Ashish Singh, MD

According to the Centers for Disease Control and Prevention, about three million Americans have glaucoma and the disease is the second leading cause of blindness worldwide. January is officially National Glaucoma Awareness month and during this time, it’s important to spread the word about this group of diseases that affects many Americans every year. Unfortunately, researchers estimate that more than half of people with glaucoma do not know they have it which is why it is crucial to recognize the various preventative methods that people can take to protect themselves from vision loss.

VMAIL Weekend recently sat down with Ashish Singh, MD, who specializes in cataract and refractive surgery. As a board-certified surgeon at Kleiman Evangelista Eye Centers serving patients in the Dallas-Fort Worth area, Dr. Singh performs laser-assisted cataract surgery, advanced technology intraocular lenses, and LASIK. He also specializes in glaucoma treatment using laser and minimally invasive glaucoma surgeries (MIGS). Here’s what he had to say about the early signs of glaucoma, encouraging high-risk patients to get screened on a regular basis and new glaucoma treatments.

Question 1: What are the early signs of glaucoma and what can patients do to protect themselves from developing the disease in the first place.

A: One of the most challenging parts of glaucoma management is that the early signs are very difficult to detect. Many people call glaucoma the "silent thief of sight" because patients don't feel any pain or have any idea it is developing. Glaucoma first affects peripheral vision which is difficult for patients to detect, and it is already late stage by the time it affects central vision. The best way for patients to protect themselves from developing glaucoma is to have an annual eye exam with their eye doctor for glaucoma screening.

Question 2: What is the profile of a typical glaucoma patient and how much does a family history of the disease play into one’s chances of developing glaucoma?

A: The typical profile of a glaucoma patient is age over 60, being nearsighted (myopic), having systemic conditions such as diabetes and hypertension, having thin corneas, having elevated intraocular pressure, and being Hispanic or African American ethnicity. Many patients with glaucoma have a strong family history, so that plays a major role in developing glaucoma.

Question 3: What advice can you give optometrists and ophthalmologists for identifying and treating patients with glaucoma?

A: My advice to eyecare providers would be to have a high index of suspicion for glaucoma in patients who fit the typical demographic, pay close attention to intraocular pressure measurements (preferably by applanation), and perform a detailed exam of the optic nerve (size, neuro-retinal rim health, and symmetry between the eyes). Ancillary testing such as Optic Nerve OCT and Humphrey Visual Field are also very helpful in identifying glaucoma. Many key studies such as the Ocular Hypertension Treatment Study (OHTS) stress the importance of early treatment of glaucoma to prevent vision loss, and I encourage eyecare providers to look to these studies in the literature to guide their treatment philosophy.

Question 4: And since early detection is key, how can ECPs encourage high risk patients to get screened on a regular basis?

A: Eyecare providers can encourage high risk patients to get screened on a regular basis by explaining that we have medical and surgical interventions available to help protect vision and maintain an excellent quality of life.

Question 5: I understand that you specialize in glaucoma treatment using laser and minimally invasive glaucoma surgeries (MIGS). Can you talk a little bit about these treatments. And are there other new treatments on the horizon that could be used to treat glaucoma patients?

A: The field of glaucoma has had an explosion of new medical and surgical treatments in the last decade. The ultimate goal of all current glaucoma treatments is to lower the intraocular pressure to prevent damage to the optic nerve. This includes new eyedrops that help either decrease the amount of aqueous fluid made in the eye or help the aqueous fluid drain from the eye more effectively.

When medical interventions do not adequately lower the intraocular pressure, surgical interventions are done. One such treatment is Selective Laser Trabeculoplasty (SLT) which is a painless, in-office procedure that takes a few minutes and uses laser pulses that open the trabecular meshwork (the drain of the eye).

The new surgical treatments for glaucoma are called Minimally Invasive Glaucoma Surgeries (MIGS). These are surgical procedures that are most often combined with cataract surgery to lower the intraocular pressure with a high safety profile and modest efficacy. A few examples of MIGS procedures are the iStent inject which implants two bypass valves in the trabecular meshwork, and the Kahook Dual Blade Goniotomy, which removes the trabecular meshwork to allow for better aqueous outflow. Both procedures help lower intraocular pressure and provide an added benefit of glaucoma treatment during cataract surgery.

New glaucoma treatments on the horizon include MIGS procedures that access the supraciliary space (an alternative drainage pathway in the eye), glaucoma drug eluting rings that can be placed under the eyelids and contact lenses that can monitor the intraocular pressure continuously throughout the day. It's truly an exciting time in the field of glaucoma!

As part of January’s National Glaucoma Awareness Month, Prevent Blindness, the nation’s leading voluntary eye health nonprofit organization, is offering a wide variety of free resources to help glaucoma patients and their caregivers find the support they need to address the many aspects of the eye disease. For more information, read “Prevent Blindness Kicks Off National Glaucoma Awareness Month by Inviting Patients and Caregivers to Join Glaucoma Community.”

Start-Up’s 24-Hour Contact Lens Has the Potential to Detect Glaucoma at Its Earliest Stages

WEST LAFAYETTE, Ind.—Imagine if a contact lens could monitor intraocular pressure (IOP) in a person’s eye on a 24-hour basis, alerting patients and doctors alike about the possibility of glaucoma. Optometrists, ophthalmologists and their patients may soon be able to benefit from new, high-tech tools to detect glaucoma at its earliest stages thanks to a start-up that will commercialize smart contact lenses developed at Purdue University, which could become the new standard of care for diagnosing and managing glaucoma patients.

New smart soft contact lens technology developed by a multidisciplinary team of engineers and health care researchers at Purdue University and Indiana University School of Optometry looks to gather important intraocular pressure measurements for 24-hour cycles as a way to detect glaucoma. A company called BVS Sight Inc. has been launched to develop the technology. Photo courtesy of Purdue University, photo by Rebecca McElhoe

BVS Sight Inc. is the first company created through a partnership between Boomerang Ventures Studio, Purdue Foundry and the Purdue Research Foundation Office of Technology Commercialization. The partnership develops Purdue-related health care start-ups and health care-related intellectual property yet to reach the market.

Chi Hwan Lee, the Leslie A. Geddes associate professor of Biomedical Engineering in Purdue’s Weldon School of Biomedical Engineering, led a research team that developed new ocular technology to continuously monitor intraocular pressure (IOP) in a person’s eye. IOP is the only known modifiable risk factor for glaucoma, which can steal a person’s vision without early warning signs or pain and affects more than 80 million people worldwide, according to the Glaucoma Research Foundation.

Studies have suggested that IOP variability is associated with retinal structure damage that occurs in patients with glaucoma and that patients with greater IOP variability may be at higher risk for glaucoma progression.

Lee, who has worked on this technology for six years, specializes in sticktronics, which are stickerlike items that contain electronics or smart technology. His lab develops wearable biomedical devices that can continuously monitor chronic diseases or health conditions in an unobtrusive manner.

Lee is BVS Sight’s co-founder and chief scientific officer. He has a joint appointment in Purdue’s School of Mechanical Engineering and courtesy appointments in the School of Materials Engineering and the Department of Speech, Language, and Hearing Sciences in Purdue’s College of Health and Human Sciences.

Some of the current wearable tonometers—or devices that measure the pressure inside one’s eyes—are equipped with an integrated circuit chip, which leads to increased lens thickness and stiffness compared to a typical commercial soft contact lens, in many cases causing discomfort for patients. Lee’s version is different.

“To address this unmet need, we developed a unique class of smart soft contact lenses built upon various commercial brands of soft contact lenses for continuous 24-hour IOP monitoring, even during sleep at home,” Lee said.

“Our smart soft contact lenses retain the intrinsic lens features of lens power, biocompatibility, softness, transparency, wettability, oxygen transmissibility and overnight wearability. Having all these features at the same time is crucial to the success of translating the smart soft contact lenses into glaucoma care, but these features are lacking in current wearable ocular tonometers.”

Dr. Eric Beier, partner and chief medical officer at Boomerang, said Lee and his smart contact lens innovation piqued his and his colleagues’ interest for several reasons.

“Our interviews with optometrists and ophthalmologists demonstrated that Lee’s technology has the potential to become a new standard of care for diagnosing and managing glaucoma patients,” Beier said. “Also, founder fit is an important factor for Boomerang in determining which technologies to commercialize. In working with Lee as we evaluated his technology, we determined that he is a great fit for Boomerang and our venture studio model.

“We also liked that Lee has been very forward-thinking in developing the technology by also developing a methodology to scale up the manufacturing of his smart contact lenses.”

Beier will be a director on BVS Sight’s board and continue to support the company through his chief medical officer and management roles at Boomerang Studio. Beier said BVS Sight must achieve several milestones to bring the smart contact lens technology to market. “We need to optimize the integrated system for patient and clinician use: smart contact lenses, power source, eyeglasses, sleep mask and software,” Beier said.

“Developing medical technologies is very complex, and the company will need to work through multiple challenges including clinical studies, regulatory approval, reimbursement and fundraising. These are all areas where Boomerang brings resources and expertise to help our portfolio companies successfully and timely navigate through these complexities.”

Beier said since the Purdue and Boomerang relationship began in 2021, Boomerang has reviewed several Purdue technologies. “We look for technologies that meet our internal selection criteria, address important macro trends we see in health care, and clearly benefit patients and clinicians,” Beier said. “We also look for academic co-founders who are excited to work with us and enable us to leverage our business-building expertise and assets.”