Talking About Glaucoma (mp3)

Robert M Schertzer, MD, MEd, FRCSC

This is the mp3 version. From episode 30 onward this is the same as the AAC version. Prior to that, the AAC version had chapter markings.

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Intro: Welcome to Talking About Glaucoma episode #34 for May 7, 2021. Here’s another recording from the vaults that is getting to see the light of day. It is one of 3 episodes recorded in person back in late February 2020 just before Covid de-railed us all from business as usual. My apologies for the sound quality on this one; I was experimenting with a BOYA dual lapel mic, recording directly into my phone: big mistake! Future recordings from episode 37 onward will go back to my professional recording gear.Email me at podcast@iguy.org if you would like to be on the show to discuss a topic in glaucoma or if you have questions that you would like to have answered on a future episode. Check out WestCoastGlaucoma on Instagram https://instagram.com/westcoastglaucoma for some short-form videos that can also be found on my robschertzer YouTube channel. https://youtube.com/robschertzer where your subscription will help improve future content.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. I'm Rob Schertzer, a Vancouver, Canada based glaucoma specialist, podcaster and HealthIT expert, and we're...talking about glaucoma.Outro:That’s our show for today! Talking About Glaucoma is a podcast of indeterminate frequency and duration. It’s available for free on Apple Podcasts, Spotify, Google Podcasts, PocketCasts, and wherever fine podcasts are curated. Please rate the podcast on Apple Podcasts, subscribe to it, and tell your friends about it, so that it can reach more listeners. Follow me at WestCoastGlaucoma on Instagram, Talking About Glaucoma on Facebook and robschertzer on YouTube. Drop me a line at podcast@iguy.org with your show ideas or questions you would like to have answered on future episodes. Keep informed to prevent needless loss of vision from glaucoma, stay safe, wear a mask and get vaccinated. See you next time on Talking About Glaucoma.—————————————————————————About our guestDaniel Laroche is Director of Glaucoma Services and President of Advanced Eyecare of New York (https://www.advancedeyecareny.com). 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 (https://www.mountsinai.org/profiles/daniel-laroche2).YouTube videosCiliary Body Suprachoroidal Microtube https://youtu.be/34WPtWZ7SeECombined Goniotomy and SC Microtobue https://youtu.be/IVe95AvBHfAPublications by Daniel Laroche:Real World Outcomes of Kahook Dual Blade Goniotomy in Black and Afro-Latinx Adult Patients with Glaucoma: A 6-Month Retrospective StudyThe Aging Lens and Glaucoma in persons over 50: Why early cataract surgery/refractive lensectomy and microinvasive trabecular bypass can prevent blindness and cure elevated eye pressureCombination microinvasive glaucoma surgery: 23-gauge cystotome goniotomy and intra-scleral ciliary sulcus suprachoroidal microtube surgery in refractory and severe glaucoma: A case seriesClear Lensectomy, Goniosynechiolysis and Hydrus Microstent in a Patient with Mixed Mechanism GlaucomaPreserving vision in the COVID-19 pandemic: Focus on health equityCombined microinvasive glaucoma surgery in osteogenesis imperfecta patient with refractory open angle glaucomaReal-world retrospective consecutive study of ab interno XEN 45 gel stent implant with mitomycin C in black and afro-latino patients with glaucoma: 40% required secondary glaucoma surgery at 1 yearIntra-Scleral Ciliary Sulcus Suprachoroidal Microtube: Making Supraciliary Glaucoma Surgery AffordableA Novel Low Cost Effective Technique in Using a 23 Gauge Straight Cystotome to Perform Goniotomy: Making Micro-invasive Glaucoma Surgery (MIGS) Accessible to the Africans and the DiasporaA novel use of trypan blue during canalicular glaucoma surgery to identify aqueous outflow to episcleral and intrascleral veins—————————————————————————Production information:This episode was recorded February 28, 2020 during the Annual Meeting of the American Glaucoma Society in Washington, DC. In a first for me, I recorded direct to a Huawei Mate20 Pro running Easy Voice Recorder Pro using a BOYA BY-M3D dual lapel microphone. As you will hear, this was a mistake but unfortunately I used this same recording setup for the next two episodes as well. After that, I’ll go back to my Shure SM58 microphones and Marantz recorder!  Mixing and sound levelling were finally completed May 5, 2021 on an M1 MacMini using Hindenberg Journalist Pro software and Flux Software sound processing. 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.Robert M Schertzer, MD, MEd, FRCSCpodcast@iguy.org Twitter - https://twitter.com/robschertzeror http://iguy.tv/twitter Blog -     http://wholelottarob.comor http://iguy.tv/blogFacebook - https://facebook.com/talkingaboutglaucomaOffice website - https://westcoastglaucoma.comor http://iguy.tv/officeYouTube channel - https://youtube.com/robschertzerInstagram - https://instagram.com/westcoastglaucomaTheme music “Middle East Gold” ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr© 2021 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC—————————————————————————

May 8

20 min 42 sec

Intro: Welcome to Talking About Glaucoma episode #33 for December 31, 2020. I bet you're glad this year is over! I'm still digging through the vaults to post episodes like this gem and have a few more that will go live soon. Email me at podcast@iguy.org if you would like to be on the show to discuss a topic in glaucoma or if you have questions that you would like to have answered on a future episode. Check out WestCoastGlaucoma on Instagram https://instagram.com/westcoastglaucoma for some short-form videos that can also be found on my robschertzer YouTube channel. https://youtube.com/robschertzer. 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. Listen in as I talk with Gus.I'm Rob Schertzer, a Vancouver, Canada based glaucoma specialist, podcaster and HealthIT expert, and we're...talking about glaucoma.Outro: Talking About Glaucoma is a podcast of indeterminate frequency and duration. It’s available for free on Apple Podcasts, Spotify, Google Podcasts, PocketCasts, and many other podcast services. Please rate the podcast on Apple Podcasts, subscribe to it, and tell your friends about it, so that it can reach more listeners. Follow WestCoastGlaucoma on Instagram and Talking About Glaucoma on Facebook. Drop me a line at podcast@iguy.org with your show ideas or questions you would like to have answered on future episodes. Keep informed to prevent needless loss of vision from glaucoma, stay safe, wear a mask and get vaccinated. See you next time on Talking About Glaucoma.—————————————————————————About our guest:Gus DeMoraes: https://www.columbiaeye.org/profile/cgdemoraes?profile=researcherRelevant publicationsDE MORAES CG, Sun A, Jarukasetphon R, Rajshekhar R, Shi L, Blumberg DM, Liebmann JM, Ritch R, Hood DC. Association of Macular Visual Field Measurements With Glaucoma Staging Systems. JAMA Ophthalmol. 2018 Nov 8 [Epub ahead of print]Mavrommatis MA, Wu Z, Naegele SI, Nunez J, DE MORAES CG, Ritch R, Hood DC. Deep Defects Seen on Visual Fields Spatially Correspond Well to Loss of Retinal Nerve Fiber Layer Seen on Circumpapillary OCT Scans. Invest Ophthalmol Vis Sci. 2018;59(2):621-628Garg A, DE MORAES CG, Cioffi GA, Girkin CA, Medeiros FA, Weinreb RN, Zangwill L, Liebmann JM. Baseline 24-2 Central Visual Field Damage is Predictive of Global Progressive Field Loss. Am J Ophthalmol. 2018;187:92-98—————————————————————————Production information:This episode was recorded March 17, 2019 during the Annual Meeting of the American Glaucoma Society in San Francisco using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were finally completed December 30, 2020 on an HP Spectre x360 laptop using Hindenberg Journalist Pro software and Flux Software sound processing. Narration was overdubbed using an Audio-Technica ATR2100-USB.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, FRCSCpodcast@iguy.orgTwitter - https://twitter.com/robschertzeror http://iguy.tv/twitterBlog - http://wholelottarob.comor http://iguy.tv/blogFacebook - https://facebook.com/talkingaboutglaucomaOffice website - https://westcoastglaucoma.comor http://iguy.tv/officeYouTube channel - https://youtube.com/robschertzerInstagram - https://instagram.com/westcoastglaucomaTheme music “Middle East Gold” ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr© 2020 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC—————————————————————————iTunes Subtitle:A talk with Gus DeMoraes on the development of the Humphrey 24-2C testing strategy.iTunes Summary: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.I'm Rob Schertzer, a Vancouver, Canada based glaucoma specialist, podcaster and HealthIT expert, and we're...talking about glaucoma.

Dec 2020

13 min 53 sec

Intro:My apologies for the >1 year gap since my last episode. It's been quite the year moving my work back to full time in Vancouver and providing patient care in our new normal of a pandemic. There are many more episodes that have been recorded; I'll keep trying to get them posted more often. Email me at podcast@iguy.org if you would like to be on the show.In this episode, I talk with Won Kim, a glaucoma colleague based at Walter Reed National Military Medical Center and Hospital in Bethesda, Maryland, about why 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.Outro:Talking About Glaucoma is a podcast of indeterminate frequency and duration. It’s available for free on Apple Podcasts, Spotify, Google Podcasts, PocketCasts, and many other podcast services. Please rate the podcast on Apple Podcasts and tell your friends about it, so that it can reach more listeners. Drop me a line at podcast@iguy.org with your show ideas.—————————————————————————Production information:This episode was recorded March 16, 2019 during the Annual Meeting of the American Glaucoma Society in San Francisco using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were finally completed September 9, 2020 on a home brewed Windows X computer using Hindenberg Journalist Pro software and Flux Audio plug-ins. Narration was overdubbed using a Blue Yeti 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.Robert M Schertzer, MD, MEd, FRCSCpodcast@iguy.orgTwitter - http://twitter.com/robschertzer or http://iguy.tv/twitterBlog - http://wholelottarob.com or http://iguy.tv/blogFacebook - http://facebook.com/talkingaboutglaucomaOffice website - http://westcoastglaucoma.comor http://iguy.tv/officeTheme music “Middle East Gold” ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr© 2020 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC—————————————————————————Today’s guest:Won I. Kim, MDMD: George Washington University School of MedicineOphthalmology Residency: San Antonio Uniformed Services Health Education ConsortiumGlaucoma Fellowship: Bascom Palmer Eye InstituteCurrent: Program Director, Walter Reed National Military Medical Center, National Capital Consortium Ophthalmology Residencywonkim74@hotmail.com—————————————————————————iTunes Subtitle:A talk with Won I. Kim, a staff Ophthalmologist and Glaucoma Specialist at Walter Reed in Bethesda, MD, discussing combined minimally invasive glaucoma surgeries as an option for treatment of glaucoma that has failed traditional surgeries.iTunes Summary: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.

Sep 2020

13 min 12 sec

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 research, 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…and we’re Talking About Glaucoma.Talking About Glaucoma is a podcast of indeterminate frequency and duration. It’s available for free on Apple Podcasts, Google Podcasts, PocketCasts, and many other podcast services. Please rate the podcast on Apple Podcasts and tell your friends about it, so that it can reach more listeners. Drop me a line at podcast@iguy.org with your show ideas.—————————————————————————Selected links:https://aeriepharma.com/https://clinicaltrials.gov/ct2/show/NCT02246764—————————————————————————Production information:This episode was recorded March 2019 during the Annual Meeting of the American Glaucoma Society in San Francisco using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were completed June 2019 on an iMac using Hindenberg Journalist Pro software. Narration was overdubbed using a Blue Yeti 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.Robert M Schertzer, MD, MEd, FRCSCpodcast@iguy.orgTwitter - http://twitter.com/robschertzeror http://iguy.tv/twitterBlog - http://wholelottarob.comor http://iguy.tv/blogFacebook - http://facebook.com/talkingaboutglaucomaOffice website - http://westcoastglaucoma.comor http://iguy.tv/officeTheme music “Middle East Gold” ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr© 2019 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC—————————————————————————Today’s guest:Richard A. Lewis, MDSacramento Eye Consultants1515 River Park Drive, Suite 100, Sacramento, CA 95815Tel: 1-916-649-1515rlewiseyemd@yahoo.comhttps://www.sacramentoeyeconsultants.com/sacramento/our-doctors/richard-a-lewis-md.htm—————————————————————————

Jun 2019

12 min 13 sec

Intro:Welcome back to Talking About Glaucoma, a podcast of indeterminate length and frequency. I’m your host Robert Schertzer, a Glaucoma Specialist from Vancouver, BC Canada. To help produce future shows more frequently, I will no longer include artwork and chapter markings. Hopefully this will get me back on track to publishing new episodes each month this coming year. As always, contact me at podcast@iguy.org if you have a glaucoma topic that you would like to discuss with me on a future episode.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.Show Notes:This topic spans decades of work that began prior to his fellowship and resumed around the year 2000 as the imaging technology began to become available to prove the theory. Aqueous outflow drugs increase the outflow pulsatility, not just flow. Goldmann thought the TM was rigid preventing he and Asher from being able to explain the pulsatile nature of the flow. The ocular pulse drives movement of the TM, which is not rigid. The drugs that improve outflow, do so by altering the blood flow to achieve their effect. This is literally a stroke volume.The theoretical sensitivity to motion is in picometer with the newer phase-based OCTs, that of the movement of electrons in an atom, though practically we achieve nanometer resolution. This is sensitivity of motion of the TM walls, and not the resolution of an image.How does this flow vary by location within the angle and from moment to moment? This is a live dynamic process. They have published numerous studies in both normal and abnormal outflow patients. Questions to answer include how this flow is altered by laser, meds, stent procedures? Does the act of doing the measurements also alter the flow? It is non-contact and non-invasive therefore should not be altering the flow but white-coat syndrome could have an influence. Perhaps in the future, we can instill a drop in the patient’s eye, measure the change in pulsatile flow, and be able to tell whether a particular medication will actually be effective.We measure 12 seconds of 31 million seconds in a patient’s year when we check IOP several times per year. By determining pulsatile outflow we have the potential to achieve new diagnostic and treatment options for our patients. This is analogous to how cardiology is using imaging modalities in patient care.Selected References for this episode related to pulsatile flow:1. Johnstone MA, Grant WM. Microsurgery of Schlemm’s canal and the human aqueous outflow system. Am J Ophthalmol 1973;76:906-917.2. Johnstone MA, Grant WG. Pressure-dependent changes in structures of the aqueous outflow system of human and monkey eyes. Am J Ophthalmol 1973;75:365-383.3. Johnstone MA. Pressure-dependent changes in configuration of the endothelial tubules of Schlemm’s canal. Am J Ophthalmol 1974;78:630-638.4. Johnstone MA. Pressure-dependent changes in nuclei and the process origins of the endothelial cells lining Schlemm’s canal.5. Johnstone MA. The aqueous outflow system as a mechanical pump: evidence from examination of tissue and aqueous movement in human and non-human primates. J Glaucoma 2004;13:421-438.6. Johnstone MA. A New Model Describes an Aqueous Outflow Pump and Explores Causes of Pump Failure in Glaucoma. In: Grehn H, Stamper R, eds. Essentials in Ophthalmology: Glaucoma II. Heidelberg: Springer, 20067. Johnstone MA. Aqueous Outflow: The case for a new model. Review of Ophthalmol 2007;14:79-84.8. Schacknow P, Samples J, eds. Aqueous Veins. The Glaucoma Book. New York: Springer, 2010:65-78.9. Johnstone M, Martin E, Jamil A. Pulsatile flow into the aqueous veins: manifestations in normal and glaucomatous eyes. Exp Eye Res 2011;92:318-327.10. Li P, Reif R, Zhi Z, Martin E, Shen TT, Johnstone M, Wang RK. Phase-sensitive optical coherence tomography characterization of pulse-induced trabecular meshwork displacement in ex vivo nonhuman primate eyes. J Biomed Opt 2012;17:076026.11. Li P, Shen TT, Johnstone M, Wang RK. Pulsatile motion of the trabecular meshwork in healthy human subjects quantified by phase-sensitive optical coherence tomography. Biomed Opt Express 2013;4:2051-206512. Johnstone MA, Saheb H, Ahmed II, Samuelson TW, Schieber AT, Toris CB. Effects of a Schlemm canal scaffold on collector channel ostia in human anterior segments. Exp Eye Res 2014;119:70-76.13. Johnstone MA. Intraocular Pressure Regulation: Findings of Pulse-Dependent Trabecular Meshwork Motion Lead to Unifying Concepts of Intraocular Pressure Homeostasis. J Ocul Pharmacol Ther 2014;30:88-93.13. Sun Y, Li P, Johnstone M, K W, T S. Pulsatile motion of trabecular meshwork in a patient with iris cyst by phase-sensitive optical coherence tomography. Quantitative Imaging in Medicine and Surgery 2015;5:171-17314. Xin C, Wang RK, Song S, Shen T, Wen J, Martin E, Jiang Y, Padilla S, Johnstone M. Aqueous outflow regulation: Optical coherence tomography implicates pressure-dependent tissue motion. Exp Eye Res 2017;158:171-186.15. Carreon T, van der Merwe E, Fellman RL, Johnstone M, Bhattacharya SK. Aqueous outflow - A continuum from trabecular meshwork to episcleral veins. Prog Retin Eye Res 2017;57:108-133.16. Wang K, Johnstone MA, Xin C, Song S, Padilla S, Vranka JA, Acott TS, Zhou K, Schwaner SA, Wang RK, Sulchek T, Ethier CR. Estimating Human Trabecular Meshwork Stiffness by Numerical Modeling and Advanced OCT Imaging. Invest Ophthalmol Vis Sci 2017;58:4809-4817.17. Xin C, Song S, Johnstone M, Wang N, Wang RK. Quantification of Pulse-Dependent Trabecular Meshwork Motion in Normal Humans Using Phase-Sensitive OCT. Invest Ophthalmol Vis Sci 2018;59:3675-3681.Production information:This episode was originally recorded March 2016 during the Annual Meeting of the American Glaucoma Society in Ft Lauderdale using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY completed in November 2018 on a MacBook Pro and an iMac using Hindenberg Journalist Pro software. There was a great deal of background noise requiring generous use of noise gate and compression filters, with reverb added back to bring the voices back to life. Narration was overdubbed using a Blue Yeti 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.Contact information:Murray Johnstone, MDClinical ProfessorUniversity of WashingtonDepartment of OphthalmologySeattle, WA USAjohnstone.murray@gmail.comRobert M Schertzer, MD, MEd, FRCSCpodcast@iguy.orgTwitter - http://twitter.com/robschertzeror http://iguy.tv/twitterBlog - http://wholelottarob.comor http://iguy.tv/blogFacebook - http://facebook.com/talkingaboutglaucomaFacebook glaucoma support group - https://www.facebook.com/groups/glaucomapatientgroup/or http://iguy.tv/patientsupportOffice website - http://westcoastglaucoma.comor http://iguy.tv/officeTheme music “Middle East Gold” ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr© 2018 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSCClosing remarks:That’s our show for today. Thanks for your patience as I slowly post new episodes including a talk about the new glaucoma drug Rhopressa. Please rate this show on iTunes as this is the best way for other people to find the show.You can subscribe using iTunes, PocketCasts, GooglePlay, Stitcher or wherever fine podcasts are found, and new episodes will appear in your podcast player as they come out. Please tell your friends and colleagues about the show.Drop me a line at podcast@iguy.org with your comments, visit WholeLottaRob.com, WestCoastGlaucoma.com, or follow me on twitter @robschertzer. Links to all of these are in the show notes. Remember to keep fighting glaucoma by early detection so that nobody loses vision from this group of diseases.

Nov 2018

35 min 8 sec

In this episode, I’m talking with Ron Fellman from Glaucoma Associates of Texas about the Fellman Fluid Wave and its clinical implications in glaucoma surgery.Episode Chapters:Intro: Ron FellmanGlaucoma Associates of TexasFluid Wave: what it isRelated strictly to conventional outflowEvidence of patency of this systemWhen unroofing Schlemm’s canal a decade ago when viscocanalostomy was being popularized, injecting BSS you could see the outflow pathwaysAt times there would be no flow into the adjacent veinsWas I in the wrong spot?Five years ago during Trabectome, wondered if the outflow could be visualizedReduced the Episcleral Venous Pressure by putting patient into some raverse Trandelenberg and raised the bottle height to its highestYou don’t see this during normal phacoemulsification because usually you are forcing the Schlemm’s canal closedHow does the fluid get to the episclera?In Trabectome, adjacent to the tip, can see segmental fluid outflow if focus at the limbus; first let foot off the foot-pedal to drop the eye pressure and look for blood to reflux in to AC, then floor the pedal and if there’s a connection through to the collector channel, then the fluid gets through the episclera via deep venous plex, mid venous plexus and then to the episcleral venous plexus super highwayBlanching is occurring as all the blood runs out of the tissueImprove outflow where there isn’t or optimize existing flow? Aqueous wants to go out the path of least resistance  If you see a blanching it means the deep and mid venous plexus are both open and this is where the trabectome will work the bestThe blanching correlates best with the patients with the lowest IOP; averaging 11.9 on 1 med vs 19 on 3 medsZero re-op on those with good flow vs 36% in patients with a poor wave seen intra-operativelyHowever we still don’t have a way to modulate wound healing with a trabectome; so can still get granulation tissue that ruins the surgeryWould fluid wave work for other MIGS procedures?With circumferential sclerotomy see a near uniform fluid waveWith an iStent if you hit the right spot, usually won’t see more than 1 or 2 clock hours of a fluid wave; and this would only be seen AFTER the iStent is in place so you can’t do this BEFORE putting in the iStentWhat’s the outcome marker for MIGS surgery? With Trab, its bleb formulation; with MIGS don’t see something when the case endsReference:Episcleral Venous Fluid Wave: Intraoperative Evidence for Patency of the Conventional Outflow SystemFellman, Ronald L. MD; Grover, Davinder S. MD, MPHJournal of Glaucoma: August 2014 - Volume 23 - Issue 6 - p 347–350 Production information:This episode was originally recorded March 2016 during the Annual Meeting of the American Glaucoma Society in Ft Lauderdale using two Shure SM58 microphones with a Marantz PMD661 digital recorder. Mixing and sound levelling were FINALLY completed in January 2018 on an iMac using Hindenberg Journalist Pro software. Narration was overdubbed using a Blue Yeti 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.Ronald L. Fellman, MDGlaucoma Associates of TexasDallas office: 214-360-0000Plano office: 972-612-9522Fort Worth Office 817-923-2000rfellman@aol.comhttp://glaucomaassociates.com/glaucoma-specialists/ronald-l-fellman-md/Robert M Schertzer, MD, MEd, FRCSCpodcast@iguy.orgTwitter - http://twitter.com/robschertzeror http://iguy.tv/twitterBlog -     http://wholelottarob.comor http://iguy.tv/blogFacebook - http://facebook.com/talkingaboutglaucomaGlaucoma Patient Group (support group) - https://www.facebook.com/groups/glaucomapatientgroup/ or http://iguy.tv/patientsupportI am pleased to announce that I am returning to Vancouver, BC. Follow my website for the latest news and for Eye Facts for patients to learn more about glaucoma. http://westcoastglaucoma.com or http://iguy.tv/officeTheme music "Middle East Gold" ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr© 2018 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSCFuture episodes include a long discussion with Murray Johnstone and a talk about the new glaucoma drug Rhopressa. If you subscribe via iTunes, PocketCasts, GooglePlay, Stitcher or wherever fine podcasts are found, you will get the new episodes as they come out. If you like the show, please leave a rating on iTunes as this is the best way for others to find it and tell your friends about the show. Drop me a line at podcast@iguy.org with your comments, visit WholeLottaRob.com, WestCoastGlaucoma.com,  or follow me on twitter @robschertzer. Links to all of these are in the show notes. Remember to keep fighting glaucoma by early detection so that nobody loses vision from this group of diseases.

Jan 2018

19 min 38 sec

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.

Jul 2017

16 min

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.

Mar 2017

16 min 29 sec

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

Jan 2017

9 min 40 sec

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.

Mar 2016

13 min 43 sec

[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.

Aug 2015

17 min 31 sec

[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.

Nov 2014

16 min 1 sec

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.

Feb 2014

10 min 28 sec

In this episode, Dr Blumenthal and I discuss the not so obvious technique of peripheral laser iridotomy, emphasizing the shift away from the 12 o'clock position to a temporal location for most patients. We discuss the rationale for this shift, that includes the dramatic reduction in photopsias, as well as some tips and tricks in performing this technique.

Feb 2013

21 min 22 sec

In this episode, Dr Berlin and I discuss the elusive quest to have the Excimer Laser Trabeculostomy (ELT) that he pioneered gain traction after 30 years of development. (See the enhanced AAC version of this same episode for a version with chapter markers and images; not compatible on all devices but ideal version for iOS or computers.)

Jan 2013

10 min 38 sec

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! (See the enhanced version of this podcast for chapter markers and images.)

Feb 2012

8 min 47 sec

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.

Nov 2011

8 min 8 sec

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.

Aug 2011

10 min 3 sec

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.

Jul 2011

7 min 5 sec

In this episode, Dr Ehrlich and I discuss baseline corneal hysteresis and its relationship with the amount of IOP reduction in prostaglandin treatment. 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.

Mar 2011

7 min 19 sec

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.

Feb 2011

25 min 51 sec

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.

Dec 2010

27 min 17 sec

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

Aug 2010

16 min 36 sec

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.

Mar 2010

55 min 52 sec

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.

Jan 2010

18 min 4 sec

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. (See AAC version for complete show notes.)

Nov 2009

31 min 42 sec

In this episode, Cindy Hutnik and I discuss Central Corneal Thickness and how we use it as part of assessing patients with glaucoma.

Sep 2009

12 min 55 sec

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.

Aug 2009

25 min

Talking with Stephen Drance in part 1 of 2 about the Collaborative Normal Tension Glaucoma studies: how IOP effects NTG and the natural history of the disease.

Jul 2009

17 min 1 sec

Discussing the Disc Damage Likelihood Scale (DDLS) with Jeffery Hederer.

May 2009

12 min 29 sec

A talk with Mark Lesk on systemic vascular endothelial dysfunction and how this pertains clinically to glaucoma. The balance between vasodilation from nitric oxide and vasoconstriction from endothelin-1. 

Apr 2009

12 min 30 sec

A talk with Michael Coote on the GONE project to help ophthalmologists improve their skills in clinical assessment of the optic nerve.

Apr 2009

17 min 3 sec

A talk with Gustavo de Moraes on the predictive value of the presence of scotomas in both hemifields in patients with glaucoma.

Mar 2009

10 min 46 sec

Introduction to the concept behind this new podcast series.

Mar 2009

1 min 4 sec