Dr. Ike Ahmed and Professor Gus Gazzard are joined by Professor Carl Sheridan to discuss the complexities of the trabecular meshwork and its significance in glaucoma management. They deconstruct some common myths and misconceptions surrounding the structure, and explore the importance of early intervention and precision treatments in obtaining maximum preservation.
The Interventional Glaucoma Podcast
Episode 3: The Trabecular Meshwork: Addressing Myths and Misconceptions
Key Takeaways
- A Complex Structure: The trabecular meshwork (TM) is a complex three-dimensional structure lined with cells that acts a dynamic pump responding to pulsatile changes in blood flow around the Schlemm’s canal and allows the passage of aqueous moving from inside to outside of the eye.
- An Active Role in Fluid Flow: The TM has often been oversimplified as a passive structure. However, we are starting to understand more deeply its anatomy, physiology, and active role in regulating fluid flow.
- A Glaucomatous TM: The structure of the TM undergoes many changes during glaucoma. The number of cells diminishes greatly, and the remaining cells become more dysfunctional, impacting the extracellular matrix and the porosity of the structure.
- Reversibility of Changes: The effects of glaucoma on the TM could be reversible, due to the TM having a stem cell population with the ability to rejuvenate, leading some surgeons to believe that it might be better to preserve at least some of the TM in patients.
- The Importance of Early Treatment: It is important to treat glaucoma early, before the tissues have degraded and stiffened up, in order to preserve the TM function for patients as long as possible.
- Minimizing Trauma: Minimizing trauma to the TM and Schlemm’s canal during surgery can prevent excessive fibrosis, inflammation and scarring, which can worsen outflow resistance and compromise long-term outcomes.
- Excimer Laser Precision: The ELIOS™ excimer laser technology offers a highly precise targeting of TM tissue, allowing for potentially gentler interventions and better preservation of TM architecture and function.
Guests
Dr. Ike Ahmed
Dr. Ike Ahmed is a world-renowned glaucoma, cataract, and anterior segment surgeon with a practice focus on the surgical management of glaucoma, complex cataract surgery, and intraocular lens complications. He is board-certified in ophthalmology in Canada and the USA and is an active member of numerous national and international societies.
Prof. Gus Gazzard
Professor Gus Gazzard is Director of Surgery at Moorfields Eye Hospital and Professor in Ophthalmology, Glaucoma Studies at UCL London. He has joined the Glaucoma Research Society as one of the top 100 glaucoma researchers in the field and is leading author of multiple publications on MIGS surgery.
Prof. Carl Sheridan
Professor Carl Sheridan is an internationally-renowned cell biologist with an interest in ocular wound healing and cell transplantation therapies for numerous sight threatening conditions. He is senior lecturer in ocular cell transplantation at the Department of Eye & Vision Sciences at the University of Liverpool. He is a full-time academic and has published and reviewed for numerous ophthalmology scientific journals.
Additional Resources
Follow Dr. Ike Ahmed on social:
Dr. Ike Ahmed | LinkedIn
Dr. Ike Ahmed | Instagram
Follow Prof. Gus Gazzard on social:
Prof Gus Gazzard | LinkedIn
Follow Prof. Carl Sheridan on social:
Prof Carl Sheridan | LinkedIn
Episode 10: Glaucoma Management Five Years From Now
Dr. Karl Mercieca, Dr. Gok Ratnarajan, and Dr. Ana Miguel discuss the future of glaucoma management.
Episode 9: Physician experiences with ELIOS and the rationale for routinely combining MIGS with cataract surgery
Dr Jose Belda, Dr María Isabel Canut, and Dr Marta Ibarz discuss the rationale and benefits of routinely combining MIGS with cataract surgery.
Episode 8: TM-MIGS: Impact on patient quality of life
Professor Christophe Baudouin, Mr Gok Ratnarajan, and Dr Ana Miguel discuss the impact of glaucoma treatments on patients' quality of life.