Talking About Glaucoma (AAC)

TAG episode 10 Damji SLT

Karim Damji & Rob Schertzer

In this episode, Dr Damji and I discuss the use of Selective Laser Trabeculoplasty (SLT) in treating patients with open angle glaucoma. The conversation includes a comparison of this to Argon Laser Trabeculoplasty (ALT), the step-wise approach to treating patients with glaucoma and where the SLT might fit it. We also cover the burning question of the repeatability of this treatment modality as well as its contraindications.

Dr Damji is Professor, Department of Ophthalmology, University of Alberta. His recent research topics include Pseudoexfoliation Glaucoma, SLT vs medications as first line glaucoma therapy, and whether SLT treatment reduces diurnal variation of intraocular pressure (IOP.)

Karim Damji, MD, FRCSC, MBA

Professor

Department of Ophthalmology

University of Alberta

2317, 10240 Kingsway Avenue

Edmonton, AB T5H 3V9

Tel: 780.735.4200

Fax: 780.735.5242

This episode was recording using Skype on December 3, 2010 and mixed in January 2010. After much delay it ws finally posted on January 20, 2010. 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:

1.  SLT as effective and safe as ALT:

Damji KF, Bovell AM, Hodge WG, et al.  Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial. Br J Ophthalmol, 2006;90(12):1490-1494. 

Pham H, Mansberger S, Brandt JD, Damji K, Ramulu PY, Parrish RK.  Argon laser trabeculoplasty versus selective laser trabeculoplasty.  Surv Ophthalmol. 2008 Nov-Dec;53(6):641-6.

Juzych MS, Chopra V, Banitt MR, et al. Comparison of long-term outcomes of selective laser trabeculoplasty versus argon laser trabeculoplasty in open-angle glaucoma. Ophthalmology, 2004;111(10):1853-1859. 

2.  360 degree SLT as effective as Latanoprost when used as first line treatment:

Nagar M, Ogunyomade A, O'Brart DP, Howes F, Marshall J.  A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma. Br J Ophthalmol. 2005 Nov;89(11):1413-7.

3.  Baseline IOP predicts SLT response:

Hodge WG, Damji KF, Rock W, Buhrmann R, Bovell AM, Pan Y.  Baseline IOP predicts selective laser trabeculoplasty success at 1 year post-treatment: results from a randomised clinical trial.  Br J Ophthalmol. 2005 Sep;89(9):1157-60.

4.  Risk of irreversible IOP spike following SLT treatment of heavily pigmented trabecular meshwork:

Harasymowycz PJ, Papamatheakis DG, Latina M, De Leon M, Lesk MR, Damji KF.  Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks.  Am J Ophthalmol. 2005 Jun;139(6):1110-3.

Repeat SLT less effective than initial treatment:

5.  Hong BK, Winer JC, Martone JF, Wand M, Altman B, Shields B.  Repeat selective laser trabeculoplasty.  J Glaucoma. 2009 Mar;18(3):180-3.

6.  SLT can be effective following ALT: 

Birt CM. Selective laser trabeculoplasty retreatment after prior argon laser trabeculoplasty: 1 year results. Can J Ophthal, 2007;52(5):715-719. 

7.  Reduced visit to visit IOP fluctuation following 360 degree SLT:

Prasad N, Murthy S, Dagianis JJ, Latina MA.  A comparison of the intervisit intraocular pressure fluctuation after 180 and 360 degrees of selective laser trabeculoplasty (SLT) as a primary therapy in primary open angle glaucoma and ocular hypertension.  J Glaucoma. 2009 Feb;18(2):157-60.

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

 © Robert M Schertzer MD Inc, 2010

TAG episode 9 Hom VF Machines

Richard Hom & Rob Schertzer

In this episode, Dr Hom and I discuss things to consider in purchasing a Visual Field machine for your practice. We look at the choice based on the scope of your practice, networking, and sharing your data with colleagues.

Dr. Hom has over 25+ years of medical optometric eye care. From 2002-2006,  he served as the Coordinator, Primary Care Optometry, San Mateo Medical Center. In that capacity, he managed a broad range of eye problems from refractive to medical. He has significant experience in managing diabetic retinopathy and was key in establishing one of the state’s first demonstration project for the screening of diabetics with digital retinal photography for retinal eye disease.  From 1984-1999, Dr Hom was a low vision and specialty contact lens consultant for Kaiser’s San Francisco Medical Center.

His varied career brought him to a passion for access and language competency in health care. He also has a deep interest in cultural and language competency in medical care.

Dr. Hom combines these two interests in continuing education lectures and as a print author and blogger http://grandrounds4ods.com
http://twitter.com/grandrounds4ods

This episode was recorded November 11, 2009 over the internet using Skype and the mix was finalized on November 22, 2009.
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Selected references:
No specific journal articles are referenced in this episode. We do refer you to your local vendor of ophthalmic instruments in helping you in your decision on what type of Visual Field device best suits your practice and hope this discussion helps guide you in the right direction.

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

 © Robert M Schertzer MD Inc, 2009

TAG episode 8 Hutnik CCT

CIndy Hutnik & Rob Schertzer

In this episode, Dr Hutnik and I discuss Central Corneal Thickness (CCT) and its use as PART of the assessment of patients at risk of glaucoma.

Dr. Hutnik completed doctorate work at the National Research Council of Canada in Ottawa prior to her medical training at the University of Ottawa.  This was followed by ophthalmic training at the University of Western Ontario and the University of Wisconsin, Madison, the latter under the mentorship of Dr. Paul Kaufman.  Dr. Hutnik has a full-time clinical glaucoma practice at the Ivey Eye Institute in London, Ontario where she is involved in the clinical training of residents and medical students.  She is a member of the international Tear Film and Ocular Surface committee of the Association for Research in Vision. 

Dr. Hutnik is Medical Coordinator of the ophthalmic basic science laboratory at the Lawson Health Research Institute in London and supervises an independent program of both clinical and basic science research.  Dr. Hutnik’s research administrative roles include membership on the Board of Directors of the Lawson Health Research Institute and Chair of the Summer Research Training Program at the University of Western Ontario. The latter fosters an interest in, and aptitude for, research in junior medical students.  In addition to the supervision of medical student and resident research, Dr. Hutnik is involved with the supervision of 4th Honours Thesis students in the Department of Pathology as well as keen secondary school students through various Co-op programs.

 

This episode was recording in Toronto in late June 2009 with editing completed September 7, 2009 in Vancouver, BC.

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Selected reference(s):
JD Brandt, JA Beiser, MA Kass, MO Gordon: Central corneal thickness in the ocular hypertension treatment study (OHTS). Ophthalmology, Volume 108, Issue 10, Pages 1779-1788 

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

 © Robert M Schertzer MD Inc, 2009

TAG episode 7 Drance NTG Pt2 Risk Fx

Stephen Drance & Rob Schertzer

In this second part of a two part conversation, we discuss the risk factors for progression in Normal Tension Glaucoma as determined by the Normal Tension Glaucoma Study.

Stephen Drance, MD, FRCSC, is Professor Emeritus UBC Ophthalmology & Visual Sciences and an Officer of the Order of Canada. He was the co-lead investigator for the Normal Tension Glaucoma studies, popularized the importance of disc hemorrhages in glaucoma which bear his name, and has made many other contributions to much of our current understanding of glaucoma. He has published 10 books, 14 book chapters, and 358 articles on Glaucoma. At the local level, he founded the UBC Eye Care Centre and Festival Vancouver. These recordings were made at the home of Stephen & Betty Drance in June, 2009.
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Selected references:
Collaborative Normal-Tension Glaucoma Study Group.
Natural History of Normal Tension Glaucoma. Ophthalmology 108; 247-253,2001

Collaborative Normal-Tension Glaucoma Study Group.
Risk factors for Progression of Visual Field Abnormalities in Normal Tension Glaucoma, Amer J Ophthalmol 131; 699-708, 2001

Schulzer, M Normal Tension Glaucoma Study Group
Errors in the diagnosis of visual field progression in normal tension glaucoma. Ophthalmology 101;1589-1593,1994

Schulzer,M and Normal Tension Study Group
Intraocular pressure reduction in normal tension glaucoma patient Ophthalmology 99;1469-1470, 1992

Anderson D. R, Drance S.M., Schulzer M, Factors that predict the benefit of lowering intraocular pressure in normal tension glaucoma Amer.J..Ophthalmol.136;820-829, 2003

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

 © Robert M Schertzer MD Inc, 2009

TAG episode 6 Drance NTG Pt1 IOP and Natural Hx

Stephen Drance & Rob Schertzer

In this episode, we discuss the role of Intraocular Pressure (IOP) in Normal Tension Glaucoma & the natural history of the condition as determined in the Normal Tension Glaucoma Study. Stephen Drance, MD, FRCSC, is Professor Emeritus UBC Ophthalmology & Visual Sciences and an Officer of the Order of Canada. He was the co-lead investigator for the Normal Tension Glaucoma studies, popularized the importance of disc hemorrahges in glaucoma which bear his name, and has made many other contributions to much of our current understanding of glaucoma. He has published 10 books, 14 book chapters, and 358 articles on Glaucoma. At the local level, he founded the UBC Eye Care Centre and Festival Vancouver. These recordings were made at the home of Stephen & Betty Drance in June, 2009.

Part 2 of this podcast will examine the relationship between the normal tension glaucoma risk factors and the natural history of the disease.

Selected references: Collaborative Normal-Tension Glaucoma Study Group. Natural History of Normal Tension Glaucoma. Ophthalmology 108; 247-253,2001 Collaborative Normal-Tension Glaucoma Study Group. Risk factors for Progression of Visual Field Abnormalities in Normal Tension Glaucoma, Amer J Ophthalmol 131; 699-708, 2001 Schulzer, M Normal Tension Glaucoma Study Group Errors in the diagnosis of visual field progression in normal tension glaucoma. Ophthalmology 101;1589-1593,1994 Schulzer,M and Normal Tension Study Group Intraocular pressure reduction in normal tension glaucoma patient Ophthalmology 99;1469-1470, 1992 Anderson D. R, Drance S.M., Schulzer M, Factors that predict the benefit of lowering intraocular pressure in normal tension glaucoma Amer.J..Ophthalmol.136;820-829, 2003

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

 © Robert M Schertzer MD Inc, 2009

TAG episode 5 Henderer Discs and more

Jeff Henderer & Rob Schertzer

We discuss lessons learned from putting the Disc Damage Likelihood Scale (DDLS) into clinical practice and the importance of looking at the neuroretinal rim - not the cup. Also, the George Spaeth concept that you only see what you look for and look for what you know. Jeffrey D. Henderer, MD http://tinyurl.com/qye6hw Dr. Edward Hagop Bedrossian Chair & Professor, Department of Ophthalmology Temple University School of Medicine Telephone: 215-707-3185 Email: [email protected] Trans. Am. Ophthalmol. Soc. Vol. 100, 2002 (DDLS publication) http://tinyurl.com/yo6slu

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

 © Robert M Schertzer MD Inc, 2009

TAG episode 4 Lesk vascular issues

Mark Lesk & Rob Schertzer

Vascular problems related to glaucoma; a discussion with Mark Lesk, MD, PhD, FRCSC, Associate Professor Universite de Montreal and director of Ophthalmology research at Maisonneuve-Rosemont Hospital. (http://recherche.maisonneuve-rosemont.org/en-ca/research/our-research-investigators/lesk-mark.html) The focus of this discussion is on research on systemic vascular endothelial dysfunction and how this pertains clinically to glaucoma. The balance between vasodilation from nitric oxide and vasoconstriction from endothelin-1.

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

 © Robert M Schertzer MD Inc, 2009

TAG Episode 3 Coote Optic Nerve Evaluation

Michael Coote & Rob Schertzer

Robert Schertzer talks with Michael Coote, about the Glaucomatous Optic Neuropathy Evaluation (GONE) Project, a joint initiative of the Royal Victorian Eye and Ear Hospital and Centre for Eye Research Australia, and the world’s first internet based system for assessing skills in diagnosing Glaucomatous discs. Assoc Prof Michael Coote MB BS FRANZCO FAICD Clinical Director - Royal Victorian Eye and Ear Hospital Consultant - Glaucoma Unit, RVEEH Board Member - Mercy Health Melbourne, Australia

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

 © Robert M Schertzer MD Inc, 2009

TAG episode 2 De Moraes VF defects both hemi-fields

Gus De Moraes & Rob Schertzer

Dr. Gustavo De Moraes, Glaucoma Research Fellow New York Eye and Ear Infirmary, talks with Dr. Robert Schertzer about the 62% increased risk of glaucoma progressing when defects are present in both the superior and inferior hemi-fields vs a defect in a single hemi-field.

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

 © Robert M Schertzer MD Inc, 2009

TAG episode 1 Introduction

Rob Schertzer

'TAG,' Talking About Glaucoma, a regular podcast hosted by Robert M. Schertzer, MD, MEd, FRCSC talking with colleagues about topics of interest in the ophthalmology subspecialty area of glaucoma. The inaugral episode introduces an upcoming series of podcasts from the annual American Glaucoma Society meeting being held March 5-8, 2009 in San Diego.

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

 © Robert M Schertzer MD Inc, 2009