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Gleams
New Surgical Approaches J a n u a r y 2 011 v o l 2 8 n o 2
to Glaucoma
By Christopher Girkin, MD, MSPH

The adoption of new surgical established track record. The

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
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 Alternatives
Several 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

This issue of Gleams is made possible in part through a charitable donation from Pfizer Medical Education Group.
 PAGE 2
New Surgical Approaches to Glaucoma
Continued from page 1
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
Gleams
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.

Board of Directors Gleams Editorial Board

Kuldev Singh, MD, MPH John Hetherington, MD Editor in Chief

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, MD
H. Allen Bouch
C. Seth Cunningham
Timothy J. Dwyer
Adrienne Graves, PhD
John W. Grunden, PharmD
H. Dunbar Hoskins, Jr., MD Carl Migliazzo, MD
Linda C. Linck
Deirdre Porter Science Editor
Rhett M. Schiffman, MD, David J. Calkins, PhD
MS MHSA
Dennis E. Singleton Medical Editors
Robert L. Stamper, MD Amish Doshi, MD
Bill Stewart Terri Pickering, MD
Art Takahara Michael Sakamoto, MD
George E. Thomas
Robert Stamper, MD
Martin B. Wax, MD
Mona Zander
Staff Editor
Andrew L. Jackson
Robert N. Shaffer, MD
Founder (1912 — 2007)

GRF Catalyst Meeting:
Leading Experts Discuss New Directions
in Glaucoma Research
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
(L-R): Philip Horner, PhD (University of Washington),
Thomas M. Brunner, and Andrew D. Huberman, PhD
(U.C. San Diego)
PAGE 3
(L-R): Nick Marsh-Armstrong, PhD (Johns Hopkins), Martin
B. Wax, MD (University of Texas), and David J. Calkins, PhD
(Vanderbilt)
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.
 PAGE 4

People Making A Difference

Silicon Valley Lecture Enlightens with Promise
of Potential Surgical Breakthroughs

October 7th: Glaucoma Research Foundation’s Board of Transcend Medical—two companies that are
Chair, Kuldev Singh, MD, MPH presented the annual introducing new surgical treatment devices for
Daniel Scott Weston Glaucoma Research Lecture. glaucoma. Board members included Fred Brinkmann,
Hosted by Gladys and George Weston in their Adrienne Graves, PhD, Michael Penn, Sr. (with
Palo Alto home, the Beatrice Meadows) and Deirdre Porter.
Weston Lecture is Also attending were Nobuko Saito Cleary and
presented annually by Gary Cleary, PharmD, PhD—Co-chairs of our 2011
a nationally recognized Annual Benefit, scheduled for Wednesday, January
scientist or clinician to 26th at the Palace Hotel in San Francisco. Our special
showcase advances thanks to Dr. and Mrs. Cleary and to all the friends and
in our knowledge of supporters who joined us for this year’s Lecture.
glaucoma, particularly
Visionary Award Presented
in the area of new
to Deirdre Porter
therapies and progress Jane Weston, MD with
toward a cure. George Weston November 17th: Glaucoma Research Foundation
Dr. Singh’s topic: “Glaucoma Surgery: When Can We co-founder H. Dunbar Hoskins, Jr., MD presented
Expect a Breakthrough?” the Visionary Award to Deirdre Porter at a reception
It was an informative talk with a tone of cautious hosted by Manika Jewelry. The Visionary Award is
optimism in which Dr. Singh compared conventional a special recognition honoring a unique vision and
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 Deirdre Porter received The Visionary Award at ceremonies
and Visually Impaired in Palo Alto, Mike Nash from in San Francisco
iScience Interventional and Sean Ianchulev, MD Continued on page 5
 Gleams PAGE 5

People Making A Difference

Continued from page 4

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.

In Appreciation
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)

DISCOVERERS ($1 Million and Above) PRESIDENT’S CLUB ($1,000 to $4,999)

Mr. and Mrs. F. T. Barr
BENEFACTORS ($100,000 to $249,999)
Allergan Foundation
Paul S. May and Frank Stein
Charlot and Dennis E. Singleton
FOUNDERS ($50,000 to $99,999)
Ann and Emmett Skinner, Jr. Jr., MD, Robert Karp, Paul R. Lichter, MD,
PACESETTERS ($25,000 to $49,999)
Neighbor to Nation
Deirdre Porter and Bradford Hall
Estate of Dorothy E. Thew
Mona and Edward Zander
PATRONS ($10,000 to $24,999)
Abbott Medical Optics
Frederick Perkins CRUT
Pfizer Inc.
Kate Obstgarten Private Foundation American Conservatory Theatre, Aurea
SPONSORS ($5,000 to $9,999)
Philip M. Eisenberg Charitable Trust
Estate of Louis Jay Goldenberg
Trust of Dorothy Craumer Newlon
Margaret Oppenheimer Revocable Trust
OptiMedica Corporation
Union Bank
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,
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-KIND
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
 PAGE 6
Glaucoma Insights
Getting Help If You Have Low Vision
By Donald C. Fletcher, MD
and Kimberly A. Schoessow, OTD, OTR/L
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.
 Gleams
Jitterbug Phone Helps Mom
with Low Vision
By Deirdre Porter
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
Deirdre Porter 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 Phone
The 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 Options
Our 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
PAGE 7
The President’s
Message
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. Brunner
President and CEO
GRF Scientific Advisors Gleams
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Montreal Neurological Institute
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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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