Glaucoma Section Newsletter: Summer 2017

Published November 7, 2017

A message from the AAO
In This Issue

Message from the Glaucoma Section Chair

Glaucoma Section Happenings at Academy 2017 Chicago

Glaucoma Section Symposium Academy 2017 Chicago

Literature Review

Glaucoma Section Officers

Lauren Ristin, OD, FAAO

Lisa Young, OD, FAAO
Immediate Past Chair





Jennifer Brown, OD, FAAO

Sarah Dougherty Wood,

Cecelia Koetting, OD, FAAO
Communications Chair

Michael Sullivan-Mee,
Diplomate Chair

Andrew Rixon, OD, FAAO
Program Chair

Steering Commitee

Rex Ballinger, OD, FAAO

Anthony DeWilde, OD, FAAO

Austin Lifferth, OD, FAAO

Rob Morris, OD, FAAO

Jeffrey Walline, OD, FAAO
Academy Board Liaison
















Summer 2017

Message from the Chair

August 2017

Dear Glaucoma Section Members,

We are getting ready for Academy 2017 Chicago and another week of great glaucoma lectures, research and events. I first would like to thank the Glaucoma Section Executive Board for their tireless efforts in creating interested and exciting lectures and events, some of which are in collaboration with the Fellows Doing Research (FDR) SIG and the Scientific Program. While each member is incredibly busy with their own practices and individual pursuits, it is their continued efforts that create our Section's stellar lineup of events at each Academy meeting.

This year I would like to highlight a new project, our exhibit hall booth. This will be a great place to see and learn more about the Glaucoma Section and will be open during all exhibit hall hours. Please stop by to introduce yourself, sign up for our google group or learn about getting involved in the Section.

See you in Chicago!

Lauren Ristin, OD, FAAO
Glaucoma Section Chair

Glaucoma Section Happenings at Academy 2017 Chicago

Come visit the Glaucoma Section at the Exhibit Hall during Academy 2017 Chicago! We will be sponsoring 2 booths at the Exhibit Hall.

Bottoms Up IOP: a research collaboration between the Glaucoma section and Fellows Doing Research (FDR) Sig investigating the relationship between IOP and optic nerve head characteristics in response to inversion. Research subjects will have OCT images taken of the optic nerve, measuring blood pressure measurements and IOP readings while in a seated position. Then they will lay on an inversion bed at a 30-degree angle for 2 minutes, followed by repeat measurements of blood pressure and IOP. Please stop by during exhibit hall hours and participate in this fun and exciting research!

Glaucoma Section Informational Booth: Come learn about the benefits of being in the Glaucoma Section, sign-up to be part of our google group discussions, learn about becoming a Diplomate in the glaucoma section, hear about events planned for Academy 2017 Chicago and even give us suggestions. The booth will be available during Exhibit Hall hours.

We are looking for volunteers to help with both the research booth and the informational booth. If you have any interest in volunteering for the research booth, please email Dr. Lauren Ristin If you are interested in volunteering at the Information booth, please email Dr. Jennifer Brown

Quick List of Glaucoma Section Events: Come Join Us!

Glaucoma Section Symposium: MIGS: Emerging Technologies in Glaucoma Surgery
Wednesday, October 11 from 3 - 5 PM

Glaucoma Section Reception
Wednesday, October 11 from 5 - 6 PM

Rapid Fire: Gonioscopy's Critical Role in Glaucoma
Thursday, October 12 from 1 - 2 PM

Business Meeting
Friday, October 13 from 7 - 8 AM

Diplomate Prep Course
Friday, October 13 from 8 - 11 AM

Keys to Preventing Vision Loss in Glaucoma
Friday, October 13 from 3 - 5 PM

Bottoms Up IOP Booth: Research Booth in Collaboration with FDR SIG
Wednesday - Friday during Exhibit Hall Hours

Glaucoma Section Information Booth
Wednesday - Friday during Exhibit Hall Hours

Glaucoma Section Symposium Academy 2017 Chicago

MIGS: Emerging Technologies in Glaucoma Surgery

Evolving technologies in the field of micro-invasive glaucoma surgery (MIGS) have set the stage for a shift in treatment approach for qualifying patients with open angle glaucoma. It offers a welcomed new option for patients intolerant to medical management who lack the severity that necessitates the high risks of traditional surgical procedures. Optometrists must be prepared to accurately identify and selectively refer those candidates who would benefit most from this new technology.


Joseph Sowka, OD, FAAO

Joseph Sowka, OD, FAAO received his Bachelor of Sciences degree from Cornell University, graduating with Distinction in 1985 and his Doctor of Optometry degree from the Pennsylvania College of Optometry (PCO) in 1989. He completed a Residency in Primary Care at PCO (now Salus University) in 1990.

In 1992, Dr. Sowka accepted a university appointment at Southeastern University of the Health Sciences (now Nova Southeastern University). Dr. Sowka has been at Nova Southeastern for 24 years and is currently a Professor. He has developed and teaches the course in Glaucoma and Vitreoretinal Disease for the past 22 years. He is currently the longest tenured faculty member within the college. Dr. Sowka has authored numerous refereed journal publications and textbook chapters. Dr. Sowka is on the Editorial Review Board for Review of Optometry and is a Contributing Editor for that journal as well as numerous others. He is the lead author on The Handbook of Ocular Disease Management, now in its 18th edition. He also coauthors Therapeutic Review column in Review of Optometry. Dr. Sowka is a founding member of the Optometric Glaucoma Society (OGS) and the Optometric Retina Society (ORS) and an Executive Board member for both societies. He is currently the President of the Optometric Glaucoma Foundation. He is the Vice Chair of the Neuro-ophthalmic Disorders in Optometry Special Interest Group of the American Academy of Optometry.He is also on the Advisory Board and Professional Speakers Bureau for numerous companies. Dr. Sowka has lectured extensively nationally and internationally.


Brett G. Bence, OD, FAAO

Dr. Brett G. Bence is a partner, Director of Optometry, and serves on the Board of Directors at Northwest Eye Surgeons (NWES). NWES, founded in 1986, consists of 6 medical and surgical co-management centers around the Puget Sound area of western Washington State. He practices full time and limits his practice to medical and peri-surgical ocular care with a special interest in glaucoma.The practice has 4 Fellowship-trained glaucoma surgeons. Over his career, he has balanced patient care with nearly 200 lectures and scientific presentations at post-graduate educational and scientific meetings. He has served on the Board of Directors of the American Academy of Optometry since 2005, and as President for 2015&2016.

He is Board Certified by the American Board of Optometry. He was honored as the OD of the Year by the Washington Association of Optometric Physicians in 1997 and received the President’s Distinguished Service Award. In 2016, he received the Distinguished Alumnus Award from the University of Houston College of Optometry.

Madhu S.R. Gorla, MD

Dr. Madhu Gorla is a partner at Chicago Glaucoma Consultants.Dr. Gorla received his M.D. from Boston University, completes his internship at Mt. Sinai Medical Center (Cleveland) and performed his residency at Columbia University/St. Luke's Roosevelt Medical Center (New York) He completed both a neuroscience research fellowship at Harvard and a glaucoma fellowship at the University of Pennsylvania.

He is the Director of Medical Student Education and Clinical Assistant Professor at Rush University along with an assistant Professor in the Ophthalmology Department. Dr Gorla often lectures to medical groups, optometrists, and the general public covering various subjects about the eye.

He was a sub-investigator for the Ocular Hypertension Treatment Study, has written book chapters and numerous articles as well as being a reviewer or the Journal of Glaucoma.

Sarah Dougherty Wood, OD, MS, FAAO

Sarah Dougherty Wood, OD, MS, FAAO graduated with honors from IU School of Optometry. She completed a residency at the Kansas City VAMC and a two year research fellowship at the Boston VAMC. Dr. Wood also received a Master’s degree in Vision Science from NECO. She is a member of the Optometric Glaucoma Society and serves on the executive committee of the glaucoma section of the AAO. She is currently a clinical instructor of ophthalmology at University of Michigan’s Kellogg Eye Center where she focuses on glaucoma, research, and dry eye. In addition, she is a lecturer for KMK Educational Services.


Literature Review

Ganglion cell-inner plexiform layer change detected by optical coherence tomography indicates progression in advanced glaucoma
Shin JW, Sung KR et al.
Ophthalmology 2017; 1-9

Review and Commentary By Andrew Sacco, OD, FAAO

This study was retrospective in nature with study participants from one clinic in Seoul, Korea between the years of 2009 and 2016. Detecting progression in glaucoma is one of the challenges we face with this disease. Serial testing of retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) with OCT can be repeatable, sensitive, and show structural change in these tissues. Also, serial evaluation of RNFL thickness can be predictive of visual field progression.

However, progressive changes in the GCIPL in glaucoma have not been studied comprehensively. Thinning rates of the GCIPL and RNFL were compared in two groups of glaucoma patients- “progressors” and “nonprogressors.” Since many landmark glaucoma trials use VF as a primary outcome, progressors and nonprogressors were determined by VF testing using the Early Manifest Glaucoma Trial (EMGT) linear regression of VF index. 136 patients had macular cube scans utilizing the Guided Progression Analysis (GPA) tool of the Cirrus HD-OCT (Zeiss). Out of 196 eyes, 38.8% (76 eyes) showed progressive GCIPL thinning on GPA. GCIPL change detected by GPA showed sensitivity of 79% and specificity of 74% when used to predict VF change per the EMGT guidelines.

The rate of change of the GCIPL was significantly higher in the progressors than nonprogressors regardless of the severity of the glaucoma, and regardless of severity of the glaucoma, progressive thinning of the GCIPL had a higher probability of VF progression. Due to inter test variability and fluctuation in VF testing in those with advanced disease, VF testing has some limitations. Likewise, RNFL thinning as a determinant of progression is limited by the “floor effect,” in which further loss of tissue in advanced disease is difficult to detect. As the papillomacular bundle and GCIPL is relatively robust, it does not suffer from the floor effect as the RNFL does, is easily tested and is concentrated in the area frequently tested with 24-2 VF analysis, it may represent a better way to predict or monitor glaucoma progression. GCIPL testing is reproducible and doesn’t suffer from artifacts as glaucoma becomes more severe. One must account for age related physiologic loss of GCIPL as the Cirrus HD-OCT does not provide age adjusted results on GPA. Once adjusted for that, it may represent a new biomarker to predict glaucoma progression.