Eyeworld

EW GLAUCOMA 48 by Faith A. Hayden EyeWorld Staff Writer In Armenia, a perfect partnership North American surgeons, Armenians hold glaucoma intervention S ometimes all the pieces, no matter how widespread or diverse, manage to con- vene in the perfect collab- oration. For a glaucoma intervention at the Republican Eye Hospital, Yerevan, Armenia, this meant the combining of charity, in- dustry, and research half a world apart. Since January 2011, a team of ophthalmologists from North Amer- ica has partnered with the Armenian Eye Care Project (AECP) and Glaukos Corp. (Laguna Hills, Calif.) to help bolster glaucoma care in Armenia with the iStent, a glaucoma drainage device from Glaukos. Surgeons joined Lilit Voskanyan, M.D., chief of glaucoma surgery, Republican Eye Hospital, to assist her with Arme- nia's large glaucoma population, as well as to gain experience working with the iStent. "This initiative is a combination of a lot of different backgrounds," said Iqbal (Ike) K. Ahmed, M.D., as- sistant professor, University of Toronto. "It started off as an AECP program and then built into an ini- tiative to bring top surgeons to the area to train local surgeons. A num- ber of surgeons that went had lim- ited experience with the iStent, so going there provided an opportunity for them to learn as well." California-based AECP is a non- profit organization founded in 1992 to provide the war-torn country with the equipment, knowledge, and medicine it needs for proper eyecare. Richard A. Hill, M.D., asso- ciate professor of ophthalmology, University of California, Irvine, co- founded AECP and Glaukos, and is one of the inventors of the iStent. Glaukos covered the expenses of the trip and provided the doctors with many of the surgical devices and clinical support needed. "Armenia has a very poor popu- lation and a great need for glaucoma treatments," said Kerry D. Solomon, M.D., director, Carolina Eyecare Research Institute, South Carolina. "Standard glaucoma sur- gery is wrought with a high failure and complication rate. Given the economic health of the country, the medication compliance rate is very poor. Medications are expensive." The iStent, though, could be a solution to many of Armenia's glau- coma problems because it's a mini- mally invasive, affordable procedure. Three generations—known as G1, G2, and G3—are available in the country, and the North American doctors utilized all of them. The first generation of the device is currently sitting at the FDA awaiting approval in the United States. "The post-op care is signifi- cantly less in these procedures," said Thomas W. Samuelson, M.D., di- rector, glaucoma service, and in- structor, ophthalmic pharmacology, Regions Hospital, St. Paul, Minn. "The traditional glaucoma surgeries like trabeculectomy present the pa- tient with life-long risk. Patients are vulnerable to infection and late complications. With the Glaukos procedure, we don't subject patients to that risk. They need continued surveillance and sometimes drug therapy, but the amount of medica- tion needed is significantly re- duced." Doctors who traveled to Arme- nia included Drs. Ahmed, Solomon, and Samuelson, as well as David F. Chang, M.D., clinical professor of ophthalmology, University of Cali- fornia, San Francisco, and Eric D. Donnenfeld, M.D., co-chairman, cornea, Nassau University Medical Center, East Meadow, N.Y. The surgeons came to the coun- try in intervals, each performing a different number of glaucoma sur- geries with the device. Drs. Solomon and Donnenfeld, for example, per- formed more than 100 surgeries in 2 or 3 days using all three generations of the iStent. February 2011 August 2011 A rmenia has an underserved glaucoma population. Glaukos Corp. (Laguna Hills, Calif.) has a glaucoma device that is awaiting ap- proval from the FDA. In an impressive display of international cooperation, Glaukos is working through the Armen- ian Eye Care Project to bring some of the finest North American surgeons to Armenia to implant the Glaukos devices in glaucoma patients. This project helps Armenians gain access to highly so- phisticated glaucoma devices and also gives American surgeons an opportunity to gain greater familiarity with the Glaukos implants before FDA approval. The Glaukos iStent is a breakthrough concept in glaucoma control because it is implanted into Schlemm's canal and reduces intraocular pressure without re- quiring a filtration bleb. The absence of a bleb helps avoid many of the risks of traditional glaucoma procedures such as trabeculectomy. Glaukos has com- pleted FDA studies for the first genera- tion device and expects approval in the near future. The company has already developed two newer generations of the iStent, and the Armenian experience will be invaluable in assessing efficacy. The list of ophthalmologists who have trav- eled to Armenia for this project reads like a Who's Who of North American cataract/ glaucoma surgeons. Reay Brown, M.D., glaucoma editor Glaucoma editor's corner of the world Surgeons from North America, including Dr. Ahmed (center, in green scrubs), are working with the AECP and Glaukos to improve glaucoma care in Armenia Source: Iqbal (Ike) K. Ahmed, M.D. Dr. Ahmed performs surgery at the Republican Eye Hospital in Yerevan, Armenia

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