Ophthalmology conference strives for glaucoma solutions

Gary Abramov is CEO of PBI Ophthalmic. (Courtesy photo)

Glaucoma is the second leading cause of blindness in the world. As the pressure inside the eye builds up, the optic nerve is affected, which leads to its slow degradation and ultimately, its death. There are no early symptoms, no pain or frequently, even discomfort, while the sufferer’s vision gradually declines. Glaucoma is a chronic disease and is not currently curable. It affects primarily people over 40, although even small children sometimes are affected as well. In San Diego County, about 50,000 people over the age of 40 are at risk.

Glaucoma impacts five million people in the U.S. alone and costs the U.S. government an estimated $2.9 billion annually, according to Prevent Blindness America. The worldwide number of sufferers is close to 67 million, according to the Glaucoma Research Foundation. In addition, an estimated two million Americans have an elevated intra-ocular pressure (IOP), which is a precursor to glaucoma, and most do not know it.

Because glaucoma does not present outward symptoms, its early diagnosis, monitoring and management are of paramount importance.

It is also estimated that the cost of caring for a patient who has been diagnosed with an early stage glaucoma is relatively low, on the order of $700 per year for medicines and physician office visits.  On the other hand, the U.S. Department of Health and Human Services statistics show that on the average, the cost to society when an American goes blind at age 45 is upwards of $1 million over the remainder of that person’s lifetime (average 30 years).

Glaucoma is managed with several medications and also surgery to restore draining of the eye to relieve the pressure inside. A tiny tube can be implanted in the eye to provide drainage, or a small incision can be made to allow fluid to drain from the inside of the eye.

New treatments are on the horizon. At the recent American Academy of Ophthalmology conference in San Francisco, I attended presentations focused on new surgical techniques and medications. This conference attracted over 1,500 ophthalmologists from all over the world.

On the technology front, researchers from the University of Southern California presented a concept for a novel ultra-miniature pump, which would inject minute amounts of drugs directly into the eye to manage glaucoma. The pump would be similar to the implantable insulin pumps for diabetics, but orders of magnitude smaller. This tiny pump would be implanted into the back of the eye, between the muscles that move it.

The pump uses an ingenious method of expelling drugs: it uses electricity to first split water into oxygen and hydrogen which then expand and push the liquid drug out and into the eye. Since the eye actually needs a tiny (nano-liters) amount of drugs to control glaucoma, the pump would contain enough drugs to last several months and then can be refilled, without removal, with a small needle. Innovations like these hold promise for glaucoma patients’ improved care and convenience.

Also, there was also a somewhat humorous, but at the same time alarming, presentation about people having trouble putting drops in their eyes. It was very apparent that the majority of people, including some doctors, cannot properly instill eye drops: they miss the eye altogether, touch the eye with the tip of the dropper (increasing the risk of contamination), and use (waste) too many drops. This is very serious, because using medication continuously is of paramount importance to the maintenance of glaucoma. Also, if a medicine is used up faster than planned (by using, say, three drops instead of one), the patient may end up without medication for a while, since insurance may not reimburse it out of schedule. At $1,000 per ounce, the glaucoma medicines are literally ‘liquid gold’ and very few patients can afford them without assistance. So learning to use the medicines properly is very important.

The concurrent ophthalmic equipment show boasted the newest advances in the ophthalmic diagnostic and treatment equipment. All major international equipment makers were present with many extremely sophisticated device offerings. The latest in digital image processing, optical metrology and ultrasonic imaging are being utilized in the diagnosis and treatment of eye diseases. The technical sophistication of some of the instruments is simply amazing: it draws on the latest advances in applied physics, computer-, and life sciences. Even traditional cutting instruments, like scalpels are proposed to be replaced with ultra-precise plasma micro-knives operating with minimal adjacent tissue damage which helps healing.

Our own San Diego Eye Bank also had a booth at the show, and reminded me of the importance of being a cornea donor: there are close to 50,000 cornea transplants performed annually in the U.S., saving the eye sight of many grateful people.

Gary Abramov is CEO of PBI Ophthalmic, a medical device company developing novel eye care diagnostic devices, most of which are for use with children. The company is currently developing a new portable tonometer device for diagnosis of glaucoma.

Tags: American Academy of Ophthalmology, glaucoma, Glaucoma Research Foundation, PBI Ophthalmic, Prevent Blindness America, San Diego Eye Bank, SDNN, U.S. Department of Health and Human Services, University of Southern California

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