Feb 25, 2015

Interview Transcript

Interviewer: What's the future of glaucoma treatment? We'll examine that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Norm Zabriskie is a glaucoma expert at the Moran Eye Center, and if you know somebody who has glaucoma or been diagnosed yourself, you know that you can't necessarily cure it right now. All you can do is treat it, and manage it, and keep it from getting worse. But is there something in the future that might change that? What is the future of glaucoma treatment? Is it always going to be about managing or are there some cure possibilities in the future?

Dr. Zabriskie: Well, we sure hope there are, and we would love to be able to talk with patients about reversing their disease, or even maybe making it where they didn't have to take drops every day.

Interviewer: Yeah

Dr. Zabriskie: So to talk about the first of those, and that is what would make just what we do now easier? There are a number of, for example, extended drug delivery mechanisms and instruments that are being developed right now. For example, maybe an implantable drug that would be good for six months or something like that.

Interviewer: So you don't have to do those daily drops, yeah.

Dr. Zabriskie: So you don't have to do a drop every day. So that's one part of it that is very, very important. And I see some of those things being relatively near in the future, where either you could put a little plug into your tear duct or you could maybe inject a little medicine that would be good for six months and you wouldn't have to worry about drops for six months.

Interviewer: That would be awesome, wouldn't it?

Dr. Zabriskie: And come back and do it again and you're good to go.

Interviewer: Yeah.

Dr. Zabriskie: That would be great. And I think those are pretty near in the future, actually. The other part of that equation is really what we would like to talk about, and that is somehow, someway, reversing or improving damage that has already been done, basically regenerating the optic nerve. And that's really the Holy Grail, not only of glaucoma but of spinal cord injury, of stroke, all of those things are kind of in the same basket, so to speak.

Interviewer: Yeah, meaning once the damage is done . . .

Dr. Zabriskie: Yeah, that's right. How do you get it back? But all of the research, in my opinion, all of the research that's being done in all of those areas will all be cross-applicable. You know, if the spinal cord injury problem is solved, potentially the glaucoma problem will be solved as well because it's all involving the regeneration of nervous tissue.
Stem cells, you know, is probably what most people look toward as a possible treatment modality in the future where we can actually talk about regenerating lost or damaged nervous tissue which is really what we want to talk about in glaucoma. Don't have a timetable for that. There is certainly tons of research being done around the world, not only in glaucoma specifically, but as I mentioned, spinal cord injury and others that hopefully will unlock some of those answers in the not too distant future.
But that's really what we're looking toward. So the idea there, as I mentioned previously, what we do now is just lower the pressure. But what we'd like to talk about is actually regenerating the optic nerve, or even maybe a step before that would be protecting the optic nerve. Right now the only way we can protect the optic nerve is to lower the pressure. But there is research and attempts being made to try to find drugs and other medicines that might protect the optic nerve from further damage that are pressure independent, meaning they don't just involve lowering pressure, but they actually directly inhibit some of the processes that are going on in the optic nerve that result in the damage.
So I'd say those three things are the future of glaucoma treatment. Better drug delivery systems that are much more extended so we don't have to do drops every day, coming up with drugs and treatments that actually protect the optic nerve from damage that is occurring, and that protection is independent of lowering the pressure. It's direct neuro-protection, we call that. And then the final, the ultimate, would be to actually be able to regenerate lost or damaged nervous tissue. That's probably the furthest down the road. But that's what we're hoping for.

Interviewer: What about even before that, preventing that pressure from even happening? I mean, are there people looking at that?

Dr. Zabriskie: Sure, that's another important thing of looking at what it is in the processes of the eye and the balance of pressure that caused the pressure to go up in the first place.

Interviewer: Which is the cause, that's the thing that makes it all happen.

Dr. Zabriskie: In many instances, but yet we know, see, we know that there's probably 25%, 30% even of people that never have a high pressure and yet have severe glaucoma. So we know there's like this black box of other factors, be it genetic susceptibility, something about that optic nerve that just makes it susceptible to damage, maybe blood flow, maybe other factors that we don't even know about yet that are damaging the optic nerve other than pressure. But certainly, pressure is what we concentrate on the most now, because that's what we can treat. And as I mentioned, it has been proven now that lowering the pressure is absolutely beneficial. I don't think there's any doubt about that.

Interviewer: But as far as figuring out a way for those instances where pressure is the cause, how do you prevent that pressure from happening in the first place? Not quite sure at this point yet?

Dr. Zabriskie: Don't have that yet, yeah. You know, a way to actually go into the system, the drainage system itself.

Interviewer: Yeah, and figure out what's happening.

Dr. Zabriskie: And clear it out or drain it out. Again, some of our surgeries are designed a little bit to try to do that. But as far as a drop or something that really gets at that issue, don't have anything that's super effective in that regard.

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