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May 2023 Newsletter
MESSAGE FROM THE PRESIDENT
Dear Readers,
This is an especially busy season for the Foundation, and TGF’s 28th Annual Scientific Think Tank is on the front burner. Scheduled for June 9th and 10th, the Think Tank is the premier forum for the exchange of ideas among leading scientists in diverse fields to bring their knowledge to the challenges of glaucoma. Over the years, this international gathering has significantly increased the number of people working in the field, while helping to set the course for future glaucoma research.
This year’s presenters, from the US, the UK and Australia, collectively represent the vanguard of exploration by medical science. And, for the first time, the Think Tank will incorporate the latest science into a forum designed to bring patients, advocates and caregivers into the discussion on living with glaucoma.
Research, collaboration and education lie at the heart of our mission.
In March, Dr. Thomas V. Johnson III, MD, PhD, a clinician-scientist and the Allan and Shelley Holt Rising Professor of Ophthalmology at the Wilmer Eye Institute at Johns Hopkins, gave a research update on the progress that has been made in optic nerve regeneration and restoration and the challenges ahead.
In April, Dr. Alon Harris, MD, FARVO, Professor of Ophthalmology, Vice Chair of International Research and Academic Affairs, and Director of Ophthalmic Vascular Diagnostic & Research Program at Mount Sinai Hospital shared what research can now tell us about the various relationships between blood pressure, eye pressure (IOP), and vascular blood flow as they relate to glaucoma.
These and other webinars are available on TGF’s website and on YouTube. We are especially grateful to Santen, Inc. for providing funding for these presentations. With Santen’s support, our webinars have been viewed by thousands of people in the U.S. and abroad, strengthening a valuable educational link between TGF and a broad audience of researchers, physicians, and patients.
We are equally grateful to you, our friends, for your ongoing support of all that we do. Thank you.
Elena Sturman
DOCTOR, I HAVE A QUESTION.
How Are Doctors Using Home Tonometry?
Question answered by
BARBARA WIROSTKO, MD, FARVO
Dr. Wirostko is Adjunct Professor of Ophthalmology at the Moran Eye Center and Department of Biomedical Engineering, University of Utah, SLC. Chief Medical Officer of Qlaris Bio and cofounder of MyEyes LLC.
IOP fluctuates constantly, between doctor visits and even throughout the day. The more frequently your IOP is measured, the better overall picture your doctor will have of your eye pressure fluctuations.
The most common approach to getting this information is to measure your eye pressures in the clinic or doctor’s office at different times of day over several visits. But we are probably currently missing the maximum IOP in our patients because it’s occurring at other times when patients are not seeing their doctors.
We thought the maximum IOP was early morning; now home IOP testing is actually showing us that it is even earlier – during the early waking hours. We don’t yet fully understand why IOP spikes occur in some people, and how IOP fluctuations affect the eye in the long term. The degree of that fluctuation may be just as much a risk factor as maximum IOP.
With the availability and FDA approval of the iCare Home, eye pressure measurement is now feasible outside the clinical setting. It’s a way of getting the data out there, it’s knowledge. Even a week or two of home IOP monitoring (iCare Home can be rented from MyEyes and elsewhere) can provide a comprehensive picture of IOP trends that might reveal spikes and/or variations not possible with measurements only taken during office hours. Measurement results are uploaded to a cloud database from where they are easily accessible both to the doctor and the patient.
As a clinician, I can use this information in different ways, for example, before diagnosing patients and also with patients whose glaucoma is progressing, but who have normal pressures in the office. The patterns we see may also suggest different surgical interventions. With a chronic disease like glaucoma, we know that eye drops can become ineffective, surgeries can fail, a sustained release med like Durysta can wear off – so what do we do if doctors see patients every 3 or 4 months?
One of my patients said to me, “If I didn’t have the iCare Home I wouldn’t have known that my trab was failing.” Like this patient, some wish to purchase the iCare Home device for longer term use.
They ask why shouldn’t they own it? There’s no downside except for the cost. As a clinician, I ask: why should insurance not be covering this for all patients? That’s the question on my mind right now.
At MyEyes, we’ve put together a consortium with several of our colleagues around the country. It’s basically a consensus panel -- we are now pulling together the totality of the data to go to the payers and make the argument that insurance should cover this. It’s important. It’s getting patients to get better management and care and doctors to have better and more information. That’s in the works – we will be having a meeting at ARVO. If you are making treatment decisions based on a number, and you don’t have the right number, how can you make an educated decision?
I think home monitoring empowers and educates patients. They can see what’s happening and learn more about their disease. If we could get insurance to cover home IOP monitoring, it would be momentous!
It’s Allergy Season
Some studies show that pollen seasons are getting longer and more intense across the country. Several over-the-counter and prescription medications can help with seasonal allergy symptoms.
We’ve all read labels on over-the-counter cold and allergy medications that say ‘do not take if you have glaucoma.’ It really depends on which type of glaucoma you have. Antihistamines and decongestants generally have no effect on open-angle glaucoma — the most common form of the disease.
But people with closed-angle glaucoma, also called narrow-angle glaucoma or angle-closure glaucoma, should avoid or use them with caution. That is because one of the side effects can be the enlargement (dilation) of the pupil which in rare instances can cause an acute glaucoma attack in individuals whose anterior chamber angles are anatomically narrow. It may take some trial and error to find the best medication regimen. Patients should talk to their doctor about options.
Here are a few general anti-pollen tips. Pollen tends to be highest between early morning and midday, as well as on hot, dry, windy days. Plan your exercise or errands accordingly. If you are prone to allergy symptoms and have to go out in the morning, or do yardwork – wear a high-quality N95 mask which will help filter out pollen. Indoors, use an air conditioner with a HEPA filter rather than a fan, and keep your windows closed during high pollen periods.
Preservative-Free Glaucoma Eye Drops
It is estimated that roughly half of all patients on long-term glaucoma therapy suffer from ocular surface disease (OSD), which includes dry eye syndrome. OSD can cause redness, tearing, irritation, burning, foreign body sensation, light sensitivity and sometimes blurred vision.
One of the issues is that all multi-dose ophthalmic medications are required to have a preservative to maintain the antimicrobial environment in the bottle. While OSD can be caused by active ingredients in in a particular glaucoma eye drop, it’s widely known that the preservative benzalkonium chloride (BAK) used in many drops can affect the ocular surface. In fact, the prolonged use of eye drops preserved with BAK is a strong risk factor for ocular surface disease in patients with glaucoma. And patients who must use two or more medications have worse OSD.
There is an acknowledged need for the pharmaceutical industry to continue addressing BAK-free options, minimizing OSD and improving patients’ quality of life as well as adherence to their medication regimen.
These products fall into two categories: BAK-free preserved medicines (using alternative preservatives to BAK) and preservative-free medicines.
There are currently three preservative-free medications available in the United States. Two other drugs use alternative preservatives.
The three available topical glaucoma medications completely free of preservatives are: Zioptan (tafluprost ophthalmic solution 0.0015%, Cosopt PF (dorzolamide-timolol ophthalmic solution 2%/0.5%, and Timoptic in Ocudose (timolol maleate ophthalmic solution 0.25% and 0.5%. The FDA has just approved the first formulation of latanoprost, Thea’s lyuzeh.
Generic versions of preservative-free Zioptan, Cosopt and preservative-free Timoptic.are also available.
Each of these products is supplied as a sterile solution in single-use containers. Once the vial is opened, the patient should apply the medication to the eye, and then immediately should discard the container and its remaining contents. Patients with poor dexterity may have difficulty handling the small containers. And the risk of contamination is a concern if a patient saves excess solution for later.
The two BAK-free products that use other preservatives and aim to reduce toxicity to the ocular surface are Travatan Z (travoprost ophthalmic solution 0.004%, preserved with SofZia, and Alphagan P (brimonidine tartrate ophthalmic solution, 0.1% or 0.15%, preserved with Purite.
LIVING WITH GLAUCOMA
Meet Patricia Caulfield
Abstract Artist Pat Caulfield of York, Pennsylvania was diagnosed with glaucoma 11 years ago. As a glaucoma patient with vision loss, she believes it’s crucial to be your own best advocate. “It’s one of the most important things I stress when I give talks. There’s so much good information out there,” she says, “and there is no reason not to know more about this disease. If you don’t do the research, you won’t know what questions to ask.”
As a professional artist, Pat has been working hard to create awareness and education about the disease through art. “I believe that the practice of art can heal and can help, and can help express yourself in different ways through art and creativity even if you don’t have 100 percent of your vision.”
With three shows of her art this past year, her work as a resident artist at a local gallery and through her social media presence, Pat has long used art to reach out and educate. Just now she’s working on a proposal for a gallery to mount an interactive display of works by visually impaired artists. Her unique idea is to give gallery visitors blindfolds with holes in each of them and ask them to look at the art and then draw what they see on a wall. The point she’s making is that vision loss doesn’t follow a pattern – every person loses vision in an undetermined way. Glaucoma isn’t a cookie cutter disease. It affects each person’s diagnosis and vision loss differently and different methods of treatment must be utilized to encourage the best outcome.”
Pat’s glaucoma was first diagnosed during a regular eye exam when she was 55. “I was shocked,” she says, “and went to see a doctor who immediately prescribed laser surgery. I said, ‘no,’ I need to learn more first. And then I went to the Wilmer Eye Institute at Johns Hopkins Hospital in Baltimore, where my doctor confirmed that I had glaucoma but didn’t think laser would help. After five successful years on eye drops, my specific drop was discontinued and none of the many drops I tried seemed to work. Then, all of a sudden, I lost almost half my vision. With pressures up to 46, I immediately had surgery for a Baerveldt Shunt on my left eye. That worked for a while. But then I started losing central vision in the right eye. My rapid progression, not the norm, just ripped through. I then had trabeculectomies done in both eyes. It was terrifying!
“I had been a successful kitchen/bath designer for over 20 years. But about the time I lost my central vision I had to make some changes. I don’t drive as much anymore – locally but not on the highway. I stepped back from my design career and started taking my art more seriously. I took courses, then taught art history at a local school. I’m very active in our regional art world and beyond.” Pat has successfully curated two art shows for visionally impaired artists on the West Coast. She has also just been selected as one of three women artists for an upcoming show in Lancaster, PA.
For the past two years Pat has been a guest lecturer, speaking to honor students in the neuroscience department at Boston University about vision loss and the internal process of creating art. “We talk a lot about the way it affects how you create – both intellectually and emotionally. We discuss how colors are affected with cataracts and that details can become lost with the progression of glaucoma.
“Through my outreach, I have met incredible people with such tenacity and strength,” Pat says. “One woman is a medical doctor in India who is now legally blind from glaucoma. She’s creating an outreach program in India for people with glaucoma to come in and enjoy expressing themselves despite their visual impairment. Then there’s a gentleman in London, with only five percent of his vision, who uses braille as full-scale interactive art and teaches blind children how to read his paintings. I never would have met these people if I didn’t have glaucoma myself.
“While I’ve already lost a lot of vision, a few weeks ago my doctor confirmed that my vision was stable. I just hope I can maintain the vision I have now for the rest of my life. I’d be perfectly content with that!
Patricia works in mixed media on birch cradleboard and paper using acrylic paint, collage, oil pastel, oil sticks, pencil, watercolor crayon and vine charcoal along with sanding and distressing.
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