Advances in Glaucoma Neuroprotection Supplement/Monograph

November 2007

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Accreditation

Lippincott CME Institute, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

Lippincott CME Institute, Inc. designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Commercial Support

This CME activity is supported by an unrestricted educational grant from Allergan Pharmaceuticals, Inc.

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The target audience of this CME program is glaucoma specialists, clinical/academic ophthalmologists, and other health care professionals interested in the care and disease management of patients with glaucoma.

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Glaucoma is the second leading cause of blindness worldwide.¹ The number of sufferers is estimated to reach 60 million globally by 2010, with an anticipated increase to almost 80 million by 2020.²

To date, reduction of intraocular pressure (IOP) is the scientifically proven method for treating glaucoma, however researchers are beginning to understand that lowering IOP is only a partial solution.³ In order to supplement present therapy and further reduce the progressive loss of vision experienced by glaucoma sufferers, newer approaches to the treatment of glaucoma are currently being studied.⁴

It is becoming apparent that there are pressure-independent mechanisms associated with the development of glaucomatous optic neuropathy, and there has been considerable effort to develop therapeutics that rescue the retinal ganglion cells from undergoing secondary degeneration after the original insult has occurred.⁵

With recent scientific advances being made toward treating other neurodegenerative diseases, there are a variety of different agents that could potentially protect and restore the optic nerve and the subsequent progression of glaucoma and potential loss of vision.⁶ In the November 1999 Issue of Archives of Ophthalmology, Robert N. Weinreb, MD, Distinguished Professor and Director of the Hamilton Glaucoma Center at the University of California, San Diego, said “interest has been increasing in preventing progression of glaucomatous optic neuropathy using approaches based on the premise that glaucoma is a neurodegenerative disease. Neuroprotection of the glaucomatous optic nerve therefore would be an adjunctive therapeutic paradigm for use with conventional intraocular pressure-lowering treatments or by itself”.⁷

A full understanding of the epidemiology of open-angle glaucoma and current and possible future treatments for patients with this disease, including the mechanism of action using neuroprotection methods, is necessary for maintaining the basic competence required of ophthalmologists by the Institute of Medicine and the Accreditation Council for Graduate Medical Education, and in providing optimal patient care. New information about advances in the field of glaucoma treatment, particularly neuroprotection, has not been widely disseminated to practicing ophthalmologists. ^8,9,10 Participant evaluation assessment responses to previous CME activities offered by LCMEI in 2006 indicated that this information about new advances in glaucoma neuroprotection is of high value to ophthalmologists for practical use in their clinical practice, as well as to clinicians involved with academic glaucoma research.

Given the wide array of treatment options, a CME activity to discuss these current treatment alternatives would prove to be a valuable educational opportunity for the target audience of global ophthalmologists. The information imparted during this CME activity will help improve the practitioner’s knowledge in this area, which in turn may lead to improved competence and patient care.

The educational design of this CME activity (journal supplement) will provide participants with the opportunity to learn about expert opinions and results of the latest research directly from recognized, leading international experts.

Participants in this activity will have an opportunity to complete an evaluation assessment questionnaire that will facilitate an overall metric to assess: quality of education, fair balance, value/applicability of learned material within clinical practice, and provide participants with the opportunity to suggest topics for future development of neuroprotection CME activities.

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Faculty Credentials and Disclosure Information

Co-Chairs

Robert N. Weinreb, MD
Distinguished Professor of Ophthalmology
Director, Hamilton Glaucoma Center
University of California, San Diego
La Jolla, California, USA

Dr. Weinreb has disclosed that he has/had the following financial relationships/interest with
commercial companies pertaining to this educational activity:

Consultant/Advisor: Allergan, Alcon, Bausch & Lomb, Merck, Novartis, Pfizer

Ivan Goldberg, MD
Clinical Associate Professor
University of Sydney
Director, Eye Associates
Glaucoma Services, Sydney Eye Hospital
Sydney, Australia

Dr. Goldberg has disclosed that he has/had the following financial relationships/interest with commercial companies pertaining to this educational activity:

Grant/Research Funding: Alcon, Allergan, Pfizer and Novartis
Consultant/Advisor: Alcon, Allergan, Pfizer, Ellex
Speakers Bureau: Alcon, Allergan, Pfizer, Ellex, Merck.

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Faculty

Jonathan G. Crowston, MD, PhD
Professor of Glaucoma
University of Melbourne,
Center for Eye Research Australia
Melbourne, Australia

Dr. Crowston has disclosed that he had/has no financial relationship with or interests in any commercial company pertaining to this educational activity.

Christopher A. Girkin, MD, MSPH, FACS
Professor of Ophthalmology
Director, Glaucoma Service and Optic Nerve Imaging Center
University of Alabama at Birmingham School of Medicine
Birmingham, AL, USA

Dr. Girkin has disclosed that he had/has the following financial relationship/interests with commercial companies pertaining to this educational activity:

Grant/Research Funding: Allergan, Pfizer, Optuvue, Carl Zeiss Meditec
Consultant/Advisor: Allergan, Alcon, Merck, Pfizer
Speakers Bureau: Allergan, Alcon, Merck, Pfizer

David Greenfield, MD
Professor of Ophthalmology
University of Miami Miller School of Medicine
Bascom Palmer Eye Institute
Miami, Florida, USA

Dr. Greenfield has disclosed that he has/had the following financial relationships/interest with commercial companies pertaining to this educational activity:

Grant/Research Funding: National Eye Institute, Allergan, Carl Zeiss Meditec, Heidelberg Engineering, Pfizer
Consultant/Advisor: National Eye Institute, Allergan, Carl Zeiss Meditec, Heidelberg Engineering, Pfizer

Neeru Gupta, MD, PhD
Associate Professor of Ophthalmology & Vision Sciences
Laboratory Medicine & Pathobiology Director
Glaucoma and Nerve Protection Unit
University of Toronto
Keenan Research Centre Li Ka Shing Knowledge Institute
St. Michael's Hospital
Toronto, Ontario, Canada

Dr. Gupta has disclosed that he has/had the following financial relationships/interest with commercial companies pertaining to this educational activity:

Consultant/Advisor: Alcon, Allergan, Merck, Forest, Pfizer

Anders Heijl, MD, PhD
Professor and Chairman
Lund University
Dept of Ophthalmology
Malmö University Hospital
Malmö, Sweden

Dr. Heijl has disclosed that he has/had the following financial relationships/interest with commercial companies pertaining to this educational activity:

Grant/Research Funding: Allergan, Carl Zeiss Meditec, Alcon, Santen
Consultant/Advisor: Allergan, Carl Zeiss Meditec, Alcon, Pfizer

Roger Hitchings FRCS
IGA Professor of Ophthalmology
Consultant Ophthalmic Surgeon
University College London
Moorfields Eye Hospital
London, England.

Dr. Hitchings has disclosed that he has/had the following financial relationships/interest with commercial companies pertaining to this educational activity:

Grant/Research Funding: Allergan
Consultant/Advisor: Allergan, Pfizer, Santen

Jeffrey M. Liebmann, MD
Clinical Professor of Ophthalmology
New York University School of Medicine
Director, Glaucoma Services
Manhattan Eye, Ear and Throat Hospital &
New York University Medical Center
New York, New York, USA

Dr. Liebmann has disclosed that he has the following financial relationships/interest with commercial companies pertaining to this educational activity:

Consultant/Advisor: Allergan, Alcon, Pfizer

Stuart A. Lipton, MD, PhD
Professor and Scientific Director
Center for Neuroscience, Stem Cells, and Aging,
Burnham Institute for Medical Research,
Professor, The Salk Institute, The Scripps Research Institute
University of California at San Diego
La Jolla, California, USA

Dr. Lipton has disclosed that he had/has the following financial relationship/interests with commercial companies pertaining to this educational activity:

Grant/Research Funding: Allergan, NeuroMolecular Pharmaceuticals
Consultant/Advisor: Allergan, Chemicon, NeuroMolecular Pharmaceuticals,
Stock Shareholder: NeuroMolecular Pharmaceuticals (scientific founder)
Other: Inventor on memantine patent for glaucoma use

Manuel Vidal-Sanz, MD
Professor of Experimental Ophthalmology
Director of the Laboratory of Experimental Ophthalmology
Department of Ophthalmology
Faculty of Medicine
University of Murcia
Murcia, Spain

Dr. Vidal-Sanz has disclosed that he had/has the following financial relationship/interests with commercial companies pertaining to this educational activity:

Grant/Research Funding: Allergan, Novartis

M. Roy Wilson, MD
Chancellor, University of Colorado at Denver
and Health Sciences Center (UCDHSC)
Professor of Ophthalmology, School of Medicine, UCDHSC
Denver, Colorado, USA

Dr. Wilson has disclosed that he had/has the following financial relationship/interests with commercial companies pertaining to this educational activity:

Consultant/Advisor: Pfizer

Yeni H. Yücel MD, PhD, FRCPC (Neuropathology)
Professor & Director, Ophthalmic Pathology Laboratory
Departments of Ophthalmology & Vision Sciences
Laboratory Medicine & Pathobiology
Faculty of Medicine
University of Toronto
Keenan Research Centre Li Ka Shing Knowledge Institute
St. Michael's Hospital
Toronto, Ontario, Canada

Dr. Yücel has disclosed that he had/has the following financial relationship/interests with commercial companies pertaining to this educational activity:

Grant/Research Funding: Allergan
Speakers Bureau: Allergan

Conflict of Interest (COI) Peer Reviewers

Neville N. Osborne, PhD, DSc
Professor of Ocular Neurobiology
Department of Ophthalmology
Oxford University
Oxford, UK

Professor Osborne has disclosed that he has no financial relationship with or interests in any commercial company pertaining to this educational activity.

Stuart McKinnon, MD, PhD
Associate Professor
Departments of Ophthalmology and Neurobiology
Duke University Medical Center
Durham, North Carolina

Dr. McKinnon has disclosed that he has no financial relationship with or interests in any commercial company pertaining to this educational activity.

Medical Writing/Editorial Assistance

Mary C. Love
Medical Writer
Columbia, Maryland

Ms. Love has disclosed that she has no financial relationships with or interests in any commercial company pertaining to this educational activity.

Identification and Resolution of Faculty Conflict of Interests

Lippincott CME Institute has identified and resolved any faculty and staff conflicts of interest regarding this educational activity.

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Off-label or Investigational Usage Discussion

The following faculty members have disclosed that their content discusses off-label usage of or unapproved drugs:

Dr. Goldberg has disclosed that memantine has not been approved by the U.S. Food and Drug Administration for use in the treatment of glaucoma. Please consult product labeling for the approved usage of this drug or device.

Dr. Gupta has disclosed that memantine has not been approved by the U.S. Food and Drug Administration for use in the treatment of glaucoma. Please consult product labeling for the approved usage of this drug or device.

Dr. Lipton has disclosed that memantine has not been approved by the U.S. Food and Drug Administration for use in the treatment of glaucoma. Please consult product labeling for the approved usage of this drug.

Dr. Yucel has disclosed that memantine has not been approved by the U.S. Food and Drug Administration for use in the treatment of glaucoma. Please consult product labeling for the approved usage of this drug or device.

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Learning Objectives

After completing this CME activity, participants should be able to:

1. Define and discuss new treatment options for glaucoma patients
2. Delineate the role of neuroprotection in glaucoma, and its value in the treatment of glaucoma
3. Describe the rationale for the use of glaucoma neuroprotection as a pressure-independent therapy
4. Discuss the quality of life and economic factors associated with glaucoma

Method of Physician Participation

To earn CME credit, participants must read the entire supplement, complete a post-test with a passing score, and complete the evaluation assessment questionnaire provided. Upon successful participation in the CME activity, participants will be provided with a CME certificate up to 8 weeks following the activity. Questions regarding CME participation can be directed to:

Lippincott CME Institute, Inc.
770 Township Line Road, Suite 300
Yardley, PA 19067
USA
Phone: +1 267-757-3531
Fax + 1 267-757-0651

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Evaluation Methods

Eight evaluation assessment questions will be included as part of the CME Quiz. These questions ensure that we determine that each activity's learning objectives have been met, that the activity was of educational value to the target audience and was unbiased, and offer participants a method of feedback.

Participation Expiration Date

This CME activity will expire on December 1, 2008.

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