The adoption of new surgical

approaches into a physician practice

that treats a chronic disease like

glaucoma is no simple matter.

The slow course of the disease

makes it difficult for researchers

and developers of new surgical

approaches to determine if

patients fare better with the new

intervention, often taking many

years and several large studies to

achieve a reasonable degree of

certainty.

Additionally, since the most

common classic glaucoma surgeries

—shunts and trabeculectomy—are

associated with some potentially

hazardous outcomes, when surgical

intervention is considered for a

patient the disease is often serious

enough that vision is threatened.

While these classic techniques

have risks, they also have an

established track record. The

results, both good and bad, are well

known. New surgical techniques

offer the promise of less risky

treatment, but their problems and

long-term effectiveness is less

understood.

Three Surgical AlternativesSeveral new surgical approaches

have been developed in an effort

to reduce complications associated

with conventional glaucoma surgery.

Each approach exploits a specific

strategy to reduce the pressure

within the eye.

• The Express mini-shunt can

be used with conventional

trabeculectomy techniques to

standardize the operation and

perhaps reduce the chances of the

eye pressure getting too low in the

immediate post-operative period,

Continued on page 2

New Surgical Approaches to Glaucoma

By Christopher Girkin, MD, MSPH

This issue of Gleams is made possible in part through a charitable donation from Pfizer Medical Education Group.

GleamsJanuar y 2011 vol 28 no 2

A F r e e P u b l i c a t i o n F r o m G l a u c o m a R e s e a r c h F o u n d a t i o n

which is occasionally a problem with conventional

approaches.

• The Trabectome device removes tissue from the

drain inside they eye (the trabecular meshwork) using

an electro-surgical handpiece that disrupts the tissue.

• Canaloplasty involves the dilation of the entrance to

the outflow pathways in the wall of the eye (Schlem’s

canal) in addition to constructing an artificial fluid

outflow mechanism within the eye wall to reduce the

pressure in the eye.

While each of these techniques has potential

advantages, there are limited data to support long-

term efficacy and even less data that is not derived

from studies directly supported by the companies

that develop these products.

At the current time the clear indications for these

procedures are still being determined. Many questions

remain as to how these approaches should best be

utilized in the treatment of glaucoma.

Is it right for you?It is important to recognize that the long-term

effectiveness of these approaches is not yet known.

Conventional surgery such as trabeculectomy continues

to be an acceptable and appropriate option especially

in patients with advanced disease.

If you are a glaucoma patient, you might consider

one of these new surgical approaches in consultation

with your physician if:

• you do not have advanced disease, and

• you do not require a very low target

intraocular pressure.

Important questions to ask your physician about

a new surgical procedure would be:

1) the number of these procedures they have

performed,

2) their success rate with the procedure, and

3) if they have any financial conflicts with these

emerging technologies.

Christopher A. Girkin, MD, MSPH

is Professor of Ophthalmology and

Director of the Glaucoma Service at the

University of Alabama at Birmingham.

Dr. Girkin has authored or co-authored

over 130 journal articles, abstracts, and book chapters

in major ophthalmic publications covering both neuro-

ophthalmology and glaucoma.

PAGE 2 Gleams

New Surgical Approaches to GlaucomaContinued from page 1

Kuldev Singh, MD, MPH Board Chair

Thomas M. Brunner President and CEO

Andrew G. Iwach, MD Vice Chair

Michael L. Penn, Sr.Secretary

Frederick H. Brinkmann Treasurer

J. Bronwyn Bateman, MDH. Allen Bouch

C. Seth CunninghamTimothy J. Dwyer

Adrienne Graves, PhDJohn W. Grunden, PharmD

John Hetherington, MDH. Dunbar Hoskins, Jr., MD

Linda C. LinckDeirdre Porter

Rhett M. Schiffman, MD, MS MHSA

Dennis E. SingletonRobert L. Stamper, MD

Bill StewartArt Takahara

George E. ThomasMartin B. Wax, MD

Mona Zander

Robert N. Shaffer, MD Founder (1912 — 2007)

Editor in ChiefCarl Migliazzo, MD

Science EditorDavid J. Calkins, PhD

Medical EditorsAmish Doshi, MD

Terri Pickering, MDMichael Sakamoto, MD

Robert Stamper, MD

Staff EditorAndrew L. Jackson

Board of Directors Gleams Editorial Board

The Glaucoma Research Foundation Catalyst Meeting took place at the Mandarin Oriental Hotel in San Francisco from September 9 to 11, 2010 in San Francisco. Eighteen leading scientists and physicians from around the world met to discuss retinal ganglion cell degeneration in glaucoma.

The group addressed three aspects of nerve degeneration: the genetics, the sequence of events, and markers of progression. For each aspect they considered what we know, what we need to know, and what tools and models we need to achieve our research goals.

Many participants recommended pursuing new models of glaucoma for the purpose of understanding the sequence of events. Another reason for defining the earliest events was the opportunity for a “rescue strategy.” Functional imaging was recommended as an important

technique for validating the sequence of events, the progression of vision loss, and the impact of potential therapeutic interventions.

There was a strong sense among attending scientists and physicians that these efforts will result in identifying new physiologic or molecular biomarkers that will be useful in the diagnosis and management of glaucoma.

New Directions in Collaborative Research

Following the Catalyst Meeting, the Glaucoma Research Foundation Science Committee began the process of choosing a team of investigators for a new collaborative research program. The new team will build on the research of the Catalyst For a Cure with a focus on identifying new, sensitive and specific, clinically applicable markers for disease detection, progression, and therapeutic intervention.

(L-R): Philip Horner, PhD (University of Washington), Thomas M. Brunner, and Andrew D. Huberman, PhD (U.C. San Diego)

(L-R): Nick Marsh-Armstrong, PhD (Johns Hopkins), Martin B. Wax, MD (University of Texas), and David J. Calkins, PhD (Vanderbilt)

GRF Catalyst Meeting: Leading Experts Discuss New Directions

in Glaucoma Research

PAGE 3

October 7th: Glaucoma Research Foundation’s Board Chair, Kuldev Singh, MD, MPH presented the annual Daniel Scott Weston Glaucoma Research Lecture. Hosted by Gladys and George Weston in their Palo Alto home, the Weston Lecture is presented annually by a nationally recognized scientist or clinician to showcase advances in our knowledge of glaucoma, particularly in the area of new therapies and progress toward a cure. Dr. Singh’s topic: “Glaucoma Surgery: When Can We Expect a Breakthrough?”

It was an informative talk with a tone of cautious optimism in which Dr. Singh compared conventional vs. new surgical glaucoma treatments, and discussed additional options the near future may hold. The lecture occasionally challenged the audience with technical descriptions of surgical procedures, prompting an in-depth question and answer session.

GRF Board member Art Takahara opened the evening. An active volunteer, Art inspired our increased activities in Silicon Valley several years ago.

Many of our Bay Area friends attended including Wing-See Leung, Chief Executive Officer of Prevent Blindness Northern California, Carolyn Dingman and Dawn Wilcox from Vista Center for the Blind and Visually Impaired in Palo Alto, Mike Nash from iScience Interventional and Sean Ianchulev, MD

of Transcend Medical—two companies that are introducing new surgical treatment devices for glaucoma. Board members included Fred Brinkmann, Adrienne Graves, PhD, Michael Penn, Sr. (with Beatrice Meadows) and Deirdre Porter.

Also attending were Nobuko Saito Cleary and Gary Cleary, PharmD, PhD—Co-chairs of our 2011 Annual Benefit, scheduled for Wednesday, January 26th at the Palace Hotel in San Francisco. Our special thanks to Dr. and Mrs. Cleary and to all the friends and supporters who joined us for this year’s Lecture.

Visionary Award Presented to Deirdre Porter

November 17th: Glaucoma Research Foundation co-founder H. Dunbar Hoskins, Jr., MD presented the Visionary Award to Deirdre Porter at a reception hosted by Manika Jewelry. The Visionary Award is a special recognition honoring a unique vision and

People Making A DifferenceSilicon Valley Lecture Enlightens with Promise

of Potential Surgical Breakthroughs

Continued on page 5

PAGE 4

Deirdre Porter received The Visionary Award at ceremonies in San Francisco

Jane Weston, MD with George Weston

In Appreciation

Gleams PAGE 5

Our deepest appreciation for the generosity of our donors at the $1,000 level and above, including members of The Catalyst Circle, The Blanche Matthias Society, and institutional

donors. (Contribution of record from July 1, 2010 to October 31, 2010)

People Making A Difference Continued from page 4

DISCOVERERS ($1 Million and Above)Mr. and Mrs. F. T. Barr

BENEFACTORS ($100,000 to $249,999) Allergan FoundationPaul S. May and Frank Stein Charlot and Dennis E. Singleton

FOUNDERS ($50,000 to $99,999)Ann and Emmett Skinner, Jr. PACESETTERS ($25,000 to $49,999)Neighbor to NationDeirdre Porter and Bradford HallEstate of Dorothy E. ThewMona and Edward Zander

PATRONS ($10,000 to $24,999)Abbott Medical OpticsFrederick Perkins CRUTPfizer Inc.Kate Obstgarten Private Foundation

SPONSORS ($5,000 to $9,999)Philip M. Eisenberg Charitable TrustEstate of Louis Jay GoldenbergTrust of Dorothy Craumer NewlonMargaret Oppenheimer Revocable TrustOptiMedica CorporationUnion Bank

PRESIDENT’S CLUB ($1,000 to $4,999) Thea Amberg, Anonymous, Arlene Anthony, K. Arakelian Foundation, Employees Community Fund of the Boeing Company, Peter Falzon, Anthony R. Fisher, PhD, Walter H. Girdlestone, Margaret W. and Joseph F. Govednik, Adrienne L. Graves, PhD, Ann and H. Dunbar Hoskins, Jr., MD, Robert Karp, Paul R. Lichter, MD, Kurt and Betty Loesch, Janet Martin, Maryland Charity Campaign, Robert C. Nevins, Michael L. Penn, Sr., Khadir N. Richie, Karen and Harry Roth, MD, Virginia M. Shaffer, Shigemi Sugiki, MD, FACS, Wells Fargo Community Support Campaign, Gladys and George M. Weston, DDS

GIFTS-IN-KINDAmerican Conservatory Theatre, Aurea at Stanford Court, Charles Schwab Corporation, Delta Gamma Diablo Valley Alumnae Chapter, Germaine and Timothy Dwyer, The Grand Hyatt Union Square, John Hetherington, MD, Ann Hoskins, Mandarin Oriental San Francisco, The Palace Hotel, Deirdre Porter, Santen, Inc., Suslov Family Trust, Jane Weston, MD

commitment to a future free of glaucoma—attributes that Ms. Porter has exhibited year after year with her generous support of Glaucoma Research Foundation through volunteerism and service on our Board of Directors, and by her generous contributions toward research to find a cure.

Present to honor Ms. Porter were her peers including Adrienne Graves, PhD, Linda Linck,

Michael Penn, Sr., Bill Stewart, and Art Takahara. Special guests at the reception included Paul S. May and Frank Stein, June Behrendt, Irene Harris, Robert Karp, and Barbara and Robert Voss. 2011 Auction supporters were represented by Janelle Granfors (Personality Hotels), and Frank Gleeson (The Palace Hotel). Owner Peter Walsh welcomed guests to Manika Jewelry on Maiden Lane in San Francisco.

Some glaucoma patients have lost significant vision, making some desired activities difficult. Too often, these patients are told that “nothing can be done” by using medical or surgical treatment to improve visual function.

But, in most of these cases, there is something that can be done. With help from a low vision specialist, you can learn new skills to compensate for your limited vision, use magnifiers to help with common tasks, and get tips on how to change your living environment.

Most patients have more visual capacity than they realize. A low vision specialist will start by evaluating how much good vision you still have. Patients who have peripheral vision loss from glaucoma can learn how to compensate for a diminished visual field, helping to get around more safely and find objects more easily.

An occupational therapist can also help you learn new ways to do daily tasks. Some examples are:

• Sort medications into weekly pill boxes.• Use electronic devices to magnify print.• Listen to audio rather than read books.• Explore using large-print books and e-readers.• Bend the tip of your finger over the rim of a cup to know when to stop pouring liquid. Home environments can be modified to make

them safer. Occupational therapists help patients decide what type of lighting is most comfortable,

adding ambient lighting to rooms to improve mobility, and using directed task lighting for detail activities. Colors and contrast can be enhanced to make tasks easier. For example, patients may benefit from colored soap and towels that stand out from the tub and tile in the bathroom.

A home safety evaluation can identify hazards that may contribute to falls and injuries, such as electrical cords crossing walkways and staircases without handrails or adequate lighting. Area rugs can be removed or secured with nonskid backing, and patients can benefit from grab bars or shower chairs in the bathroom.

Most importantly, people with low vision due to glaucoma can still enjoy a range of activities, independence, and an improved quality of life.

Donald C. Fletcher, MD is Director

of the Frank Stein and Paul S. May

Center for Low Vision Rehabilitation

at California Pacific Medical Center

and Affiliate Scientist, Smith-Kettlewell Eye Research

Institute in San Francisco.

Kimberly A. Schoessow, OTD, OTR/L is an

Occupational Therapist at the Vision Rehabilitation

Center, Massachusetts Eye and Ear Infirmary and an

Instructor in Ophthalmology at Harvard Medical School.

Glaucoma InsightsGetting Help If You Have Low Vision

By Donald C. Fletcher, MD and Kimberly A. Schoessow, OTD, OTR/L

PAGE 6

My mother calls it her “lifeline”—her Jitterbug cell telephone.

Mom’s vision has deteriorated over the years so that large-number telephones don’t work for her any more. On good

days and given enough time, sometimes she can manage a call with one of her land-line phones using a combination of tactile helps and her CCTV camera and screen. But the best help is her Jitterbug cell phone.

The Jitterbug produces a comfortably familiar dial tone when it is on and opened. With a touch on the zero/operator key, Mom reaches a U.S.-based operator 24/7, who greets her by name. Mom asks to be connected with, for example, “from my list, Doctor Smith.” The operator can see Mom’s list, makes the selection, and the connection is made.

Two key points: (1) Jitterbug provides a discount for the visually impaired that eliminates its usual five-minute charge for operator assistance with these calls. (2) I maintain and update Mom’s list (limited to 50 contact numbers) on-line.

About the PhoneThe Jitterbug telephone,

made by Samsung, is a rounded clamshell shape, with a comfortable soft rubber cushion that nicely helps to capture good quality sound. The keys are big, round, and have a raised border that makes them easy to distinguish by touch. There is a dedicated push button that activates the speaker. An external display shows basic information and a two-inch display inside scrolls a list of options and text messaging.

Service OptionsOur experience with Jitterbug

has been excellent but you need to consider and select the services you wish to use. We don’t use the included messaging capabilities or extra-charge services such as Medication Reminders, or the LiveNurse hotline. Jitterbug phones piggyback on other carriers, and have coverage over most of the country. No roaming charges. No contract required. At this writing, the phone itself lists for $99, there is a one-time set up fee of $35, and rate plans start at $14.99 a month for 50 anytime minutes.

More information is available at www.greatcall.com

Glaucoma Research Foundation sponsored a Catalyst Meeting in September that brought

together leading glaucoma investigators to define what is most needed in glaucoma research to move more rapidly toward better patient treatments and ultimately a cure. Based on the successful research of the Catalyst For a Cure and the recommendations from the Catalyst Meeting we will expand our research to the identification of new, novel markers for glaucoma that will enable scientists to more effectively test potential new therapies and assist doctors in early diagnosis and treatment of glaucoma.

Your donations make possible the innovative research that is needed to find new and better treatments for eye doctors to use in treating glaucoma —thank you!

Thomas M. BrunnerPresident and CEO

The President’s Message

Jitterbug Phone Helps Mom with Low Vision

By Deirdre Porter

Gleams PAGE 7

Deirdre Porter

GRF Scientific AdvisorsJack P. Antel, MD Montreal Neurological Institute

Constance L. Cepko, PhDHarvard Medical School

Moses V. Chao, PhDSkirball Institute, New York University

Balwantray Chauhan, PhDDalhousie University

George Cioffi, MDDiscoveries in Sight

Anne Coleman, MD, PhDJules Stein Eye Institute

Christopher A. Girkin, MDUniversity of Alabama at Birmingham

Eugene M. Johnson, PhDWashington University Medical School

Sayoko Eileen Moroi, MD, PhDUniversity of Michigan

Dennis D.M. O’Leary, PhDSalk Institute

Harry A. Quigley, MDWilmer Eye Institute

Martin Raff, MD, PhDUniversity College, London

Joel S. Schuman, MDUniversity of Pittsburgh School of Medicine

Ernst Tamm, MDUniversity of Regensburg, Germany

Douglas E. Vollrath, MD, PhDStanford University

Martin B. Wax, MDUniversity of Texas

Arthur Weber, PhDMichigan State University

Robert N. Weinreb, MDUniversity of California San Diego

Janey L. Wiggs, MD, PhDMassachusetts Eye & Ear Infirmary

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©2011 by Glaucoma Research Foun dation. All rights reserved. No parts of this publication may be reproduced without permission from the publisher. Gleams articles are intended to help readers understand glaucoma. Every effort is made to assure the accuracy of this information. This information is not a substitute for the advice and recommendations of a health professional. Always consult a health professional prior to any decision regarding your eyes or other health concerns. ISSN #1072-7906

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