Talking About Glaucoma (mp3)

TAG 23 ab-interno trabecular bypass surgery

Tom Samuelson & Rob Schertzer

[This is the .mp3 un-enhanced version of this podcast. The 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

TAG 22 HiFU Therapy (mp3 version)

Schertzer & Aptel

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

TAG 21 Eytan Blumenthal Laser Iridotomy mp3

Schertzer & Blumenthal

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/
-------------------------------------------------
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

​​

TAG 20 Michael Berlin ELT mp3

Michael Berlin & Rob Schertzer

In this episode, Dr Berlin and I discuss the elusive quest to have the Excimer Laser Trabeculostomy (ELT) that he pioneered gain traction after 30 years of development. (See the enhanced AAC version of this same episode for a version with chapter markers and images; not compatible on all devices but ideal version for iOS or computers.)

Dr Berlin's contact information:
Glaucoma Institute of Beverly Hills
8733 Beverly Blvd
Los Angeles, CA
1-310-855-1112
[email protected]
http://www.glaucoma-institute.com/about_us.asp

This episode was recorded live in March 2011 during the American Glaucoma 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 and sound levelling were completed in June 2012 on a MacPro, MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Heil PR40 Microphone. Final editing was completed December 2012.

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:

Eyetube.net video
http://eyetube.net/video/elt-excimer-laser-trabeculostomy-a-better-way-to-treat-open-angle-glaucoma/

Youtube video
http://youtu.be/XZ2Lpv1qQ_8

Dr Berlin's original patent for laser delivery system
http://www.google.ca/patents?id=CCQ3AAAAEBAJ&zoom=4&dq=berlin%20erbium%20laser%20trabeculectomy&pg=PA1#v=onepage&q=berlin%20erbium%20laser%20trabeculectomy&f=false
-------------------------------------------------
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

TAG episode 19 Al Solish bleb needling

Al Solish & Rob Schertzer

In this episode, Dr Solish and I discuss the art of “needling” a filtering bleb, or as he likes to call it, a Slit Lamp Revision (SLR), to resuscitate its function. Beginning with the history of when he first thought of the idea as a resident and it was shot down and how this evolved to using antimetabolites in conjunction with the needling in order to discourage fibroblasts from forming more scar tissue from the procedure. You might be surprised to learn what types of blebs are more likely to improve with Slit Lamp Revision! (See the enhanced version of this podcast for chapter markers and images.)

Dr Solish’s contact information:
[email protected]
http://www.drsolish.eyemd.org/
Unit 230
630 S Raymond Ave
Pasadena, CA 91105-3283
Ph: (626) 577-1115

This episode was recorded live in March 2011 during the American Glaucoma Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were completed in February 2012 on a MacPro, MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Heil PR40 Microphone.

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:
Solish, A., Solish, S. Treatment of leaking filtration blebs using mitomycin C. J. Glaucoma, 8:1 supp. 1999.

Solish, A. Treatment of leaking filtration blebs with bleb extension utilizing mitomycin C. 6th Congress of the European Glaucoma Society London, UK, Discussed poster June 12, 2000.

Solish, A. Clinical Experimental Evidence for a New Theory of Leaking Filtration Blebs UCLA Jules Stein Eye Institute Research and Alumnit Conference June 2, 2001

Solish, A. Treatment of leaking filtration blebs with bleb expansion utilizing mitomycin C. PAAO Buenos Aires, July 24, 2001

Solish, A. Treatment of leaking filtration blebs with bleb expansion utilizing mitomycin C .AGS  San Juan Puerto Rico February 28 2002

Solish, A. “Treatment of leaking filtration blebs with bleb expansion utilizing mitomycin C”. May 2002

Solish, A “Is mitomycin really the cause of leaking filtration blebs? “AAO meeting Chicago October 15, 2005

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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, 2012

TAG episode 18 Krishna Eye HandBook

Ro Krishna & Rob Schertzer

In this episode, Dr Krishna and I discuss the Eye HandBook app that he and partner Dr Ken Lord developed. This app, available for both iOS and Android devices, has been a huge success. How can you disagree when the price is FREE and it is loaded with useful information for eye care professionals? At the time of this recording in March 2011 the Android version had yet to be released but it has since been released…see links in the show notes for downloading the iPhone or Android versions.

Dr. Krishna is Board Certified in Ophthalmology and Fellowship trained in glaucoma. He completed his ophthalmology residency at the Cleveland Clinic Foundation in Cleveland, Ohio, where he also served as Chief Resident. He completed his glaucoma subspecialty training at the prestigious Bascom Palmer Eye Institute in Miami, Florida. He was honored as a recipient of a scholarship from the Heed Foundation during his fellowship. He is actively involved in resident and medical student education and research at the Eye Foundation of Kansas City, Truman Medical Center and Department of Ophthalmology, University of Missouri-Kansas City (UMKC) School of Medicine. He is Director of the Glaucoma service and Associate Professor of Ophthalmology at the University of Missouri - Kansas City (UMKC) School of Medicine. Dr. Krishna has published book chapters and numerous articles in the areas of his expertise. He is a partner at Sabates Eye Centers and Medical Director/CEO at Epic Surgery Centers.(All biographical information taken from the Eye HandBook website)

Dr Krishna’s contact information:
Leawood Eye Center - University Park Medical Plaza
11261 Nall Ave.
Leawood, KS 66211
(913) 261-2020
[email protected]

Sabates Eye Centers: http://www.sabateseye.com/doctors/bio/krishna.html
Eye Handbook website: http://www.eyehandbook.com/about_ehb.php

This episode was recorded live in March 2011 during the American Glaucoma Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed in November 2011 on a MacPro, MacBook Pro and MacBook Air 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.

—————————————————————————
Selected references:
Eye HandBook at iTunes app store:
http://itunes.apple.com/us/app/eye-handbook/id335546959?mt=8

and in the Android Market Place
https://market.android.com/details?id=com.CloudNineDevelopement.EyeHandbook&hl=en  

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

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, 2011

TAG episode 17 Sarkisian Ologen

Steve Sarkisian & Rob Schertzer

In this episode, Dr Sarkisian and I discuass his use of Ologen branded collagen matrix in attempts to improve the success of glaucoma surgery. This novel modification has yet to gain widespread support and would still be considered experimental at the time of this recording.

Steven R. Sarkisian, Jr., MD is the director of the glaucoma fellowship at the Dean A. McGee Eye Institute and serves as a clinical associate professor of Ophthalmology at the University of Oklahoma in Oklahoma City. Dr Sarkisian has a special interest in nanotechnology applications for the treatment of glaucoma; innovation in glaucoma surgery; and glaucoma drainage devices.

Dr Sarkisian’s constact information:
Steven R. Sarkisian, Jr., M.D.
Clinical Associate Professor of Ophthalmology
University of Oklahoma College of  Medicine The Dean A. McGee Eye Institute
608 Stanton L. Young
Oklahoma City, OK 73104-5065
PHONE (405) 271-6060
FAX (405) 271-4442

web profie: http://www.dmei.org/index.php?pID=212&subID=632
email: [email protected]

This episode was recorded live in March 2011 during the American Glaucoma Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed on a MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue Microphone Yeti through Audio HiJack on a MacPro.

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 reference:
New Methods and Modifications of Glaucoma Filtration Surgery
Sarkisian, Steven R. Jr MD; Rouse, J. Matthew MD International Ophthalmology Clinics:
Summer 2011 - Volume 51 - Issue 3 - p 95–106
More references on the media center section at the Ologen website:
http://www.oculusgen.com/page02-04.php

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

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, 2011

TAG episode 16 De Moraes VF Progression

Gus De Moraes & Rob Schertzer

Talking About Glaucoma #16 for late July 2011 - Dr Gus De Moraes, Risk factors for VF Progression in glaucoma patients

In this episode, Dr De Moraes and I discuss risk factors for visual field progression in patients already diagnosed with and being treated for glaucoma.

Dr De Moraes’ group found that patients with established glaucoma were more likely to progress when peak IOP was 18 mm Hg (millimeters of mercury) or higher. Other risk factors included thinning of the cornea, presence of disc hemorrhage in the retina of the eye, and atrophy in part of the eye.

This study was supported by the Joseph and Geraldine LaMotta Research Fund of the New York Glaucoma Research Institute, and one investigator’s work was supported by the Glaucoma Research and Education Fund of Lenox Hill Hospital; both institutions are located in New York. Please see the article in Archives of Ophthalmology cited in these notes for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support.

Dr Gustavo De Moraes is Associate Professor of Ophthalmology at the New York University School of Medicine.

Dr De Moraes’ constact information:

Gustavo De Moraes, M.D.
New York Eye and Ear Infirmary
310 East 14th Street
New York, NY 10003
Tel:  (212) 477-7540 Extension: 375
email: [email protected]

http://www.med.nyu.edu/people/demorc02.html

This episode was recorded live in March 2011 during the American Glaucoma Society annual meeting using a Shure SM58 microphone with a Marantz PMD661 digital recorder. Mixing and sound levelling were performed on a MacBook Pro and MacBook Air using Levelator, Fission, and Garage Band. Narration was overdubbed using a Blue Microphone Yeti.

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 reference:
Arch Ophthalmol. 2011;129[5]:562-568. (http://archopht.ama-assn.org/cgi/content/abstract/129/5/562)

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, 2011

TAG episode 15 Ehrlich hysteresis

Josh Ehrlich & Rob Schertzer

In this episode, Dr Ehrlich and I discuss baseline corneal hysteresis and its relationship with the amount of IOP reduction in prostaglandin treatment.

Dr Josh Ehrlich is a fourth year medical student at the Weill Cornell Medical College in New York City. He begins his Ophthalmology residency July 2012 at the Wills Eye Institute.

E-mail: email: [email protected]
http://www.med.cornell.edu

This episode was recorded using more brand new and fun recording gear! Namely, a Marantz PMD-661 Digital recorder and a Shure SM-58 microphone. Voice overs were done using a Blue Microphones YETI and mix down on a MacBook Air and MacBook Pro using Garage Band ‘11.

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
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, 2011

TAG episode 14 Heuer new devices

Dale Heuer & Rob Schertzer

In this episode, Dr Dale Heuer and I discuss the latest glaucoma surgical techniques and devices in search of solid evidence for their safety and effecacy. Trabeculectomy is the operation that we love to hate so we are always looking for something better. In some countries, new devices just require proving safety without having to show efficacy whereas in other countries both must be proven. Canaloplasty involves threaded a fibre-optic canula around the full circumference of Schlemm’s canal, using viscoelastic to then dilate the canal, pull a suture through to tighten it and change the canal’s position, then creating a descemet’s window before closing. The ExPress mini-shunt is a metal tube under a trabeculectomy scleral flap to create a more predictable trab. The trabectome removes the trabecular meshwork with cautery. The iStent implant is a metal snorkle creating a direct communication between the anterior chamber and Schlemm’s canal. An ER:YAG laser technique of creating direct communication between the AC and the canal has been pioneered by Dr MIchael Berlin but has still not gained traction. Other blebless techniques including the SOLEX gold plate used to create a cyclodialysis are still being tried. In the end, we still have our proven trabeculectomy as well as tube-shunt glaucoma drainage devices, both of which we have solid evidence of safetly and efficacy.

As an addendum, during the show I mentioned that I was going to be performing canaloplasty in the future. I have now performed three surgeries and have three more booked for March 2011. The procedure is like angioplasty for the eye compared with a trabeculectomy or other bleb forming surgeries that are more like bypass surgeries. There is also 4 year data showing canaloplasty success with IOP lowering >30% so this does show some promise as one of the new surgeries though it is technically a bit more complicated despite being less invasive than a trab.
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Dale K. Heuer, MD
Professor & Chairman, Department of Ophthalmology
Medical College of Wisconsin
Director, Eye Institute
Phone: (414) 955-2020
FAX: (414) 955-6300
E-mail: [email protected]
The Eye Institute
925 N. 87th St.
Milwaukee, WI. 53226
http://www.mcw.edu/ophthalmology/faculty/FacultyProfiles1/DaleKHeuerMD.htm
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This episode was recorded at the West Coast Glaucoma Centre in Vancouver, BC, on November 19, 2010.  The recording gear for this episode included the Blue Microphones YETI, MacPro, Iomega SSD Flash external drive and Audio Hijack Pro software. Fission was used to convert the audio file to AIFF for Levelator to balance the sound levels. The final audio editing, chapter markers, show notes and images were put together using Garage Band ‘11 on an 11” MacBook Air. I have a lot of fun doing this by myself and recording these interviews with my colleagues. Look for more episodes as I still have another couple that are recorded that I have to edit.

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
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, 2011