Eyeworld Daily News

EW SHOW DAILY 6 ASCRS News Today Monday, May 8, 2017 idea of transcorneal drainage is now being investigated by MicroOptx (Maple Grove, Minnesota), and its device is set to begin a human feasi- bility study this year. In 1999, Drs. Brown and Lynch developed the EyePass Glaucoma Implant (GMP Vision Solutions, Ft. Lauderdale, Florida), which is considered the first trabecular bypass device. "We really thought the EyePass would fix glaucoma surgically," Dr. Brown said, adding that what they didn't expect was how hard, long, and expensive approval would be. The EyePass completed several FDA studies, but the project was abandoned during the Phase 3 clini- cal trial because the parent company underwent a reorganization. Concepts from EyePass, how- ever, live on today in the iStent (Glaukos, San Clemente, California), which acquired rights to EyePass patents. "And innovation goes on," Dr. Brown said. "We are currently working with a team at Georgia Tech to develop technology that will en- hance the efficacy of MIGS devices." With some of his own devices not fully coming to fruition in their originally conceived state, Dr. Brown has wondered why he didn't give up and stop innovating in these moments. "For the first 30 years, it was only failure and disappointment," he said. "But with each innovation, I thought we really had the answer. Hope is a powerful driver but not always rational. "My own view is that innova- tion is a compulsion. ... It almost seems like people who [innovate] can't stop," he added. Dr. Brown's lecture, "Overcom- ing Resistance: Making Glaucoma a Surgical Disease," speaks to both the literal goal of overcoming resis- tance to outflow in the eye and this lowering pressure and also the more philosophical resistance to change when a new option faces already established treatment paradigms. While the existing paradigm for glaucoma treatment starts with medical therapies (eye drops), Dr. Brown said he's always felt it should be a surgically treated disease. "Medical therapy is very expen- sive, causes many side effects, and compliance is terrible. We know that many patients continue to lose vision despite seeming to have good control with drops. Surgery elimi- nates most of these problems but only if it is safe and effective. The development of MIGS and the new surgical technology gives us a better combination of 'safe and effec- tive' than we have ever had. These breakthrough surgical treatments finally give us the potential to make glaucoma more of a surgical disease. Eye drops will always be an import- ant part of glaucoma therapy, but it will be good for patients if surgery plays a much bigger role than it does now," he said. Just as it was decades before Dr. Kelman's invention of phacoemulsi- fication became mainstream for cat- aract surgery, so too, Dr. Brown said, efforts for surgical glaucoma therapy have only in the last 5 years started making their way to patients. "When surgeons today use phaco—or when they implant an iStent—it may look like an obvious innovation that was inevitable and quickly adopted. The truth is that it took decades of development, many millions of dollars, and overcoming so much resistance for these innova- tions to look like 'overnight success- es,'" he said. Dr. Brown has authored more than 90 peer-reviewed articles on glaucoma and cataract surgery. He served as chairman of the ASCRS Glaucoma Clinical Committee from 2006 to 2010 and is currently the editor of the Glaucoma section of EyeWorld magazine. In addition to this honor, Dr. Brown received the Innovator Award from the Ameri- can Glaucoma Society in 2014, the Senior Achievement Award from the American Academy of Ophthalmol- Reay Brown continued from page 5 ogy in 2009, and the Distinguished Alumnus Award from the Wilmer Institute in 2013. Dr. Brown deliv- ered the Obstbaum Lecture at the 2011 ASCRS Glaucoma Day. "Next time you are in the operating room, look around at all of the equipment. Each item was invented or developed by a person or group who wanted to solve a problem or make some process bet- ter. It is likely that you are as smart as they are/were. The difference is that they tried to change some- thing or improve it. We all do many things every day in the OR that we know could be better. My advice is to think about what it would take to make it better. Break down the process and focus on the difficult or problem steps. Why do we always do it this way and yet it always leads to the same problem? How would you like to change it? What would it take? Then, do it! We only know what has been invented—we don't know what hasn't," Dr. Brown said. The 2017 Charles D. Kelman, MD, Innovator's Lecture will take place today as part of the ASCRS Innovators General Session from 10:00–11:30 a.m. EW Editors' note: Dr. Brown has financial interests with Glaukos, Allergan, Rhein Medical (St. Petersburg, Florida), Alcon (Fort Worth, Texas), and Aerie Pharma- ceuticals (Irvine, California). • Graham Barrett, FRANZCO, 2016 • Shigeru Kinoshita, MD, PhD, 2015 • Warren Hill, MD, 2014 • Richard Mackool, MD, 2013 • Douglas Koch, MD, 2012 • Richard Lindstrom, MD, 2011 • Henry Edelhauser, PhD, 2010 • Robert Osher, MD, 2009 • Theo Seiler, MD, PhD, 2008 • Okihiro Nishi, MD, 2007 • Kensaku Miyake, MD, 2006 • Carmen Puliafito, MD, 2005 • John Marshall, PhD, 2004 • Ioannis Pallikaris, MD, 2003 • David Apple, MD, 2002 • Gholam Peyman, MD, 2001 • Stephen Klyce, PhD, 2000 • David McIntyre, MD, 1999 • Manus Kraff, MD, 1998 • Luis Ruiz, MD, 1997 • James Gills, MD, 1996 • Leo Bores, MD, 1995 • I. Howard Fine, MD, 1994 • D. Peter Choyce, MS, 1993 • Joaquin Barraquer, MD, 1992 • David Miller, MD/ Robert Stegmann, MD, 1991 • Herbert Kaufman, MD, 1990 • C. William Simcoe, MD, 1989 • John Pearce, ChM, 1988 • Daniele Aron-Rosa, MD, 1987 • Steven Shearing, MD, 1986 • Charles D. Kelman, MD, 1985 Past lecturers

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