Thank you for attending our Blindness and Glaucoma Webinar on Friday, June 16. Please read on for the full transcript from the webinar.
ALEXANDRA LUZIER:
Thank you, everybody, for being here.
Thank you, and welcome to our blindness and glaucoma webinar. My name is Alexandra Luzier. I am the Vice President of Business Development and communications with accessible pharmacy services.
We are so so excited to have everybody here with us today, and especially to have these 2 incredible presenters with us.
Elena, Sterman and Dr. Shukla with us today to be speaking about all things regarding glaucoma in the blind and low vision world first, I wanna give a huge huge thank you to everybody for attending.
And I also want to give a huge thank you and excuse me to the glaucoma foundation, as well as to Columbia University's Irving Medical Center for putting this on with us today.
We had a thousand people register, and we're so so excited for the turnout.
So thank you. Thank you. Thank you for coming and spending your Friday afternoon or morning with us, depending upon where you are for those of you who are joining us for the first time.
We are accessible pharmacy services. We're a home delivery pharmacy.
We specialize in individuals who have a disability, and we are the only provider of its kind.
We are the largest blind owned healthcare company in the country.
We have done a few of these webinars before on various healthcare topics, ranging from eye drops to diabetes to breast cancer.
They have all been recorded, and they are all available on our website.
If you are interested in checking those out, our website is accessible pharmacy.com. Throughout this webinar.
Melissa will be here to supply us with ASL interpretation.
So thank you, Melissa, and this webinar is also, excuse me, also has live closed caption. After the webinar is over, in the next few days we will be sending out a follow-up email, so that follow-up email will have a few things.
It will have links to the video and audio recordings of the webinar as well as the video and audio recordings of the webinar as well as the transcript.
It's also gonna have recordings from the webinar, from our presenters as well as a chance for you to respond with feedback, which we really really encourage and appreciate. Before we get started I just want to run through some quick announcements.
Like, I said before, we do a few of these webinars throughout the year. We have set dates for the next 2 webinars for 2023.
On Friday, September 29, we will be having a webinar surrounding mental health.
On Friday, October thirteenth, we are gonna have one discussing clinical trials for the blind community.
Both webinars will feature experts from various organizations relating to those topics, and we'll have registrations open very soon for each of those webinars like, as I said before, all of our previous webinars were recorded, and are available in video audio and transcript form on our website, accessible pharmacy.
One of the ones we did last year. Was in collaboration with the Chicago lighthouse with optometrist, Dr. Kelly Scherer as well as their occupational therapist, Laura Hayes. They're phenomenal, and it was all about. Eye drops simply put. They talked about tips and techniques to administer, administer eye drops safely and effectively. It was super super informative, it was great. So if you're interested in learning more about that, webinar, please go check it out on our website.
Or if you just have questions about eye drops in general, we would love to discuss all of it with you.
Our phone number is (888) 633-7007
I also wanted to let everyone know that the Glaucoma Foundation has an upcoming webinar.
This Tuesday, June twentieth. Also surrounding eye drops, specifically minimizing adverse reactions from eye drops.
They have a stellar lineup of an individual speaking, and it looks fantastic.
So please, if you are interested in attending that event, please visit their website for that registration.
We also just launched our information for this year's blind health Expo, 2023. We were absolutely overwhelmed with the positive response that we got from last year's expo, which was the first time that we put on that event.
We had no idea what to expect, and I just want to say thank you to everybody who attended and participated in.
If you exhibited. Thank you. Thank you. Thank you as well.
The blind health expo is a completely virtual event. It's an online expo of healthcare information products, services and medication for individuals who are blind who are living in the low vision community as well as any disability community.
So this year will be a 2 day event running on both Friday, December first, and Saturday, December second.
Last year we had 120 exhibitors and thousands of attendees, so we are super excited to put on the event this year with everyone's feedback from last year and make it even bigger and better.
We already opened attendee Registration. It is free to attend.
We would love for you all to check it out, and that registration link is open and available on our website, accessible pharmacy.com more information on being an exhibitor will be available in the next few weeks.
So when that comes out in the next few weeks, please please check it out.
If you are interested. But yes, that is the blind health expo, free to attend, free to exhibit taking place virtually on Friday, December first, and Saturday, December second.
My last few announcements are really, really quick. We are expanding our services to support patients in other languages.
We're really excited about this. It's a natural parallel to what we currently do and the communities we currently service. And we will have more information on that coming soon.
We are also in the process of launching an incredibly robust and complex diabetes initiative for individuals living with diabetes as well as living with low vision.
I will have more information on that also very soon, probably in the next few months, and lastly, we are working to expand our work and outreach in the deaf communities as well.
We will also update more on that in the next few months. I'm just super super excited about all of it.
And I can't wait to share everything with all of you now to get to the webinar itself.
It is my absolute pleasure to introduce our first speaker, for today, as I mentioned before, we are doing this webinar in collaboration with the Glaucoma Foundation.
We are so thankful to have this webinar in collaboration with the glaucoma foundation. We are so thankful to have Elena Sturman with us to speak today. we've been friends with Elena for a while now, and we have participated in a few of her webinars.
So we are super honored to have her here with us, to speak about all the wonderful things that she does.
She is the President and the CEO of the glaucoma Foundation.
Elena is amazing, and she has over 20 years of experience in fundraising and executive management, and it gives me great pleasure to introduce her to speak about the glaucoma foundations background and all of their patient support services. As well, so please without further, ado Elena please take it away.
ELENA STURMAN:
Thank you so much. Alexandra, and thank you to accessible pharmacy to Andy and Alexandra for inviting me.
I'm delighted to be here with all of you.
Let me share my slides.
Let me try again.
Can you see my slides? Is it a full screen?
Perfect. Thank you very much. So my first slide shows the logo of the Glaucoma foundation and our tagline, our vision, your site.
And today I'd like to tell you a little bit about who we are and what we do.
So this slide shows all of our board of director, the Glaucoma Foundation was founded in 1984.
Widely misdiagnosed and grossly misunderstood.
We have come a long way since then, raising awareness about bringing more scientists, clinicians, and researchers to work in a field and creating many patient programs to date Glaucoma Foundation consists of 20 volunteers who serve on the board.
There are scientists and clinicians, business and finance directors, psychologists, communications leaders, and philanthropists at the head of the foundations are 3 world renowned Glaucoma specialists.
The first photo is the overall chairman, Dr. Gregory H. Harmon. The second photo is the founder of the foundation, will renowned glaucoma specialist, Dr. Robert Rich. He's also co-chair of the Scientific Advisory Board, and the third photo is of Dr. Luis Pasquale, who is co-chair of the Scientific Advisory Board, as well.
My next slide shows photos of our Scientific Advisory Board members.
Our Scientific Advisory Board comprises 36 experts from around the globe who work on the problem of glaucoma, and who help us identify and fund the most promising research in glaucoma
This flight shows the rendering of human head, and the connection of optic nerve from the eye to the brain, and in the last 39 years the glaucoma found foundation foundation has funded many, many millions in basic and applied research last year was our banner year, when it comes to fundraising we have committed over a million dollars in research funds that consists of our regular Grant funds.
Our name grants and our larger grants. For 2 years.
This slide shows a photo of a Think Tank in progress. Our annual international thinking is a meeting that brings experts from different fields from across the country, and around the globe to share their insights and to chart the course for future research.
Over the years these meetings have been incredibly successful, bringing many collaborations and getting past to many discoveries.
This slide shows anatomy over the human eye, and has towards education and outreach.
And that's what glaucoma found. Do we provide education and outreach for patients and physicians?
This slide shows a screenshot from the glaucoma foundation's website, the Glaucoma Foundation's website, www.glaucoma foundation.org has wealth of information, anything from the eye in its structure to latest research, to diagnosis and treatment of glaucoma and to very importantly patient center where patients can find a specialist, including a low vision therapist.
This slide shows images of the publications that Glaucoma Foundation produces.
Our Buy Monthly Newsletter goes to 16,000 households electronically.
And it's also available on our website, together with our live research and our patient guide doctor, I have a question. Both the newsletter and Patient Guide are also available in print for those who do not use the Internet or emails.
This slide shows a woman talking to 2 attentive listeners, and it says on top, Tell your story.
And that's what the glaucoma foundation does.
We encourage our patients to share their stories with our readership. Patients provide insight to one another, how to successfully live with his glaucoma, and how to manage self-care, and for physicians understanding, a patient's experience is the key step in providing patient-centric care.
This slide shows a man typing on the laptop, and it also shows a photo of. Dr. Aaki Shukla, and we provide support for our patients through our online support group that calls a Pop. And it stands for adult patients under pressure. Patients can connect with each other.
They can share their hopes and frustrations, share the latest medications and procedures, and whenever there is a medical question, Dr. Shukla moderates the group, and Dr. Shukla is a member of the Glaucoma Foundation's Medical Advisory Board.
This slide shows men watching his laptop watching a video on a laptop and taking notes a glaucoma foundation provides monthly webinars to our constituents, and in the last couple of years we have covered a myriad of topics anything from what the quote hands have to do with low glaucoma, and the slide shows the poster from that webinar to the body.
Eye relationship and the slide shows the webinar from the poster.
From that webinar, and the discussion between a patient and therapist of how to preserve your mental and emotional health while heading, and the slide shows a poster from that webinar.
Next slide shows a poster from a recent medical education webinar, a group of people listen attentively and all of the sponsors for the first time in history of the Glaucoma Foundation.
Last year we held a medical education symposium for both optometrists and ophthalmologists, where both groups were in the audience and presenters.
It was a very successful webinar; we were able to grant 220 CE credits and had close to 300 people in attendance, both virtually and in person.
My next slide shows a young teenager in headphones, looking at his laptop, and it also shows a poster from a new initiative that goes, start with the young.
This past January, the Glaucoma Foundation brought a brand new initiative.
We'll start with the young in partnership with Stem Institute.
It was geared towards middle school and high school students from underserved neighborhoods who are mostly Latinos and blacks.
The goal of this new program was to teach these youngsters about what glaucoma is for dangers.
It presents, and how important it is to get a comprehensive eye Exam. We hope that they will bring this message to their families, their loved ones, their parents, and their grandparents, and we continue this info session every year. This info session was run by Dr. Curios who is one of our minority glaucoma fellows.
A program is run with research to prevent blindness. And on this slide you see 7 of 9 fellows that you granted over the years.
We also administer our career advancement award in glaucoma research with research to prevent blindness and the slide shows the latest.
Our Dr. Matthew Van Hooke, from University of Nebraska.
This slide shows what women and different icons for social media poll, social media platforms, and TGF are on all of them.
We are on Twitter, TIKTOK, Instagram and Facebook.
That's a way we connect with our patient and we are even on TIKTOK
And this slide shows that Tiktok, icon and our tik tok Ambassador Jacquori Dpple, Jakori is a glaucoma patient, an artist, an educator, and a very very talented young man.
He creates a series of TIK TOKS for us about glaucoma, what is it? And what it isn't. His personal experience, and how to find trusted sources.
If you are on tik tok, please follow us. If your children are on tiktok, please tell them to follow us.
This slide shows a poster on a bus shelter that says she doesn't know it yet, but she's going blind, and that was part of our glaucoma awareness campaigns last January for glaucoma awareness month. We had a lot of posters like that. We also had billboards, and we had public service announcements on a local radio.
This slide shows an image of a white-haired man.
It shows an image of Ikea huntonometer, and it says, your Ioop rises and falls throughout the day.
How can you monitor its highs and lows of glaucoma? The Foundation has many partners.
One of the partners is a company called My Eyes. My eyes provide a home tonometer to patients for a short period of time, with the prescription from their physician.
What we learned during our partnership is that patients who need Ike are most often the ones who cannot afford.
So the glaucoma Foundation was able to secure a grant and provide Ikea to patients who are financially disadvantaged.
Rent- and to date with 35 patients, and many of them report that knowing when their Iop spikes has changed the course of the trip.
This slide shows posters from various events. I am very fortunate to travel around the country to talk about patient issues and meet with organizations whose mission is in line with ours.
This slide shows 3 pictures lying upside down on a couch, and it says, Sibling survey it also shows a pie chart of the other survey and the glaucoma foundation is very fortunate to provide surveys for our constituents.
That gathered the data that helps researchers and big Pharma to find the best way to allocate their resources and also the best way to advance patient care.
This slide shows the platinum seal of transparency from a candidate, a four-star charity navigator and a woman looking ahead. The glaucoma foundation relies on contributions from corporations foundations and many generous individuals to fulfill our mission. We are very grateful for their support and their confidence in our work. For our work we've been awarded the highest grades from 2 most trusted evaluators of nonprofits, candidate and charity navigator.
This slide shows a closeup of an artist broadcast, working on a painting.
And it says, visions for video and in August we will launch our fourth annual TGF are challenged to celebrate vision.
It's a fully digital peer-to-peer challenge fundraiser where amateur and professional artists could share their digital copies of art.
We play it on our website and each artist has his or her sub page.
When you go on a website, you can see artist Bio, and that is a photo.
But we pixelate the art and art only comes into focus when the fundraising threshold is met, and last year we were able to raise $85,000 through this challenge to support research.
And if we hope that those of you who are on this webinar will be interested to go on our website, we'll participate.
And my last slide again has the TGF logo, and I'm very grateful for allowing you to listen to me and to present today and thank you for your attention.
And now it is my great pleasure to introduce the next speaker, Dr. Aaki Shukla is a board certified ophthalmologist. Fellow, trained local man, cataract, surgery, and is the Leonard Loader, assistant Professor of Ophthalmology at Columbia University Medical Center, Dr. Shukla, published over 60 peer-reviewed articles, and her research interests include structure function relationships in glaucoma optimization of surgical outcomes and sustainability in ophthalmology.
She serves on the Ophthalmology Glaucoma editorial board, the World Glaucoma Association Associate Advisory Board, the AGS Glaucoma Screening Task Force, the AAO Sustainability Task Force, and the ASCRS Young Eye Surgeons clinical committee, and the glaucoma foundation medical advice report
Ladies and Gentlemen, please welcome Dr. Aaki Shukla.
AAKRITI SHUKLA, MD:
Elena, thank you so much for that very nice introduction I guess we'll launch into the presentation.
I'd like to first make sure that you can all see my slides full screen. Wonderful!
So thanks very much to accessible pharmacy. Alexandra and Andy, and the Glaucoma foundation for the opportunity to present to all of you.
Today, I'm really honored to have this opportunity to speak to such an important audience.
Our patients. So today we'll be talking about lifestyle in glaucoma.
We'll first go over the definition of glaucoma.
The epidemiology of this condition. Management goals in glaucoma options to fulfill these goals.
And finally, we'll talk about some of the lifestyle changes that patients, all of you ask us about in the clinic.
These include the use of vitamins, exercise, meditation, and yoga, whether quitting smoking will help with glaucoma, and whether the use of marijuana may enhance the treatment.
Of course, this list of questions is really much longer than what I have here, and I'm eager to learn more about what this audience wants to talk about.
Perhaps in future follow-up conversations. So this slide shows a picture of a glaucomatous optic nerve as well as a normal optic nerve.
And I want to tell you that glaucoma is often undiagnosed.
About half of those people who have glaucoma actually don't know that they have it, and one in 40 adults older than 40 years of age, have glaucoma with vision, loss glaucoma tends to not be symptomatic until late in its course of disease although some people have central visual field defects that can be symptomatic.
Early on, and sometimes patients describe symptoms such as hazy vision, or looking through a fog or a lot of glare being press that can be associated with glaucoma vision from glaucoma at this point cannot be recovered, although there are a number of promising studies, that show that probably in about 10 years time we will be able to provide some neuro enhancement or recovery of the vision loss from glaucoma.
The number of people affected by glaucoma will double in the next few years.
So right now, there are about 64 million people affected by glaucoma.
This was a measurement that was taken in 2013. This is projected to increase to 111 million people by 24.
So how is glaucoma defined? Glaucoma is a characteristic optic neuropathy, it's associated with a development of distinctive patterns of visual dysfunction, it's a degenerative disease of the optic nerve that presents to the physician at various stages. On this slide I have a photograph that shows the spectrum of disease in glaucoma.
On the left side is undetectable disease. This is the point in which we see accelerated retinal gaml and cell death, retinal nerve, fiber, layer changes, and eventually as we move to the right side of the picture, we go from undetectable disease which we can't find even on their best of instruments to asymptomatic disease which we know exists, but is not yet affecting the person's life, and finally, to functional impairment in which there are visual field changes that really are affecting the person's quality of life and functions.
Here I have a picture of a glaucoma optic nerve, as well as the macula.
This part of your retina. That's responsible for your central vision.
So what is your doctor looking at when they look into your eye?
So glaucomatous, optic neuropathy is defined by many of the features that we see here.
These include vertical elongation of the cup, which is a very central part of the optic nerve.
In this picture this part looks a little bit wider than the rest of the optic nerve, it's also defined by thinning or notching of the neuro retinal rim.
This is the orange part of the optic nerve that we can see here.
That's in the outer periphery of the white area retinal nerve fiber layer loss.
So this is projections of the optic nerve onto the retina, and this is lost in glaucoma.
We also see progressive change in glaucoma, and we like to measure any functional change in glaucoma on a visual field, testing.
Many of you who have had glaucoma are being screened for Glaucoma have undergone visual field testing, and we know that it's no one's favorite test.
But it is very helpful to us glaucomatous.
Visual field defects appear the way that they do in this photograph, which you can see on my slide shows a defect that respects the horizontal midline.
So the defect in this picture is all down below this is an inferior visual field defect, and you can see that it starts out near the nasal part of the person's visual field and then extends to the periphery, and is may be affecting the way that this person is reading, even walking down steps. There may be areas where this is not very clear, for this patient.
So, having this visual field provides the physician with some understanding of where the patient is having functional defects. And very importantly, it allows us to track these defects over time as patients typically, undergo serial visual fields.
Here I have a picture of a a visual field that starts out as normal and over time develops visual field loss, and in this series of 4 pictures we can see that eventually this person has developed severe damage from glaucoma.
And there's only 1 point in the center that this person is able to see out of within this eye, because of glaucoma's progressive nature.
Glaucoma treatment really aims to slow down the rate of visual function.
Loss over the participant's lifetime. An intraocular pressure reduction is the only known modifiable risk factor to slow the progression of glaucoma.
Essentially, we don't want any sort of progression to occur, and especially not progression to the point of having a significant effect on the person's quality of life.
The mainstays of glaucoma management include eye drops, laser.
That's done in the office or surgery that's done in the operating room, and the common goal of these treatments or these management options is to lower the intraocular pressure or eye OP and mitigate disease progression.
However this doesn't work for everyone, because some patients may not tolerate the medications.
Well, some may not get the expected treatment from their laser, and some may be poor surgical candidates, so really, for a variety of reasons, not a day goes by in clinic.
That patient is. Don't ask me, what more can I do for my glaucoma?
You know I'm using my prescribed medications appropriately.
I underwent the laser or surgery you asked me to do but I'm now wondering what sort of lifestyle changes can be done.
Can I undertake to change the course of my Az, and so, let's talk about some of those today, because our audience may be curious about this as well.
So this slide shows a popular meme in which there's a baby saying, what more can I do for my glaucoma?
Vitamins? The answer, so, vitamins for eyes are not a new concept, as many of you know, there's a formulation of vitamins that have demonstrated some benefit in preventing macular degeneration.
However, there's no currently there's no vitamin product that is shown a clinically impactful benefit in glaucoma.
Our group from Columbia University sat to test whether a combination of nicotinamide and pyruvate, which are both over-the-counter vitamin supplements would have a positive effect on visual fields in patients who have glaucoma on this slide I have a picture of an article that was published in 2022, on a short-term clinical trial, studying these 2 over the counter vitamins.
So what is the potential mechanism of nicotinamide and pyruvate in glaucoma?
And we know that glaucoma affects the mitochondria of retinal ganglion cells. These are cells that live in the rightina, and extend back through the optic nerve and connect to the brain. And we know that glaucoma negatively impacts the cellular metabolism and energy supply of these cells and a mouse model of glaucoma or at administration of these vitamins, nicotinamide and pyruvate prevented glaucoma in 93% of eyes. And on the slide I have heat maps of gene expression changes for nicotine mide. And we can see that the eyes that received nicotinamide were remarkably similar to the control group, and the same finding was seen in the mitochondria of the patient of the mouse eyes, and we can see that the mitochondria of the eyes that received nicotinamide was also very similar to the control eyes as opposed to the mitochondria of those eyes that had glaucoma and did not receive nicotine. Mine.
Who our study that was previously published was a placebo, controlled double masked, randomized, clinical trial.
So this means that patients and their physicians did not know whether they were receiving the vitamins or an inactive rice flour, pill, or placebo.
We assessed many patients for their eligibility in the study, and ended up randomizing 40. -two of them, either to the Vitamin group or to the placebo group.
Ultimately there was a 2 to one allocation with double the number of people in the Vitamin group as compared to the placebo, and in this table we can see that most folks had early to moderate glaucoma based on their visual field this table just has some baseline demographics with the average age, the average visual field score, etc., and essentially tells us that most folks at early to moderate Glock Home in this slide have our study's main findings.
So the primary outcome of the study was improvement in visual function, based on visual fields, and in this study we found that oral administration of 3 grams a day of nicotinamide or vitamin b 3 and 3 grams a day of
Pyruvate for 2 months led to the improvement of a median of 8 additional visual field test points.
As compared to Placebo. So patients who had taken these 2 vitamins for 2 months were able to see a few more points on their visual field tests.
This is pretty promising, as this has not been shown in prior trials such as this, so what are the next steps for the study?
So these findings that we saw in this short-term two-month study are now being looked at in a larger study with long-term followup and were aiming to determine whether the effect of nicotinamide in pyruvate these 2 over the counter vitamins, in addition to standard of care, pressure, lowering therapies has a positive effect on glaucoma.
Progression as compared to Placebo.
And this is the question that we're asking is whether these vitamins can slow functional and structural progression over a longer term duration we're going to be looking at function with visual field testing.
Which we went over a little bit earlier, and probably many of you are familiar with we're going to be looking at optic nerve structure with Oct.
Testing which gives us an analysis of the very important parts of the optic nerve.
The ones that are specifically relevant in glaucoma.
The measures that are specifically relevant in glaucoma.
We'll also look at the safety and tolerability of these 2 vitamins, and look at the potential effect that they may have on the quality of life of patients so essentially, we're going to screen these patients we're going to perform a baseline visit to confirm that they are in fact eligible for the study. Then half the group will be randomized for receiving the vitamins.
The other half will be randomized to receive the placebo and everyone's going to be followed for 87 weeks.
With these visual fields, the octs, the quality of life questionnaires, and so forth, and our eventual goal is to identify therapies for glaucoma that slow or reverse optic nerve damage by targeting possible ideologies of the condition rather than just lowering the eye pressure, which is what's currently. So let's get into some other options.
Other lifestyle changes that one could possibly make. How about exercise?
So there is some evidence to show that aerobic exercise may decrease the risk of vision loss from glaucoma, and the glaucoma patients with severe vision loss are actually less likely to be active.
Participants in this study by pretty Brahmlu from Wilmer, Johns Hopkins.
They found that participants who wore accelerometers for one week to measure daily activity and longitudinal visual field measurements were analyzed, and they found that those who had more steps per day, more moderate to vigorous activity per day and more non-credentary activity per day had slower visual field loss, so the more that you were moving around the less likely it was that your visual fields progress, and they specifically said that the rate of visual field loss was decreased by 10% and those who had an additional 5,000 steps daily or 2 and a half hours of non-sedentary physical activity. This is encouraging because physical activity, we know, is good, not only for the eyes, but also for the rest of the body and for overall health, but this is promising that physical activity may be a way to improve the ocular health as well what about meditation could that help so we know that meditation involves focusing or clearing your mind, using a combination of mental and physical techniques, deep breathing and concentration.
Meditation also has been found to have beneficial effects for overall well-being.
It's noninvasive. It's low risk.
Does it do anything in Glaucoma? So in this study 60 patients were opening Oklahoma, who were taking maximal topical Medicaidations.
They were on all the eye drops they could be on, and they were scheduled for trabeculectomy.
Surgery was included in the study about meditation.
So 30 so 30 patients, half the patients underwent 3 weeks of 45 min of daily meditation sessions, in addition to all the medical therapy, while the other group continued only the medical therapy and the type of meditation that they had was focused breathing and being attentive to the present movement. This was an activity that was done as a group.
This group found that, in addition to topical therapy, 45 min of this daily mindful meditation was associated with a five-point decrease in the intraocular pressure, so just by meditation, they were able to bring their pressure down by 5 points, this is about the same as an additional eye drop is able to bring their pressure down, so that was really pretty impressive.
They also looked at some pro inflammatory and anti inflammatory genes, and that they found that the meditation was associated with the down regulation of pro inflammatory genes in the upregulation of neuroprotective gene so essentially the meditation may have been bringing down an inflammatory state in the body, overall.
We know that mindful meditation is a low risk. Low cost activity may help reduce intraocular pressure, and it may also be beneficial to one's overall health.
How about Yoga? Would that help? We all go kind of takes things one step further, and in addition to the concentration and deep breathing one practices, physical poses are these beneficial and glaucoma?
Yoga is generally considered safe, except for positions in which the head is below the heart for any sustained period of time.
So in this study of 75 patients the pressure was checked before, during and after a headstand.
So all the subjects in this study were actually normal. They were not glaucoma patients, and all subjects, except for one, maintained a headstand.
For 5 min they found that there was an average increase in the intraocular pressure by 15 points.
Immediately following the headstand, and remained elevated for 5 min, and pressure actually doubled during the headstands.
The maximum pressure they saw was doubling to 44.
So in poses where the head is below the heart, and Yoga, for a sustained period of time we do not recommend doing those.
If you are a patient with glaucoma.
How about stopping smoking? Does that help? So this study of 12 million people found that smokers had a higher level of endocular pressure compared to non-smokers?
And they adjusted for a number of different things. So they took into account age, gender, glaucoma, other eththlthomic diseases, such as age-related macular degeneration, surgery, etc.
So smokers tend to have higher pressures and non smokers.
This study found that smoking more to greater thinning of the retinal nerve fibre layer, that very important part of the optic nerve that we were speaking about earlier, and these are the nerve tissues that carry signals to the optic nerve so we know that there are many factors that affect deterioration in glaucoma.
But smoking is one that's really modifiable.
So we absolutely recommend that you stop smoking for your glaucoma and also for your overall.
Health smokers are having increased risk of developing all types of glaucoma.
Heavy smoking leads to higher risk of developing glaucoma and even cutting down how much you smoke really could help.
How about marijuana patients ask us about this all the time.
Does this provide a therapeutic benefit in glaucoma?
So we know that marijuana is made of the plant cannabis, sapia, which has 2 potent compounds, Thc.
And Cbd. Tc. Is what's responsible for the psychotropic effects that we always hear about with marijuana and actually might lower the pressure in some people.
Cbd actually can increase the pressure in some people.
The mechanism of pressure, lowering with either of these compounds, especially with Tt.
Is not well understood, but we think that maybe these cannabinoid receptors are in a ciliary body to regular mushrooms. Canal.
All these parts of the eye that are important in glaucoma pathogenesis, and they may affect aqueous production and outflow.
So, who are kind of people, are interested in marijuana for glaucoma.
There was a study that was performed on this, and they found that intentions of using marijuana.
For glaucoma was significantly associated with perceptions of its legality and acceptability.
False beliefs about marijuana use for glaucoma, treatment and satisfaction with the current glaucoma management, as well as costs of treatment, perceptions about marijuana, safety systemic adverse effects of marijuana were not really found to be significant so people aren't really thinking as much about what marijuana could do to the rest of your body, and what smoking can do to the rest of your body when they're making these decisions.
In 2,010 the American Glaucoma Society, which is the largest society of fellowship, trained glaucoma specialists in the United States, made this statement about Marijuana and its use in the treatment of glaucoma.
So let's break this down a little bit. So first of all, can marijuana lower the eye pressure.
In 1971. They did a study. I've said he was done.
That showed that marijuana smoking and normal volunteers, was found to lower the intraocular pressure by 30%.
About a decade later there was a better design study, a placebo control trial of Thc.
The one that at a part of Marilya that has psychotropic effects, and they found that the pressure was reduced from 28 down to an average of 22.
With this drug. Then they tried eye drops of Thc.
And in this study they did not find any lowering of eye pressure, but they did find that the eye drops made the ice very red.
Then there was another trial. Crossover trial on Thc.
Again, and they had only 6 patients in this study, and they found that this drug really did not lower the pressure much at all.
So let's talk about whether marijuana can raise the eye pressure.
So cannabis oil, which acts as the antagonist on the Cb.
One receptor may actually increase the eye pressure in 2,006.
There was a study that found that cannabis dial actually raised the pressure compared to Placebo in 2018 a study found that when Cannabadiol was administered with Thc.
It negated the pressure lowering effects of Tc. So, in conclusion, we really just don't know whether it's going to lower or increase the pressure.
And let's talk about its side effects. So marijuana is an unregulated botanical its potency has increased from the early 19 eighties to now from about 1% to 33%.
The potency of Ttcbd. And the potential for contaminants, such as pesticides and other molecules, vary by strain, and there are also numerous drug drug interactions, drug vehicle interactions, trotogenicity and penetration into breast milk all these
things are really unknown about this unregulated product. It also has a short duration of action.
So its peak effect in lowering the eye pressure is at about an hour to an hour and a half.
After we've taken it, and it has only a short duration of action.
So only 3 to 4 h. So imagine having to use any eye drop, you know, 6 or 8 times a day.
Most of us would probably not choose that treatment, so if you were to use marijuana you'd have to use it every 3 or 4 h for it to really have any significant effect on your eye pressure, whether it's an increase in eye pressure or a decrease in eye pressure, and this is also not very cost effective. There haven't been any well designed studies on the use of marijuana.
They all have a small sample size, which means that not many people were participating in them.
And there's a lot of pressure fluctuation in the studies that are available pressure going up or pressure going down.
So there's really a lack of evidence that shows that marijuana alters the course of glaucoma.
At this point. It's really impossible to separate the potential clinical action from the undesirable behavioral effects of marijuana and there are also so many social effects. We know that car accidents doubled after the legalization of marijuana in Colorado emergency room visits for injury, psychiatric and other medical issues are also higher end users versus non-users of marijuana and even if there was a non-zero tropic version of marijuana that were created. It has a very short duration of action.
So you'd meet. That would mean that you'd have to use it 6 or 8 times a day in order for it to be effective In lowering the eye pressure.
So the American Glaucoma Society does not recommend the use of this drug in any form for the treatment of glaucoma.
So overall in summary. We've talked about many unconventional options as complementary treatments for glaucoma.
These are topics that come up on a weekly basis in our clinic.
So what are our takeaways here? Our group of Columbia, Columbia, is trying to understand whether vitamin supplements can slow the rate of glaucoma progression, whether aerobic, other groups have looked at whether aerobic exercise and meditation may be helpful we know that Yoga is probably fine for the glaucoma patient for the most part, as long as it does not involve positions where your head is below your heart, and quitting smoking is important for glaucoma and your overall Health. We don't think that marijuana will provide any benefit for your glaucoma. And in about 50% of patients, you can actually raise your eye pressure.
We recommend continued close care with your ophthalmologist as recommended.
If you're taking Glaucoma medications, take these on time each day, and if you're taking other stomach medications, do the same for that, and take care of your overall health, which includes your mental health, because all of these treatments and diagnoses can take a toll on us and please take some time every day to help yourself in that way.
Thanks very much for listening to this presentation and I'd like to thank the glaucoma foundation as well as accessible pharmacy for your support.
And specifically, the glaucoma foundation for its support of groundbreaking research, including our vitamin trial that I discussed today.
Thank you again.
ALEXANDRA LUZIER:
Awesome. Thank you so much. Let me get this together. Thank you. Thank you.
Thank you to both of you. Thank you, Elena and Dr. Shukla for doing this with us today. Elena and her work with the Glaucoma foundation.
Elena, thank you for speaking and sharing all that information, everything the glaucoma foundation does is incredible.
Please check out their website. And all their upcoming episodes and their webinars, and Dr.
Shukla. Thank you. Thank you so much. Your presentation was wonderful.
I learned an incredible amount, I'm sure I'm speaking for everybody when I say that.
Thank you for all the work that you do, and thank you for being here and discussing it with us.
You both are absolute rock stars. We're so thankful and excited for having you both in our community.
Thank you for everybody for attending. I hope that this was a really really helpful experience, and Webinar, I also want to extend huge gratitude to Melissa for her interpretation over the past hour, and for helping us with the accessibility of this webinar as I mentioned earlier I will be sending out a follow-up email in the next few days.
That will have. First, it will have the recorded video and audio of this webinar, as well as the transcript, so that you can go back and have access to the webinar in the future, and then other than that those were recordings will also be available on our website accessible pharmacy.com as well as our Youtube page. Also, when you get the follow up email, please go ahead and respond to it and let us know your feedback on the accessibility of this webinar as well as how we can make programs like this more accessible in the future.
And any ideas you have for future speakers and future topics.
We would love to hear from you and I would just like to say, before we leave, if you are not a patient of ours here at accessible pharmacy, we would absolutely love for you to join us.
We learn about how to support more patients by listening to our current ones.
So we would love for you to join our community and give us your feedback as a patient, so that we can learn how to be more accessible and learn about other services that we should be providing if you are a provider, and believe that we have patience that would benefit from our services, please don'thesitate to reach out to us as well. We would love to hear from you please don't hesitate to reach out to us as well. We would love to hear from you, too, so the easiest way to work with us is to simply call us at 8 8 6 3 3 7 0 0 7! Alright. Thank you for attending today. This was our blindness and Glock home a webinar. We were so happy to put it together for you.
And have you all attend. Thank you, Elena. Thank you. Dr. Shukla, and thank you, Melissa. Please check out our information on our website for the upcoming Webinars in September as well as October and the Blind Health Expo at the end of the year other than that we will be in touch with the follow-up email and have a great weekend.
Bye, everybody!
ELENA STURMAN AND DR. AAKRITI SHUKLA:
Thanks very much.