Feb 21 2022 30 mins
TAG #35 GEDDE Steve - Glaucoma surgical trials: lessons learned
Intro:
There have been many trials proving surgical intervention does indeed reduce the risk of progressive glaucoma damage for our patients. These include Treatment vs No Treatment studies as well as studies that compare different types of treatment. In this episode, I talk with Steve Gedde, from the University of Miami's Bascom Palmer Eye Institute, about lessons learned from these clinical trials.
We begin by discussing the importance of Randomized Clinical Trials as the highest evidence-based medicine to compare treatments.
Studies that we discuss include: the Fluorouracil Filtering Study Group; Tube vs Trab (TVT); Primary Tube vs Trab (PTVT); Ahmed Baervedlt Comparison (ABC); Ahmed vs Baerveldt.
Some of the concepts and lessons learned include: reducing IOP prior to surgery to lessen the risk of choroidal hemorrhage from a sudden IOP drop; trabeculectomy offering titratable control that MIGS procedures do not; that it's harder to get a 20% reduction in IOP to count as a success if the IOP is lower than 25 pre-op; that Ahmed Valves have a better safety record but Baerveldt better pressure-lowering; and that antimetabolites have been shown to NOT be effective for tube-shunt surgery.
There's quite a bit of information packed into this episode so I suggest checking the program notes for links to some relevant articles and presentations related to this topic.
I'm Rob Schertzer, a Vancouver, Canada based glaucoma specialist, podcaster and HealthIT expert, and we're...talking about glaucoma.
Outro:
Talking About Glaucoma is a podcast of indeterminate frequency and duration. It’s available for free on Apple Podcasts, Spotify, Google Podcasts, PocketCasts, and many other podcast services. Please rate the podcast on Apple Podcasts, subscribe to it, and tell your friends about it, so that it can reach more listeners and encourage me to continue to produce new episodes. Follow WestCoastGlaucoma on Instagram and Talking About Glaucoma on Facebook. Drop me a line at [email protected] with your show ideas or questions you would like to have answered on future episodes. Keep informed to prevent needless loss of vision from glaucoma. See you next time on Talking About Glaucoma.
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Steve Gedde is Professor of Ophthalmology, the John G. Clarkson Chair in Ophthalmology, Vice-Chair of Education and Residency Program Director at Bascom Palmer.
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We spoke in February 2020, one of three interviews I recorded at the last in-person American Glaucoma Society annual meeting prior to Covid. My apologies that all of these recordings were made using BOYA Dual Lapel USB-C BY-M3D mics plugged into an Android phone instead of my usual professional set-up. I've done my best to make the audio quality acceptable but the sound quality is not up to my usual high standards. Fortunately there is just one more episode with this low quality...so be sure to subscribe so you can get the good stuff when available.
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I'm Rob Schertzer, a Vancouver-based Glaucoma specialist, EMR guru and tech geek and we're...talking about glaucoma.
About Steve Gedde:
https://doctors.umiamihealth.org/provider/Steven+J+Gedde/524953
Professor of Ophthalmology
John G. Clarkson Chair in Ophthalmology
Vice Chair of Education and Residency Program Director
Selected references:
This link may have restricted access to American Glaucoma Society members. It is a lecture that Dr. Gedde delivered at the March 2020 AGS Annual Meeting in Washington DC entitled: Lessons Learned from Glaucoma Surgical Trials
https://www.aao.org/annual-meeting-video/lessons-learned-from-glaucoma-surgical-trials
Here is a reasonably comprehensive list of glaucoma clinical trials, broken down as Treatment vs No Treatment and Treatment vs Treatment
https://eyewiki.aao.org/Clinical_Trials_in_Glaucoma
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Production information:
This episode was recorded February 29, 2020 during the Annual Meeting of the American Glaucoma Society in Washington, DC, unfortunately using a BOYA Dual Lapel USB-C Microphone BY-M3D - which I do not recommend. Mixing and sound levelling were finally completed to salvage the recording on February 21, 2022 using Hindenberg Journalist Pro software iZotope processing plug-ins on a Gigabyte AERO 17 computer. The narration was overdubbed using a Heil PR40 microphone.
Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.
Robert M Schertzer, MD, MEd, FRCSC
[email protected]
Twitter - https://twitter.com/robschertzer
or http://iguy.tv/twitter
Blog - http://wholelottarob.com
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Office website - https://westcoastglaucoma.com
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Theme music “Middle East Gold” ©Daniel Schertzer 2010 and published by Les Prods DOSWA Enr
© 2022 DOSWA Prods Enr/Robert M Schertzer MD. MEd, FRCSC
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iTunes Subtitle:
A talk with Steve Gedde on lessons learned from glaucoma surgery randomized controlled trials.
iTunes Summary:
In this episode, I talk with Steve Gedde, from the University of Miami's Bascom Palmer Eye Institute, about lessons learned from these clinical trials.
We begin by discussing the importance of Randomized Clinical Trials as the highest evidence-based medicine to compare treatments. Studies that we discuss include: the Fluorouracil Filtering Study Group; Tube vs Trab (TVT); Primary Tube vs Trab (PTVT); Ahmed Baervedlt Comparison (ABC); Ahmed vs Baerveldt.
Some of the concepts and lessons learned include: reducing IOP prior to surgery to lessen the risk of choroidal hemorrhage from a sudden IOP drop; trabeculectomy offering titratable control that MIGS procedures do not; that it's harder to get a 20% reduction in IOP to count as a success if the IOP is lower than 25 pre-op; that Ahmed Valves have a better safety record but Baerveldt better pressure-lowering; and that antimetabolites have been shown to not be effective for tube-shunt surgery.