A quarterly Ophthalmology & Optometry newsletter to update, inform & educate • Winter 2011 • Glaucoma We welcome your questions/comments to this e-newsletter. Contact Sheena: email@example.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, firstname.lastname@example.org Chatham, Ontario Staff Movember email@example.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%.