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Leaders in Managing the Business of Ophthalmology March 2012 The American Glaucoma Society Innovator Award CER TIFIED O E F OPHTHALMIC EXECUTIVE Tamim Qaum amim Qaaum, MD, CPE, COE, CASC, CPHIT , C ASC, CPH HIT, CPEHR,T, CPEHR, CSSGB, OCS VIA CHRISTI CLINIC,, WLINI C WIC ICHITA, KS George Baerveldt, M.D., was awarded the second AGS Innovator Award by David Greenfield, M.D. "Dr. Baerveldt is a charter member of the AGS, going back to 1986, is professor and past chair of the de- partment of ophthalmology at the University of California at Irvine, and has published many peer-re- viewed papers," Dr. Greenfield said in presenting this award. Dr. Baerveldt's many contributions to the field of glaucoma include the glaucoma drainage device that bears his name (and for which he holds six patents), as well as the Trabectome (Neomedix, Tustin, Calif.) device and procedure (for which he holds two additional patents). Dr. Baerveldt accepted the award, saying that his love of "the excitement of doing something new" dated to a young age when he and his father used to conduct ex- periments in his garage in Johannes- burg, South Africa. Saturday, March 3 Basic and clinical science of glaucoma imaging "P in t is no ey ra i in our c i is eye manag adapt t sure to both th ractitices acros th e countr incre s the r current hre t health yecare. To survive,vive impor ta t t to coup with tant to t th t te alslso hold the COE desigignation tr to relyly f fa face ds o thisis new reality w c extincti s th CO e exti curren t a d f est longer enoug to To try find it reasingly c gyly chay ch llen gg to thcare envivironment, h to provi th a competent ate t admiin strative/ gement t team. Pra ti to y ye e/ ging to survivevive t, as vide superb e, it will l be increasinglyly uple higigh quality e niis rative tion. As a phyysicia wh ti ractices th t fa y will slowlyly but hys h meet an exxceed my racti t and fu future dmin trative The Amerrican Society of Ophthalmmic A the fastesst, most reliable, and accu ophthalmic practice staffff.. cur thalmmic pr Sign y ourr staff up f for a fr ee trial memb ership! Call Susan a n at 703-788-5777 our staff up f or email all Susan or email susan@asoa.or@ susan@asoa.or g. www.ASOA.org ee trial memb d exc d my pra tice's's adminisistr rative ne ds thalmic Administrators— urate resourc e fore f that f fail to to n who , I trust AS OA OA eds." ty eyecare re The past two decades have seen tremendous advances in the tech- nologies used to image the optic nerve head in glaucoma. The most recent advance, and the topic of dis- cussion at a symposium held on the second day of the American Glau- coma Society (AGS) annual meeting, is the development and commercial- ization of spectral domain optical coherence tomography (SD-OCT). Claude Burgoyne, M.D., has spent years exploring the complex struc- tural and biomechanical properties of the optic nerve head. He stated that we often cannot fully appreci- ate the structure of the optic nerve head because some of the relevant rim tissue is invisible on clinical ex- amination. "We can't reliably know where the rim margin is," he said. According to him, SD-OCT provides highly detailed imaging of the deeper optic nerve head tissues, in- cluding the lamina cribrosa. "With SD-OCT we can see that Bruch's membrane extends to a point that is not visible on clinical examination." Better appreciation of the neural rim margin is essential in assessing rim loss in glaucoma. So has SD-OCT im- proved our diagnostic accuracy over time domain OCT? David Huang, M.D., pointed out, "Despite better resolution and greater inter-test reproducibility, both time domain and spectral domain OCT have simi- lar diagnostic accuracy for glau- coma." He suggested that this might be more related to the large degree of anatomic variation between indi- viduals than to any limits of the technology platforms. "Improve- ments in diagnostic accuracy may occur with time and with further software development to improve analysis of image data." Dr. Burgoyne agreed, saying that with more refined image processing of the deep optic nerve head structures using SD-OCT, we may be able to better correlate structural and func- tional changes in glaucoma and improve discrimination between normal and glaucomatous optic nerves based on imaging. Felipe Medeiros, M.D., observed that the relationship between structural and functional damage in glaucoma is non-linear over the range of disease severity. Specifically, he said, the rate of functional progression appears to be significantly faster later in the disease process, while the rate of structural progression may slow down late in the disease process. As a result, he said, visual field testing may be less helpful in detecting change in early glaucoma while structural testing may be less helpful in detecting change in advanced glaucoma. He and others are devel- oping an analysis that integrates both structural and functional change over time to assess the global rate of change in glaucoma. Neuroprotection symposium To protect the optic nerve from glau- coma-related damage, physicians must first understand how that dam- age occurs. "The site of damage to the axons is at the level of the lam- ina cribrosa," said Robert Nickells,