaging improvements over the years that have made this possible including the latest phase-based OCT scans that result in nanometre resolution instead of the micrometre resolution of spectral domain scans that most of us are using  in clinical practice.

Show Notes:

This topic spans decades of work that began prior to his fellowship and resumed around the year 2000 as the imaging technology began to become available to prove the theory. Aqueous outflow drugs increase the outflow pulsatility, not just flow. Goldmann thought the TM was rigid preventing he and Asher from being able to explain the pulsatile nature of the flow. The ocular pulse drives movement of the TM, which is not rigid. The drugs that improve outflow, do so by altering the blood flow to achieve their effect. This is literally a stroke volume.

The theoretical sensitivity to motion is in picometer with the newer phase-based OCTs, that of the movement of electrons in an atom, though practically we achieve nanometer resolution. This is sensitivity of motion of the TM walls, and not the resolution of an image.

How does this flow vary by location within the angle and from moment to moment? This is a live dynamic process. They have published numerous studies in both normal and abnormal outflow patients. Questions to answer include how this flow is altered by laser, meds, stent procedures? Does the act of doing the measurements also alter the flow? It is non-contact and non-invasive therefore should not be altering the flow but white-coat syndrome could have an influence. Perhaps in the future, we can instill a drop in the patient’s eye, measure the change in pulsatile flow, and be able to tell whether a particular medication will actually be effective.

We measure 12 seconds of 31 million seconds in a patient’s year when we check IOP several times per year. By determining pulsatile outflow we have the potential to achieve new diagnostic and treatment options for our patients. This is analogous to how cardiology is using imaging modalities in patient care.

Selected References for this episode related to pulsatile flow:

1. Johnstone MA, Grant WM. Microsurgery of Schlemm’s canal and the human aqueous outflow system. Am J Ophthalmol 1973;76:906-917.

2. Johnstone MA, Grant WG. Pressure-dependent changes in structures of the aqueous outflow system of human and monkey eyes. Am J Ophthalmol 1973;75:365-383.

3. Johnstone MA. Pressure-dependent changes in configuration of the endothelial tubules of Schlemm’s canal. Am J Ophthalmol 1974;78:630-638.

4. Johnstone MA. Pressure-dependent changes in nuclei and the process origins of the endothelial cells lining Schlemm’s canal.

5. Johnstone MA. The aqueous outflow system as a mechanical pump: evidence from examination of tissue and aqueous movement in human and non-human primates. J Glaucoma 2004;13:421-438.

6. Johnstone MA. A New Model Describes an Aqueous Outflow Pump and Explores Causes of Pump Failure in Glaucoma. In: Grehn H, Stamper R, eds. Essentials in Ophthalmology: Glaucoma II. Heidelberg: Springer, 2006

7. Johnstone MA. Aqueous Outflow: The case for a new model. Review of Ophthalmol 2007;14:79-84.

8. Schacknow P, Samples J, eds. Aqueous Veins. The Glaucoma Book. New York: Springer, 2010:65-78.

9. Johnstone M, Martin E, Jamil A. Pulsatile flow into the aqueous veins: manifestations in normal and glaucomatous eyes. Exp Eye Res 2011;92:318-327.

10. Li P, Reif R, Zhi Z, Martin E, Shen TT, Johnstone M, Wang RK. Phase-sensitive optical coherence tomography characterization of pulse-induced trabecular meshwork displacement in ex vivo nonhuman primate eyes. J Biomed Opt 2012;17:076026.

11. Li P, Shen TT, Johnstone M, Wang RK. Pulsatile motion of the trabecular meshwork in healthy human subjects quantified by phase-sensitive optical coherence tomography. Biomed Opt Express 2013;4:2051-2065

12. Johnstone MA, Saheb H, Ahmed II, Samuelson TW, Schieber AT, Toris CB. Effects of a Schlemm canal scaffold on collector channel ostia in human anterior segments. Exp Eye Res 2014;119:70-76.

13. Johnstone MA. Intraocular Pressure Regulation: Findings of Pulse-Dependent Trabecular Meshwork Motion Lead to Unifying Concepts of Intraocular Pressure Homeostasis. J Ocul Pharmacol Ther 2014;30:88-93.

13. Sun Y, Li P, Johnstone M, K W, T S. Pulsatile motion of trabecular meshwork in a patient with iris cyst by phase-sensitive optical coherence tomography. Quantitative Imaging in Medicine and Surgery 2015;5:171-173

14. Xin C, Wang RK, Song S, Shen T, Wen J, Martin E, Jiang Y, Padilla S, Johnstone M. Aqueous outflow regulation: Optical coherence tomography implicates pressure-dependent tissue motion. Exp Eye Res 2017;158:171-186.

15. Carreon T, van der Merwe E, Fellman RL, Johnstone M, Bhattacharya SK. Aqueous outflow - A continuum from trabecular meshwork to episcleral veins. Prog Retin Eye Res 2017;57:108-133.

16. Wang K, Johnstone MA, Xin C, Song S, Padilla S, Vranka JA, Acott TS, Zhou K, Schwaner SA, Wang RK, Sulchek T, Ethier CR. Estimating Human Trabecular Meshwork Stiffness by Numerical Modeling and Advanced OCT Imaging. Invest Ophthalmol Vis Sci 2017;58:4809-4817.

17. Xin C, Song S, Johnstone M, Wang N, Wang RK. Quantification of Pulse-Dependent Trabecular Meshwork Motion in Normal Humans Using Phase-Sensitive OCT. Invest Ophthalmol Vis Sci 2018;59:3675-3681.

Production information:

This episode was originally recorded March 2016 during the Annual Meeting of the American Glaucoma Society in Ft Lauderdale using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY completed in November 2018 on a MacBook Pro and an iMac using Hindenberg Journalist Pro software. There was a great deal of background noise requiring generous use of noise gate and compression filters, with reverb added back to bring the voices back to life. Narration was overdubbed using a Blue Yeti Microphone with Journalist Pro.

Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Contact information:

Murray Johnstone, MD
Clinical Professor
University of Washington
Department of Ophthalmology
Seattle, WA USA
[email protected]

Robert M Schertzer, MD, MEd, FRCSC
[email protected]
Twitter - http://twitter.com/robschertzer
or http://iguy.tv/twitter
Blog - http://wholelottarob.com
or http://iguy.tv/blog
Facebook - http://facebook.com/talkingaboutglaucoma
Facebook glaucoma support group - https://www.facebook.com/groups/glaucomapatientgroup/
or http://iguy.tv/patientsupport
Office website - http://westcoastglaucoma.com
or http://iguy.tv/office

Theme music “Middle East Gold” ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

© 2018 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC

Closing remarks:

That’s our show for today. Thanks for your patience as I slowly post new episodes including a talk about the new glaucoma drug Rhopressa. Please rate this show on iTunes as this is the best way for other people to find the show.

You can subscribe using iTunes, PocketCasts, GooglePlay, Stitcher or wherever fine podcasts are found, and new episodes will appear in your podcast player as they come out. Please tell your friends and colleagues about the show.

Drop me a line at [email protected] with your comments, visit WholeLottaRob.com, WestCoastGlaucoma.com, or follow me on twitter @robschertzer. Links to all of these are in the show notes. Remember to keep fighting glaucoma by early detection so that nobody loses vision from this group of diseases.

In this episode, I’m talking with Ron Fellman from Glaucoma Associates of Texas about the Fellman Fluid Wave and its clinical implications in glaucoma surgery.

Episode Chapters:

Intro: Ron Fellman

Glaucoma Associates of Texas

Fluid Wave: what it isRelated strictly to conventional outflow

Evidence of patency of this system

When unroofing Schlemm’s canal a decade ago when viscocanalostomy was being popularized, injecting BSS you could see the outflow pathways

At times there would be no flow into the adjacent veins

Was I in the wrong spot?

Five years ago during Trabectome, wondered if the outflow could be visualized

Reduced the Episcleral Venous Pressure by putting patient into some raverse Trandelenberg and raised the bottle height to its highest

You don’t see this during normal phacoemulsification because usually you are forcing the Schlemm’s canal closed

How does the fluid get to the episclera?

In Trabectome, adjacent to the tip, can see segmental fluid outflow if focus at the limbus; first let foot off the foot-pedal to drop the eye pressure and look for blood to reflux in to AC, then floor the pedal and if there’s a connection through to the collector channel, then the fluid gets through the episclera via deep venous plex, mid venous plexus and then to the episcleral venous plexus super highway

Blanching is occurring as all the blood runs out of the tissue

Improve outflow where there isn’t or optimize existing flow?

 Aqueous wants to go out the path of least resistance 

 If you see a blanching it means the deep and mid venous plexus are both open and this is where the trabectome will work the best

The blanching correlates best with the patients with the lowest IOP; averaging 11.9 on 1 med vs 19 on 3 meds

Zero re-op on those with good flow vs 36% in patients with a poor wave seen intra-operatively

However we still don’t have a way to modulate wound healing with a trabectome; so can still get granulation tissue that ruins the surgery

Would fluid wave work for other MIGS procedures?

With circumferential sclerotomy see a near uniform fluid wave

With an iStent if you hit the right spot, usually won’t see more than 1 or 2 clock hours of a fluid wave; and this would only be seen AFTER the iStent is in place so you can’t do this BEFORE putting in the iStent

What’s the outcome marker for MIGS surgery? With Trab, its bleb formulation; with MIGS don’t see something when the case ends

Reference:

Episcleral Venous Fluid Wave: Intraoperative Evidence for Patency of the Conventional Outflow System

Fellman, Ronald L. MD; Grover, Davinder S. MD, MPH

Journal of Glaucoma: August 2014 - Volume 23 - Issue 6 - p 347–350

Production information:

This episode was originally recorded March 2016 during the Annual Meeting of the American Glaucoma Society in Ft Lauderdale using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY completed in January 2018 on an iMac using Hindenberg Journalist Pro software. Narration was overdubbed using a Blue Yeti Microphone with Journalist Pro. 

Opinions expressed in this podcast  are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Ronald L. Fellman, MD
Glaucoma Associates of Texas
Dallas office: 214-360-0000
Plano office: 972-612-9522
Fort Worth Office 817-923-2000
[email protected]
http://glaucomaassociates.com/glaucoma-specialists/ronald-l-fellman-md/

Robert M Schertzer, MD, MEd, FRCSC
[email protected]
Twitter - http://twitter.com/robschertzer
or http://iguy.tv/twitter
Blog -     http://wholelottarob.com
or http://iguy.tv/blog
Facebook - http://facebook.com/talkingaboutglaucoma
Glaucoma Patient Group (support group) - https://www.facebook.com/groups/glaucomapatientgroup/ 
or http://iguy.tv/patientsupport

I am pleased to announce that I am returning to Vancouver, BC. Follow my website for the latest news and for Eye Facts for patients to learn more about glaucoma. http://westcoastglaucoma.com or http://iguy.tv/office

Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

© 2018 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC

Future episodes include a long discussion with Murray Johnstone and a talk about the new glaucoma drug Rhopressa. 

If you subscribe via iTunes, PocketCasts, GooglePlay, Stitcher or wherever fine podcasts are found, you will get the new episodes as they come out. If you like the show, please leave a rating on iTunes as this is the best way for others to find it and tell your friends about the show. 

Drop me a line at [email protected] with your comments, visit WholeLottaRob.com, WestCoastGlaucoma.com,  or follow me on twitter @robschertzer. Links to all of these are in the show notes. Remember to keep fighting glaucoma by early detection so that nobody loses vision from this group of diseases.

[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

I sat down with Chris Johnson at a recent American Glaucoma Society meeting to discuss some of my pet peeves about visual field testing and what lies on the horizon. Chris is Professor of Ophthalmology and Visual Sciences at the University of Iowa and a world renown Perimetry expert.

Episode Chapters:

1. Myopic tilted optic nerves; do we have a proper control group to compare these patients to? Liquid lens in HVF 3 corrects for spherical refractive error. Nasal steps often spill over the horizontal midline because we do not correct for tilt. SLO with microperimetry will compensate for this, not yet released at the time of this recording but is now available outside of North America e.g. Compass (Fundus Automated Perimetry) https://www.centervue.com/products/compass/

2. Flattening of Frequency of Seeing curve as defects gets worse, the VF gets less reliable because we don’t use bigger test targets when worse; i.e. the more damage, the higher the variability. Aside from increasing target size e.g. a size VI target, there is potential with Frequency Doubling perimetry to reduce this variability

3. Patchy loss: we don’t have good macular functional testing. Patchy loss testing such as Rare Bit perimetry by Lars Frisen: Frisén, L. New sensitive window on abnormal spatial vision: rarebit probing. Vision Res. 2002;42:1931–1939. https://www.ncbi.nlm.nih.gov/pubmed/12128022

4. Home testing with tablets or smartphones

5. Reached a plateau and now that imaging has been advancing, it’s time for a paradigm shift that correlates the structure and function

Production information:

This episode was originally recorded March 2015 during the Annual Meeting of the American Glaucoma Society in Coronado, CA using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY performed in July 2017 on a MacPro using Hindenberg Journalist Pro software. Narration was overdubbed using a Heil PR40 Microphone with Journalist Pro. Look for upcoming discussion with Ron Fellman and Murray Johnstone that were recorded in 2016 that are still sitting in the vault and then some new recordings are planned soon.

Opinions expressed in this podcast  are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Robert M Schertzer, MD, MEd, FRCSC
[email protected]
Twitter - http://twitter.com/robschertzer
or http://iguy.tv/twitter
Blog -     http://wholelottarob.com
or http://iguy.tv/blog
Facebook - http://facebook.com/talkingaboutglaucoma

Although I closed down the West Coast Glaucoma Center after moving to the east coast in the Fall of 2013, the website is still alive as a resource for eye information at http://westcoastglaucoma.com
or http://iguy.tv/office

Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

This podcast © 2017 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC

[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

Tom Harbin, MD

In this episode, Tom Harbin, from Eye Consultants of Atlanta, and I discuss ethical issues in the medical treatment of glaucoma. This includes generic vs brand name drugs, the need to shop around for the best price, and looking out for talks from so-called Key Opinion Leaders.

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Production information:

This episode was recorded live in March 2014 during the Annual Meeting of the American Glaucoma Society in Washington, DC using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY performed in February/March 2017 on a MacBook Pro using Levelator, and Hindenberg Journalist Pro software. Narration was overdubbed using a Heil PR40 and Audio Technica ATR2100 USB Microphone with Journalist Pro. This completes my transition from Garage Band to Hindenberg Journalist Pro which allows me to edit these shows cross-platform and hopefully will help me get episodes out more quickly like the three still awaiting release with Chris Johnson, Ron Fellman and Murray Johnstone that were recorded in 2016.

Opinions expressed in this podcast  are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.
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Tom Harbin, MD, MBA
Eye Consultants of Atlanta
http://eyeconsultants.net
http://tomharbin.com
Waking Up Blind (from Amazon.com)
Tom Harbin discloses that he has a financial interest in the sale of his book
[email protected]
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Robert M Schertzer, MD, MEd, FRCSC
[email protected]

Twitter - http://twitter.com/robschertzer
or http://iguy.tv/twitter
Blog -     http://wholelottarob.com
or http://iguy.tv/blog

Although I closed down the West Coast Glaucoma Center after moving to the east coast in the Fall of 2013, the website is still alive as a resource for eye information athttp://westcoastglaucoma.com
or http://iguy.tv/office

Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

 © 2017 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC

[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

Tracy Wright, MD

In this episode, I talk with Tracy Wright, now based at Kaiser Permanente in Washington DC. He was at the Bascom Palmer Eye Institute at the University of Miami when we recorded this conversation. The implications immediately effected how I look at visual fields in my patients but I have yet to see further studies that support what we discussed, namely that visual fields continue to progress for a long time even once the stimulus that led to the initial glaucoma damage has been removed, likely due to apoptosis. The findings you are about to here may be shocking. Please write to me with your comments.
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Production information:

This episode was recorded live in March 2014 during the Annual Meeting of the American Glaucoma Society in Washington, DC using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY performed in January 2017 on a MacBook Pro using Levelator, and Hindenberg Journalist Pro software. Narration was overdubbed using a Heil PR40 Microphone with Journalist Pro.

Opinions expressed in this podcast  are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.
--------------------------------------------------

Robert M Schertzer, MD, MEd, FRCSC
[email protected]

Twitter - http://twitter.com/robschertzer
or http://iguy.tv/twitter
Blog -     http://wholelottarob.com
or http://iguy.tv/blog

Although I closed down the West Coast Glaucoma Center after moving to the east coast in the Fall of 2013, the website is still alive as a resource for eye information at http://westcoastglaucoma.com
or http://iguy.tv/office

Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

 © 2017 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC

In this episode, I talk with Nelson Winkler (a medical student at the time) and Cheryl Khanna (Glaucoma attending) at The Mayo Clinic, who analyzed the outcomes of their team based model for Glaucoma care. This physician- led model began in 2008 and has Ophthalmologists working together with Optometrists to deliver glaucoma care. With specific definitions for progression of the disease, patients are referred back to Ophthalmology at critical points or every two years if stable. This model was born out of necessity as they have just two glaucoma sub-specialists to care for a large patient population. It has allowed better allocation of resources so that patients who really need the glaucoma subspecialty care are not over-loaded with patients who are clearly stable.

They looked at the outcomes of adherence to the American Academy of Ophthalmology's Preferred Practice Patterns for glaucoma care as their metric for success of their collaborative model.

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Dr Winkler's contact information:
[email protected]
Mayo Clinic
Dept. of Ophthalmology
200 First St SW
Rochester, MN 55905

Dr Khanna's contact information:
Mayo Clinic
Dept. of Ophthalmology
200 First St SW
Rochester, MN 55905
[email protected]
Phone: 
1-(507)-284-2787
1-(507)-284-2733
http://www.mayoclinic.org/biographies/khanna-cheryl-l-m-d/bio-20055437

Selected references:
1. Moroi SE, Newman-Casey PA, Dougherty Wood S, Khanna CL The Glaucoma Specialist’s Extended Care Network A patient-centered model for the future. The Glaucoma Specialist’s Extended Care Network A patient-centered model for the future. Glaucoma Today. 2015 July/August; 13(4):35-39. 
2. Ophthalmology AAO. Preferred Practice Pattern. Primary Open-Angle Glaucoma. 2010.
3. Hertzog LH, Albrecht KG, LaBree L, Lee PP. Glaucoma care and conformance with preferred practice patterns. Examination of the private, community-based ophthalmologist. Ophthalmology 1996;103(7): 1009-13.
4. Fremont AM, Lee PP, Mangione CM, Kapur K, Adams JL, Wickstrom SL, Escarce JJ. Patterns of care for open-angle glaucoma in managed care. Arch Ophthalmol 2003;121(6): 777-783.
5. Boland MV, Quigley HA, Lehmann HP. The impact of physician subspecialty training, risk calculation, and patient age on treatment recommendations in ocular hypertension. Am J Ophthalmol 2011;152(4): 638-45 e1.
6. Swamy L, Smith S, Radcliffe NM. Optic nerve complex imaging in glaucoma Medicare beneficiaries. Ophthalmic Epidemiol 2012;19(4): 249-55.
7. Albrecht KG, Lee PP. Conformance with preferred practice patterns in caring for patients with glaucoma. Ophthalmology 1994;101(10): 1668-1671.
8. Hicks NR. Some observations on attempts to measure appropriateness of care. BMJ 1994;309(6956): 730-3.
9. Murdoch I, Johnston RL. Consultant clinical decision making in a glaucoma clinic. Eye (Lond) 2010;24(6): 1028-30.
10. Vorwerk C, Thelen U, Buchholz P, Kimmich F. Treatment of glaucoma patients with insufficient intraocular pressure control: a survey of German ophthalmologists in private practice. Curr Med Res Opin 2008;24(5): 1295-301.
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Production information:

This episode was recorded live in March 2015 during the Annual Meeting of the American Glaucoma Society in Coronado, CA, using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in February 2016 on a MacBook Pro and MacPro using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue YETI Microphone and Garage Band.

Opinions expressed in this podcast  are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.
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Robert M Schertzer, MD, MEd, FRCSC
Associate Clinical Professor of Surgery
Dartmouth Medical School - Ophthalmology
Dartmouth College
[email protected]

Twitter - http://twitter.com/robschertzer
or http://iguy.tv/twitter
Blog -     http://wholelottarob.com
or http://iguy.tv/blog

Although I closed down the West Coast Glaucoma Center after moving to the east coast in the Fall of 2013, the website is still alive as a resource for eye information at http://westcoastglaucoma.com
or http://iguy.tv/office

Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

 © 2016 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC

[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

In this episode, I talk with Suman Thapa about delivering glaucoma care in Nepal. This conversation took place long before the two massive earthquakes in 2015. I am happy to see that Suman is back at work caring for patients.

Dr Thapa's contact information:

Suman S Thapa
Nepal Glaucoma Eye Clinic,
Tilganga Eye Centre,
Kathmandu, Nepal
Telephone: +61 3 9596 0507
Mobile: +61 414 306 973
Email: [email protected]
http://www.nepalglaucomaeyeclinic.org/glaucoma_clinic_specialist.html

Suman is also the lead singer and plays guitar for the Nepali band Rusty Nails; check out https://www.youtube.com/watch?v=3aV29XVaBQw

Selected reference:

Thapa, Suman S., et al. "A population-based survey of the prevalence and types of glaucoma in Nepal: the Bhaktapur Glaucoma Study." Ophthalmology 119.4 (2012): 759-764.

Thapa, Suman S., et al. "Central corneal thickness and intraocular pressure in a Nepalese population: the Bhaktapur Glaucoma Study." Journal of glaucoma 21.7 (2012): 481-485.

Thapa, Suman S., et al. "Rationale, methods and baseline demographics of the Bhaktapur Glaucoma Study." Clinical & experimental ophthalmology 39.2 (2011): 126-134.

Thapa, Suman S., et al. "A population based survey of the prevalence and types of glaucoma in Nepal." BHAKTAPUR GLAUCOMA STUDY (2011): 43.

Thapa, Suman S., et al. "Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: The Bhaktapur Glaucoma Study." BMC ophthalmology 11.1 (2011): 2.

Thapa, Suman S., et al. "Comparison of axial lengths in occludable angle and angle-closure glaucoma—the Bhaktapur Glaucoma Study." Optometry & Vision Science 88.1 (2011): 150-154.

Awadalla, Mona S., et al. "The association of hepatocyte growth factor (HGF) gene with primary angle closure glaucoma in the Nepalese population." Molecular vision 17 (2011): 2248.

Production information:

This episode was recorded live in March 2012 during the Glaucoma Today 2012 conference in Tel Aviv, Israel, using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in February 2014 thru August 2015 on a MacBook Pro and MacPro using Levelator, Fission, and Garage Band. Narration was overdubbed using a Heil PR40 Microphone and Garage Band.

Opinions expressed in this podcastare those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Robert M Schertzer, MD, MEd, FRCSC
Assistant Professor of Surgery
Dartmouth Medical School - Ophthalmology
Dartmouth College
[email protected]
Twitter - http://twitter.com/robschertzer or http://iguy.tv/twitter
Blog -     http://wholelottarob.com or http://iguy.tv/blog

Although I closed down the West Coast Glaucoma Centre after moving to the east coast in the Fall of 2013, the website is still alive as a resource for eye information at http://westcoastglaucoma.com

Theme music "Middle East Gold" ©Daniel Schertzer 2010 & published by Les Prods DOSWA Enr

 © 2015 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC

[This AAC .m4a version has chapter markers and artwork embedded in the podcast to enhance the experience on devices/apps that support this, which includes most podcasting apps on iOS and Android devices. It is the preferred version for experiencing this podcast.]

In this episode, Tom Samuelson and I discuss trabecular bypass procedures including the currently available & two future models of the iStent, and the Ivantis Hydrus Microstent.  With iStent being the only currently FDA approved ab-interno trabecular bypass device, it is anticipated that the first generation iStent will serve as the control for future devices much like timolol is the standard to which all new glaucoma drugs are compared. There is a tendency for doctors to prescribe third and fourth glaucoma medications even though it is well known that there is such a diminishing return after two medications. These ab-interno devices can serve as a glaucoma-lite procedure, the next step after two medications for those reluctant to proceed with a potentially more effective but more risky trabeculectomy. With the iStent as it is currently approved in the United States (a single iStent and only combined with cataract surgery), it is hit or miss whether you actually reach a collector channel on the other side. The Hydrus, being 8 mm long instead of just 1 mm, is much more ikely to lead to outflow through a collector channel. The use of multiple iStents, next generation devices, or targeting delivery to visualized collector ducts should lead to improvements in ab-interno trabecular bypass procedures in the years ahead.

Even though this episode was originally recorded almost 1.5 years ago and I've only edited and posted today, no other devices aside from the 1st generation iStent have made it to market at this time so the material is all still relevant. Thanks to my listeners for sticking with me despite the paucity of episodes. I still have at least five more to edit and post and am always looking for new material if any glaucoma specialists want to talk. Please contact me at [email protected]. (Rob Schertzer, MD, MEd, FRCSC)

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Thomas W. Samuelson is an adjunct associate pofessor of ophthalmology at the University of Minnesota and past chairman of the medical staff at the Phillips Eye Institute in Minneapolis. He is a faculty member at Hennepin County Medical Center, a major teaching hospital for the University of Minnesota residency program. On a national level, Dr. Samuelson is the recipient of the American Academy of Ophthalmology's Senior Achievement Award honoring contributions made to the Academy's educational programs.

Dr. Samuelson is the current Treasurer for the American Glaucoma Society and serves on its Executive Committee. He also oversees the glaucoma skills transfer courses for the American Academy of Ophthalmology (AAO). He serves on the Basic Clinical Science Course Committee for the AAO. Dr. Samuelson also serves as editorial board member and scientific reviewer for several ophthalmology journals.

Dr. Samuelson’s research interests include surgical procedures involving Schlemm’s Canal as well as the management of coincident cataract and glaucoma. He has also performed research on the safety of LASIK in patients with other ocular disorders, especially glaucoma. A frequent lecturer nationally and internationally (keynote lectures) on ocular surgery, he has published numerous scientific manuscripts and textbook chapters on ophthalmic surgery.

Dr Samuelson's contact information:
710 E. 24th Street Suite 100
Minneapolis, MN 55404

Phone: 612-813-3600
Fax: 612-813-3601

http://www.mneye.com/minnesota/thomas-w-samuelson-md.htm
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This episode was recorded live in March 2013 during the American Glaucoma Society annual meeting in San Francisco using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in November 2014 on a MacPro, using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue Microphone Yeti and Garage Band.

Opinions expressed in this podcast  are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.
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Selected references:

Thomas W. Samuelson, MD, L. Jay Katz, MD, Jeffrey M. Wells, PharmD, Yi-Jing Duh, PhD, Jane Ellen Giamporcaro, BS, US iStent Study Group: Randomized Evaluation of the Trabecular Micro-Bypass Stent with Phacoemulsification in Patients with Glaucoma and Cataract, Ophthalmology
Volume 118, Issue 3, March 2011, Pages 459–467.

Shakeel Shareef MD, Antonio Fea MD, PhD, Iqbal Ike K. Ahmed MD, FRCSC: The Hydrus Micro-stent. Surgical Innovations in Glaucoma 2014, pp 171-174.

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Robert M Schertzer, MD, MEd, FRCSC
Assistant Professor of Surgery
Section of Ophthalmology
Giesel School of Medicine at Dartmouth
Dartmouth-Hitchcock Medical Center
1 Medical Center Dr
Lebanon, NH 03756

Work -    http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog -     http://wholelottarob.com
email -   [email protected]

Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

 © Robert M Schertzer MD Inc, 2014

After almost a full year off the air during which time I relocated from Vancouver, BC to Hanover, NH I am working on catching up with editing and posting episodes that I've recorded over the past two years but never had time to complete. My goal as always is to produce episodes on a regular basis and hope to get some support at my new academic institution.

In this episode, I talk with Florent Aptel, a glaucoma specialist in Grenoble, France, about his work in developing a modern day hi frequency ultrasound as a treatment for glaucoma in its early stages. Their group has developed a device that selectively focuses the energy on the ciliary body without collateral damage that offers hope as a future treatment modality.

Dr Aptel's contact information:

Dr. Florent APTEL
Practicien hospitalier, Service d'Ophtalmologie 
CHU de Grenoble, P03
Hôpital A. Michallon
Boulevard de la Chantourne
38000 GRENOBLE 

http://www.eyetechcare.com/uk/company/scientific-board.html

Selected reference:

F. Aptel et al, Miniaturized high-intensity focused ultrasound device in 
patients with glaucoma: a clinical pilot study, iovs.11-8137 (http://www.iovs.org/content/early/2011/09/21/iovs.11-8137.full.pdf)

Production information:

This episode was recorded live in March 2012 during the Glaucoma Today 2012 conference in Tel Aviv, Israel, using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in January 2014 on a MacBook Pro and MacPro using Levelator, Fission, and Garage Band. Narration was overdubbed using a Heil PR40 Microphone and Garage Band.

Opinions expressed in this podcast  are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

Robert M Schertzer, MD, MEd, FRCSC
Assistant Professor of Surgery
Dartmouth Medical School - Ophthalmology
Dartmouth College
[email protected]

Twitter - http://twitter.com/robschertzer 
or http://iguy.tv/twitter
Blog -     http://wholelottarob.com
or http://iguy.tv/blog

Although I closed down the West Coast Glaucoma Centre after moving to the east coast in the Fall of 2013, the website is still alive as a resource for eye information at http://westcoastglaucoma.com

Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

 © Robert M Schertzer MD Inc, 2014

In this episode, Dr Blumenthal and I discuss the not so obvious technique of peripheral laser iridotomy, emphasizing the shift away from the 12 o'clock position to a temporal location for most patients. We discuss the rationale for this shift, that includes the dramatic reduction in photopsias, as well as some tips and tricks in performing this technique.

Dr Blumenthal's contact information:
Prof. Eytan Blumenthal
Chairman
Department of Ophthalmology
Rambam Health Care Campus
P.O. Box 9602
Haifa 31096, Israel
[email protected]
http://www.glaucoma.org.il
Fax: 972-4-854-2142
Secretary: 972-4-854-2668

This episode was recorded live in June 2011 during the  joint meeting of the Canadian Glaucoma Society and the Canadian Ophthalmological Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder.  It is finally seeing the light of day after I've been side-tracked with too many other projects. Mixing, editing, and sound levelling were completed in February 2013 on a MacPro, MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue Microphone Yeti and a Heil PR40 Microphone. Final editing was completed February 2013.

Opinions expressed in this podcast  are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

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Selected references:
Iridotomy for glaucoma
http://www.glaucoma.org.il/glaucoma/laser/iridotomy
http://www.glaucoma.org.il/videos/glaucoma-videos/iridotomy-who-needs-the-treatment
http://westcoastglaucoma.com/education/glaucoma/peripheral-iridotomy/
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Robert M Schertzer, MD, MEd, FRCSC
Clinical Associate Professor
Dept of Ophthalmology & Visual Sciences
University of British Columbia
[email protected]
http://iguy.tv/podcast

http://iguy.tv is now set-up as a page to connect you to all my bits and bytes all over the web; go to that landing page as a convenient one-stop hub to all my activities

Work -    http://westcoastglaucoma.com
or http://iguy.tv/office
Twitter - http://twitter.com/robschertzer
or http://iguy.tv/twitter
Blog -     http://wholelottarob.com
or http://iguy.tv/blog

Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr

 © Robert M Schertzer MD Inc, 2013

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