Talking About Glaucoma (TAG) AAC

TAG Episode 19 - Bleb Needling: Slit Lamp Revision (AAC Enhanced)

Robert M Schertzer, MD, MEd, FRCSC — Mon, 06 Feb 2012 02:43:21 +0000

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!

Dr Solish’s contact information:
ultraeye@alum.mit.edu
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
podcast@iguy.org
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 - The Eye HandBook app (AAC Enhanced)

Robert M Schertzer, MD, MEd, FRCSC — Fri, 04 Nov 2011 21:22:07 +0000

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.

Scroll to just above ‘Post a Comment’ at the footer to open the audio file for this podcast if accessing directly from wholelottarob.com instead of via RSS, iTunes, or EyeHandbook app.

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
krishnarohit@yahoo.com

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.

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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
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Robert M Schertzer, MD, MEd, FRCSC
Clinical Associate Professor
Dept of Ophthalmology & Visual Sciences
University of British Columbia
podcast@iguy.org

Work - http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog - http://wholelottarob.com

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

© Robert M Schertzer MD Inc, 2011

TAG Episode 17 - 10Aug2011: Ologen enhanced Glaucoma Surgery with Steve Sarkisian (AAC Enhanced)

Robert M Schertzer, MD, MEd, FRCSC — Wed, 10 Aug 2011 05:15:15 +0000

Scroll to just above ‘Post a Comment’ at the footer to open the audio file for this podcast if accessing directly from wholelottarob.com instead of via RSS, iTunes, or EyeHandbook app.

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: Steven-Sarkisian@dmei.org

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

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Robert M Schertzer, MD, MEd, FRCSC
Clinical Associate Professor
Dept of Ophthalmology & Visual Sciences
University of British Columbia

e-mail -  podcast@iguy.org
Work -    http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog -     http://wholelottarob.com

Theme music “Middle East Gold” ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr
© Robert M Schertzer MD Inc, 2011

TAG Episode 16 (AAC)- 26Jul2011 VF progression risk fx with Gus DeMoraes

Robert M Schertzer, MD, MEd, FRCSC — Tue, 26 Jul 2011 17:29:32 +0000

Scroll to just above ‘Post a Comment’ at the footer to open the audio file for this podcast if accessing directly from wholelottarob.com instead of via RSS, iTunes, or EyeHandbook app.

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: gustavonyee@gmail.com

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)
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Robert M Schertzer, MD, MEd, FRCSC
Clinical Associate Professor
Dept of Ophthalmology & Visual Sciences
University of British Columbia
podcast@iguy.org

Work - http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog - http://wholelottarob.com

© Robert M Schertzer MD Inc, 2011

TAG Episode 15 - 28Mar2011: Corneal hysteresis & response to PG analogs with Josh Ehrlich (AAC Enhanced)

Robert M Schertzer, MD, MEd, FRCSC — Tue, 29 Mar 2011 04:53:41 +0000

Scroll to just above ‘Post a Comment’ at the footer to open the audio file for this podcast if accessing directly from wholelottarob.com instead of via RSS, iTunes, or EyeHandbook app.

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: jre2001@med.cornell.edu
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.

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Robert M Schertzer, MD, MEd, FRCSC
Clinical Associate Professor
Dept of Ophthalmology & Visual Sciences
University of British Columbia
podcast@iguy.org

http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog - http://wholelottarob.com

TAG Episode 14 - 21Feb2011: New glaucoma devices with Dale Heuer (AAC Enhanced)

Robert M Schertzer, MD, MEd, FRCSC — Mon, 21 Feb 2011 13:00:05 +0000

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: dheuer@mcw.edu
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
podcast@iguy.org

Work - http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog - http://wholelottarob.com

© Robert M Schertzer MD Inc, 2011

TAG Episode 13 - 6Dec2010: Glaucoma risk factors with Marcelo Nicolela (AAC Enhanced)

Robert M Schertzer, MD, MEd, FRCSC — Fri, 03 Dec 2010 17:27:18 +0000

Show notes Talking About Glaucoma #13 December 2010 Glaucoma Risk Factors

In this episode, Dr Nicolela and I discuss the risk factors for the development of glaucoma. This includes talking about the difference between risk factors for developing disease vs those for disease to progress. Much of our current knowledge is based on information from clilnical trials and population studies over the past decade. Bear in mind that still intraocular pressure remains as the single most important modifiable risk factor, even in normal tension glaucoma patients.

Some of the risk factors discussed include intraocular pressure (IOP), age, race (african americans and U.S. Latinos), pachymetry (corneal thickness), family history, and low perfusion pressure as well as signs that likely represent early manifestation of the disease itself such as vertical disc cupping and disc haemmorhages.

Dr Nicolela is Associate Professor and Fellowship Director in the Department of Ophthalmology & Visual Sciences at Dalhousie University.

Dr Marcelo Nicolela
Department of Ophthalmology & Visual Sciences
1278 Tower Road
Rm. 2035, 2 W Victoria
Halifax NS B3H 2Y9

Tel: (902) 473-3622
Fax: (902) 473-2839
Email: nicolela@dal.ca

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Selected References

References for exfoliation as independent risk factor for glaucoma development:
• Päivi Puska. Unilateral exfoliation syndrome: conversion to bilateral exfoliation and to glaucoma: a prospective 10-year follow-up study. J Glaucoma. 2002;11(6):517-24.
• Grodum K, Heijl A, Bengtsson B. Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology. 2005;112(3):386-90.

Reference for exfoliation as risk factor for glaucoma progression:
• Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E; Early Manifest Glaucoma Trial Group. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol. 2003;121(1):48-56.

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This episode was recording during the Canadian Ophthalmogical Society 2010 Annual Meeting in Quebec City. The recording gear for this episode included the Blue Microphones YETI, MacBook Pro 2010 15.4”, LaCie Rugged 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. 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.

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Robert M Schertzer, MD, MEd, FRCSC
Clinical Associate Professor
Dept of Ophthalmology & Visual Sciences
University of British Columbia
podcast@iguy.org
Work - http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog - http://wholelottarob.com
© Robert M Schertzer MD Inc, 2010

TAG Episode 12 - 17Aug2010 Foster: ACG Epidemiology & Management (AAC Enhanced)

Robert M Schertzer, MD, MEd, FRCSC — Thu, 19 Aug 2010 04:26:54 +0000

In this episode, Mr Foster and I discuss angle closure glaucoma focusing on epidemiology, mechanism and treatment (iridotomy and cataract extraction.)

Mr Paul Foster a consultant glaucoma specialist with a particular interest in angle-closure glaucoma. He runs the only specialist clinic for angle-closure glaucoma in Europe at Moorfields Eye Hospital. He has had extensive clinical and research training in glaucoma in London, Oxford and Singapore.

Mr Foster’s primary research interests concern the epidemiology (the distribution, risk factors and control) of glaucoma and myopia, with a special interest in the detection, prevention and treatment of angle-closure glaucoma. I am currently running several randomised clinical trials on management of angle-closure glaucoma. I am also collaborating with colleagues at Cambridge University and The Norfolk and Norwich University Hospital to run a study of eye disease in 10,000 people in East Anglia (The EPIC Norfolk Eye Study) which aims to give information about the impact of lifestyle, environment, diet and genetics on major age-related eye diseases in the UK.

Mr Foster’s contact information

Secretary’s phone: 020 7566 2652
Secretary’s email: bernadette.blair@moorfields.nhs.uk
http://www.drfosterhealth.co.uk/consultant-guide/Mr-Paul-James-Foster-3331042.aspx
http://www.moorfields-private.co.uk/Consultants/paulfoster

This episode was recording in Quebec City on June 28, 2010 during the annual meeting of the Canadian Ophthalmological Society using the Blue Microphone Yeti on a MacBoook Pro computer. Levelator was used to level the sound levels then the final mix was performed with Garage Band which also allowed embedding images in the AAC version.

Selected references:

Text Books

Author(s): Garway-Heath, Foster, Hitchings, Title: Atlas of Clinical Ophthalmology, Chapter: Primary Gl, Year: 2004, Publisher: Elsevier-Mosby

Journals

Author(s): He MG, Friedman DS, Ge J, Huang W, Jin C, Lee PS, Khaw PT, Foster PJ, Title: Laser peripheral iridotomy in primary angle closur, Journal: Ophthalmology, Volume: 114, Year: 2007, PageNo: 494-500

Author(s): Yip JL, Machin D, Aung T, Khaw PT, Wong TY, Khaw KT, Seah SK, Foster PJ, Title: Socio-Economic Status and Intraocular Pressure: Th, Journal: British Journal of Ophthalmolology , Volume: 91, Year: 2007, PageNo: 56-61

Author(s): de Silva DJ, Gazzard G, Foster PJ, Title: Laser iridotomy in dark irides., Journal: British Journal of Ophthalmology, Volume: 91, Year: 2007, PageNo: 222-225

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Robert M Schertzer, MD, MEd, FRCSC

Clinical Associate Professor

Dept of Ophthalmology & Visual Sciences

University of British Columbia

Please provide feedback either by email at podcast@iguy.org OR, by leaving comments on the podcast section of my blog at http://www.wholelottarob.com/tag-aac

Work - http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog - http://wholelottarob.com

TAG Episode 11 - Mar 18, 2010 Schuman & Burgoyne Imaging (AAC Enhanced)

Robert M Schertzer, MD, MEd, FRCSC — Thu, 18 Mar 2010 12:30:43 +0000

In this episode, Drs Schuman, Burgoyne and I discuss optic nerve and nerve fiber layer iimaging in glaucoma. To clarify the different modalities, the Confocal Scanning Laser Ophthalmoscope (CSLO) has been popularized as the Heidelberg Engineering device, current version being the HRT 3; the Scanning Laser Polarimeter is the GDx machine, and; the original Optical Coherence Tomography unit and its next 2 generations were popularized by Zeiss and use Time Domain scanning whereas the latest technology uses Spectral Domain technology to achieve much higher resolution with the Spectralis OCT made by Heidelberg Engineering.

Dr. Schuman is at University of Pittsburgh Medical Centre and is an inventor of Time Domain Ocular Coherence Tomography. His research interests include imaging of the eye, laser-tissue interactions, aqueous outflow, and clinical pharmacology.

Joel S. Schuman, M.D.

Professor and Chairman of Ophthalmology

Director of UPMC Eye Center

Professor of Bioengineering

Eye & Ear Institute - Suite 816

203 Lothrop Street

Pittsburgh, PA 15213

Phone: 412-647-2205

Email: SchumanJS@upmc.edu

Fax: 412-647-5119

Dr. Burgoyne is at Devers Eye Institute in Portland, OR and has been making major advances in the use of Spectral Domain OCT looking at the structural detection of cellular function.

Claude F. Burgoyne, M.D.

Senior Scientist and Van Buskirk Chair for Ophthalmic Research Research Director, Optic Nerve Head Research Laboratory Clinical Professor of Ophthalmology Oregon Health and Sciences University

Devers Eye Institute Discoveries in Sight Research Laboratories 1225 NE 2nd Avenue Portland, OR 97208 - 3950

tel:503-413-4739

e-mail: cfburgoyne@deverseye.org

www.deversresearch.org

www.deverseye.org

This episode was recorded February 26, 2010 with Rob Schertzer using a Blue Snowball Mic on a MacPro running HiJack Pro with Joel and Claude connected over Skype from Pittsburgh and Portland. Levelator was used to compress the sound pressure level and the final editing was performed in March 2010 with Garage Band on a MacBook Pro. Editing was completed on 17Mar2010.

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Selected references:

No specific journal articles are referenced in this episode.

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Robert M Schertzer, MD, MEd, FRCSC

Clinical Associate Professor

Dept of Ophthalmology & Visual Sciences

University of British Columbia

podcast@iguy.org

Work - http://westcoastglaucoma.com

Twitter - http://twitter.com/robschertzer

Blog - http://wholelottarob.com

TAG Episode 10 - Jan 19, 2010 w/ Karim Damji discussing SLT (AAC Enhanced)

Robert M Schertzer, MD, MEd, FRCSC — Wed, 20 Jan 2010 05:20:35 +0000

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.

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Robert M Schertzer, MD, MEd, FRCSC

Clinical Associate Professor

Dept of Ophthalmology & Visual Sciences

University of British Columbia

podcast@iguy.org

Work - http://westcoastglaucoma.com

Twitter - http://twitter.com/robschertzer

Blog - http://wholelottarob.com

(c) Robert M Schertzer MD Inc, 2010

TAG Episode 9 - Nov 22, 2009 (AAC version)

Robert M Schertzer, MD, MEd, FRCSC — Mon, 23 Nov 2009 14:20:25 +0000

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.

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Robert M Schertzer, MD, MEd, FRCSC
Clinical Associate Professor
Dept of Ophthalmology & Visual Sciences
University of British Columbia
podcast@iguy.org

Work - http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog - http://wholelottarob.com

(c) Robert M Schertzer MD Inc, 2009

TAG Episode 8 - Sep 7, 2009

Robert M Schertzer, MD, MEd, FRCSC — Tue, 08 Sep 2009 05:50:52 +0000

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

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Robert M Schertzer, MD, MEd, FRCSC
Clinical Associate Professor
Dept of Ophthalmology & Visual Sciences
University of British Columbia
podcast@iguy.org

Work - http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog - http://wholelottarob.com

(c) Robert M Schertzer MD Inc, 2009

TAG Episode 7 - Aug 2, 2009

Robert M Schertzer, MD, MEd, FRCSC — Mon, 03 Aug 2009 04:04:59 +0000

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
podcast@iguy.org

Work - http://westcoastglaucoma.com
Twitter - http://twitter.com/robschertzer
Blog - http://wholelottarob.com

(c) Robert M Schertzer MD Inc, 2009

TAG Episode 6 - July 8, 2009

Robert M Schertzer, MD, MEd, FRCSC — Thu, 09 Jul 2009 04:31:00 +0000

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

TAG episode 5 - May 7, 2009

Robert M Schertzer, MD, MEd, FRCSC — Fri, 08 May 2009 04:29:00 +0000

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: jeffrey.henderer@temple.edu Trans. Am. Ophthalmol. Soc. Vol. 100, 2002 (DDLS publication) http://tinyurl.com/yo6slu

TAG Episode 4 - April 16, 2009

Robert M Schertzer, MD, MEd, FRCSC — Fri, 17 Apr 2009 04:26:00 +0000

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.

TAG Episode 3 - April 1, 2009

Robert M Schertzer, MD, MEd, FRCSC — Thu, 02 Apr 2009 04:23:00 +0000

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

TAG Episode 2 - March 16, 2009

Robert M Schertzer, MD, MEd, FRCSC — Tue, 17 Mar 2009 04:19:00 +0000

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.

TAG Episode 1 - March 11, 2009

Robert M Schertzer, MD, MEd, FRCSC — Thu, 12 Mar 2009 02:18:00 +0000

'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.