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					                A quarterly Ophthalmology & Optometry newsletter to update, inform & educate • Winter 2011 • Glaucoma




                      We welcome your questions/comments to this
       e-newsletter. Contact Sheena: sheena.heuvelmans@anjemaeyeinstitute.com
                     Please visit us at: www.anjemaeyeinstitute.com


I want to thank you for taking the time to attend the Fall
Seminar Series. We had many wonderful conversations about a variety
                                                                                                                                  Eyemaginations
of topics. To recap, we reviewed the indications for the new istent, a                                                            Eyemaginations has been
microbypass stent used to treat open angle glaucoma either at the time
                                                                                                                                  added to our website for your
of cataract surgery or on it’s own. We reviewed the findings of the the
                                                                                                                                  patients to learn more about
CRUISE-BRAVO study which showed that treating retinal vein occlusions with
                                                                                                                                  their eye diseases. It is web
intravitreal anti-VEGF drugs accelerate a patient’s gain in visiual acuity in
                                                                                                                                  based, narrated with a free
combination with reduced macular edema. This study demonstrated that
rapid treatment of CME from VO enables a more complete recovery of vision.                  Private Practice                      interface in which patients can
                                                                                                                                  learn about their eye problems.
At AEI, we guarantee that we will treat your patient within 7 days of referral.
Finally, we reviewed many cases of conjunctival and oculoplastic lesoins,
                                                                                            Locations                             Patients or family members
ranging from benign to the very sinister and deadly. Thank you for attending                                                      go through our website as
                                                                                            Chatham
these talks. I appreciate the opportunity to teach you, and the time that you               209-857 Grand Avenue West,            the portal to free education
take to meet our staff, who attended the CME events.                                        Chatham, Ontario N7L 4T1              loops - between 1-2 minutes on
                                                                                            Ph: 519-380-0008                      anything eye related.
Further, I thank you for your support of my Movember efforts. Thanks to you,
                                                                                            Fax: 519-354-9982
we raised over $14,000 dollars, which placed us in the top 100 teams out                                                          Please feel free to use this
of 110,000 teams in Canada.                                                                 Cell: 519-809-3097
                                                                                                                                  for your practices, or for your
                                                                                            Sarnia                                patient education.
Again, thank you very much.
                                                                                            150 Christina St. N. (Bayside Mall)
  Kindest regards,                                                                          Sarnia, Ontario N7T 7W5
  Dr. Christopher M. Anjema, MD, FRCSC                                                      Ph: 519-336-6556
  Chief of Ophthalmology,
                                                                                            E Referral (non emergency):
  Chatham-Kent Health Alliance,
                                                                                            dr.anjema@gmail.com
  Chatham, Ontario                                     Staff Movember                       chrisanjema@hotmail.com


    The new building. Exterior and interior, the front desk/waiting room.
istent: A clinically
                                                                                    Please join us for an
significant, novel
                                                                                    update in Ophthalmology
therapeutic approach                                                                6:30 Reception
Cataract and glaucoma frequently occur in the same patient                          7:00 Dinner & Discussion
especially as our Canadian population continues to age.                             Chatham        Wednesday, May 4                        Rossini’s Restaurant
Studies have shown that cataract surgery alone is capable of
modestly reducing IOP and minimizing the patients need to be
                                                                                    Sarnia         Wednesday, May 11                       On the Front Restaurant
on numerous glaucoma meds to control intraocular pressure                           Tecumseh       Wednesday, May 18                       La Cucina
(IOP). Questions continue to be raised as to the longevity or the
reduction of IOP, the effect on diurnal pressure control, and the
outcome of how low IOP can be achieved.
                                                                                         pts. with POAG who were taking multiple medications and were to undergo
                                              Recently in July of 2009 a new             phacoemulsification were included. Fea compared phacoemulsification alone
                                              minimally invasive ab interno device,      (control group vs. phacoemulsification with implantation of istent (combined group).
                                              istent was approved by HPB in July of      At 15 months postoperatively the mean IOP in the combined group was 14.8 +- 1.2
                                              2009. It is still waiting approval by      mmHg (from a baseline 17.9mmHg +- 2.9mmHg) which was statistically lower
                                              the FDA which is expected to be in         than the IOP in the control group (15.7 +- 1.1 mmHg, from a baseline of 17.3 +-3
                                              early summer of 2011. It is to date        mmHg. Subsequently after a 1 month washout of all ocular hypotensive medications
                                              the smallest medical device 1mm to         for 1 month (16 months after surgery), the mean IOP in the combined group was
                                              be implanted in humans. The istent is      16.6mmHg +-3.1mmHg which was statistically significantly lower than the mean
                                              indicated for use in conjunction with      IOP of 19.2 +- 3.5mmHg in the control group. Fea also observed that both groups
                                              patients undergoing cataract surgery       used fewer medications, but after 15 months 24% of pts in the control group were
                                              for the reduction of IOP in patients       free of drops compared to 67% in the combined group.
                                              with mild to moderate open angle
                                              glaucoma currently treated with ocular     Istent re-establishes natural physiological trabecular outflow, and it leaves the
                                              hypotensive medications.                   conjunctiva untouched and avoids the complications risks associated with filtering
                                                                                         blebs. Thus istent represents a novel therapeutic approach that provides clinically
                                               Istent is implanted through the same      significant reductions in IOP and potentially medication use.
                                               clear corneal incision (minimum
                                               1.5mm) and designed to fit the
                                               anatomy of the eye’s outflow system.
                                               It’s purpose is to stent open the
                                               trabecular meshwork (TM) thereby
                                               re-establishing natural continuous           IOL Master V. 5.0 enhances
physiological outflow facility of the aqueous humour through the canal of Schlem
located behind the TM therefore reducing IOP. The device is L –shaped, a half pipe          optical biometry
lumen design is 1mm in length with rails not to block collector channel and allows
                                                                                            A drawback of the older version of laser optical biometry is the failure to achieve
bidirectional flow of the aqueous fluid. It is made of heparin coated titanium which
                                                                                            measurements in approximately 15% of the eyes because of dense cataract,
is non-ferromagnetic and will not interfere with MRI.
                                                                                            vitreous hemorrhage, retinal thickening
Since istent approval in Canada and Europe numerous studies have been                       of the macula, or scars on the cormea
conducted. A prospective, non-randomized, uncontrolled, multicenter study in                or other less common causes. In most
Europe by Speigel et al published in the European Journal of Ophthalmology                  cases dense cataract, such as mature
2009, involved 58 pts. with uncontrolled primary open angle glaucoma (POAG)                 white cataract, and especially posterior
(subjects had pigmentary glaucoma and pseudoexfoliation). Patients underwent                subcapsular cataract, is the reason for
clear corneal phacoemulsification followed by implantation of istent. The mean              meausurement failure. The IOL Master
IOP reduction achieved from istent (baseline 21.7 +- 3.9) at 24 months was 16.9             V. 5.0 enhances optical biometry,
which showed a 5 mmHg drop, and the decrease in glaucoma meds (baseline                     resulting in fewer failures in eyes with
mean # of meds 1.6) at 24 months they were at 0.4 and with patients who had                 severe cataract. This improvement was
achieved an IOP < 18mm Hg were medication free.                                             most noticeable in eyes with posterior
                                                                                            subcapsular cataract, in which the
In Italy, Fea recently published in Journal of Cataract and Refract Surgery 2010,           proportion of measurement failures was
enrolled 36 pts., it was a prospective randomized, double masked study,                     reduced by approximately 50%.

				
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