In this episode of 'Talking About Glaucoma,' host Rob Schertzer, a Vancouver-based glaucoma specialist, chats with guest Gavin Docherty about the evolving understanding of preservative-free therapies in glaucoma management. They discuss the historical rationale for including preservatives in eye drops and the recent studies showing that preservative-free options are equally effective while reducing side effects such as hyperemia, burning, and irritation. The conversation covers the benefits of preservative-free drops in terms of improving patient compliance and minimizing ocular surface damage, which could potentially lead to fewer surgeries and better outcomes. They also share clinical experiences and highlight the barriers to transitioning patients to preservative-free medications, including issues related to cost, accessibility, and environmental waste. The episode concludes with an emphasis on the importance of collaboration among eye care providers to enhance patient care.

In this episode, Dr. Mahnia Madan and I discuss the challenges of managing glaucoma and dry eye conditions. We explore the impact of glaucoma medications on dry eyes, the importance of tailored treatment plans, cyclosporines, lid hygiene, in-office therapies like IPL, and the collaborative approach between optometrists and ophthalmologists. The discussion emphasizes the need for personalized care to improve patients' quality of life.

In this episode, I talk with Abdullah “Abed” Sarhan, CEO and Co-founder of Retinal Logic, about the company's use of AR and VR technology for vision screening. Abbott shares his background in deep learning and healthcare, the development of the virtual reality prototype, the device's availability and Health Canada approval, and its differentiation from other companies' technologies. He also discusses the various test sizes and algorithms available, ongoing research, user experience, and the company's future roadmap.

Going beyond the basics with Optic Coherence Tomography with Hady Saheb. Our discussion includes Ganglion Cell Layer analysis, structure-function correlation, the floor effect, viewing-software vs printouts and explaining test results to patients.

In this episode, I talk with Dr Shivani Kamat, Assistant Professor of Ophthalmology and Glaucoma Fellowship Program director at UT Southwestern, about Plateau Iris. The discussion includes the difference between plateau iris configuration and syndrome, how to distinguish plateau iris from other glaucomas and treatment options.

In this episode, I talk with Carla Siegfried, Jacquelyn E. and Allan E. Kolker, MD Distinguished Professor of Ophthalmology and Vice-Chair of Diversity, Equity, and Professionalism at Washington University School of Medicine, about the gold standard glaucoma surgical procedure: the trabeculectomy. We exchange detailed tips for success for each step of the surgery and post-operative care. It is clear from our discussion that we must continue to train others so that the trabeculectomy does not become a lost art. This is a procedure requiring no special devices and remains the gold standard for achieving low pressures despite its higher complication rate compared to other procedures.

There have been many trials proving surgical intervention does indeed reduce the risk of progressive glaucoma damage for our patients. These include Treatment vs No Treatment studies as well as studies that compare different types of treatment. In this episode, I talk with Steve Gedde, from the University of Miami's Bascom Palmer Eye Institute, about lessons learned from these clinical trials.

In this episode, I talk with Daniel Laroche. We have crossed paths for many years at conferences having both started our practices at the same time, but this was the first time we sat down to record our conversation. Daniel Laroche is Director of Glaucoma Services and President of Advanced Eyecare of New York. He is affiliated with the New York Eye and Ear Infirmary, and Assistant Professor of Ophthalmology at the Mount Sinai School of Medicine, New York.

In this episode, I talk with Gus DeMoraes, a frequent guest of the pod. Gus is Associate Professor of Ophthalmology at Columbia University where he serves as Medical Director of Clinical Trials. When we originally sat down to record this way back in March 2019, he had just presented some of the work he had done in collaboration with Don Hood. This has now appeared on Humphrey perimeters as the 24-2C testing strategy and is becoming a new the standard of care. It is based on reports in recent years that glaucoma damage often occurs in the macular area but missed because the standard 24-2 testing strategy only tests in 6 degree increments. These early central glaucomatous defects are often hidden between the test points.

In this episode, I talk with Won Kim, a glaucoma colleague based on Walter Reed in Bethesda, Maryland, about how he has been combining multiple minimally invasive glaucoma procedures in patients who have failed traditional glaucoma surgery. I'm Rob Schertzer, a Vancouver, Canada based glaucoma specialist, podcaster and HealthIT expert, and we're...talking about glaucoma.

The goal of the late Dave Epstein was to find a drug that treats the cause of glaucoma by improving trabecular meshwork outflow. After many years of trying, Aerie Pharmaceuticals was formed and refined a Rho Kinase inhibitor called Netarsudil. In April 2018 this came to market as Rhopressa and March 2019, combined with latanoprost, as Roclatan. Today I’m talking with Rick Lewis, a glaucoma colleague based in Sacramento and Chief Medical Officer for Aerie Pharmaceuticals.

In this episode, I talk with Murray Johnstone from Seattle about pulsatile flow through the Trabecular Meshwork and collector channels. We discuss the imaging improvements over the years that have made this possible including the latest phase-based OCT scans that result in nanometre resolution instead of the micrometre resolution of spectral domain scans that most of us are using in clinical practice.

I sat down with Ron Fellman at a recent American Glaucoma Society meeting to discuss the use of the fluid wave in assessing the aqueous humour outflow pathway and its clinical application.

I sat down with Chris Johsnon at a recent American Glaucoma Society meeting to discuss some of my pet peeves about visual field testing and what lies on the horizon. Chris is Professor of Ophthalmology and Visual Sciences at the University of Iowa and a world renown Perimetry expert.

In this episode, Tom Harbin, from Eye Consultants of Atlanta, and I discuss ethical issues in the medical treatment of glaucoma. This includes generic vs brand name drugs, the need to shop around for the best price, and looking out for talks from so-called Key Opinion Leaders.

In this episode, I talk with Tracy Wright, now based at Kaiser Permanente in Washington DC. He was at the Bascom Palmer Eye Institute at the University of Miami when we recorded this conversation. The implications immediately effected how I look at visual fields in my patients but I have yet to see further studies that support what we discussed, namely that visual fields continue to progress for a long time even once the stimulus that led to the initial glaucoma damage has been removed, likely due to apoptosis. The findings you are about to here may be shocking. Please write to me with your comments. -------------------------------------------------- Production information: This episode was recorded live in March 2014 during the Annual Meeting of the American Glaucoma Society in Coronado, CA, using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY performed in January 2017 on a MacBook Pro using Levelator, and Hindenberg Journalist Pro software. Narration was overdubbed using a Heil PR40 Microphone with Journalist Pro. 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 podcast@iguy.org 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 Center 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 or http://iguy.tv/office Theme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr © 2017 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC

In this episode, I talk with Nelson Winkler (a medical student at the time) and Cheryl Khanna (Glaucoma attending) at The Mayo Clinic, who analyzed the outcomes of their team based model for Glaucoma care. This physician- led model began in 2008 and has Ophthalmologists working together with Optometrists to deliver glaucoma care. With specific definitions for progression of the disease, patients are referred back to Ophthalmology at critical points or every two years if stable. This model was born out of necessity as they have just two glaucoma sub-specialists to care for a large patient population. It has allowed better allocation of resources so that patients who really need the glaucoma subspecialty care are not over-loaded with patients who are clearly stable.

[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, I talk with Suman Thapa about delivering glaucoma care in Nepal. This conversation took place long before the two massive earthquakes in 2015. I am happy to see that Suman is back at work caring for patients.

[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. 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. 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.

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.