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Minimally Invasive Options with Maximum Results in Treating Glaucoma

Presented by the Johns Hopkins School of Medicine.

Supported by an educational grant from Allergan, Inc.

Though eye drops for lowering intraocular pressure (IOP) are effective for treating glaucoma, patients are required to commit to lifelong treatment, which has proven difficult for many patients. Adherence and persistence rates to such medications are notoriously suboptimal. Invasive incisional surgery procedures, while very effective in reducing IOP, are associated with a number of complications. Minimally invasive glaucoma surgery (MIGS) has the potential to significantly improve the management of glaucoma for a variety of patients, including those with refractory disease, by reducing the need for IOP-lowering medications and delaying the need for more invasive procedures. MIGS fills an unmet treatment need between medical therapy and invasive surgery, though the exact place in treatment has yet to be defined. In addition, innovations in pharmacotherapy delivery devices, if approved, offer the potential to alter the paradigm for glaucoma patients who may not require surgical intervention. A number of implantable and external pharmacotherapy delivery devices are currently in development.

This web-based symposium archive activity will provide ophthalmology clinicians with the knowledge and confidence to determine patient eligibility when considering the various MIGS devices available, determine which MIGS procedure or device is most appropriate for a particular patient, and manage the technical aspects of implementing MIGS. Information on potential role of impending drug delivery devices as they become available will also be discussed.

The goal of this program is to provide comprehensive ophthalmologists and glaucoma specialists with information and tools to identify patients who might benefit from MIGS and determine which type of MIGS is appropriate for a particular patient, as well as to understand the potential role of impending drug delivery devices.

This educational initiative is primarily intended for glaucoma specialists and comprehensive ophthalmologists. No prerequisites required.

After attending this activity, the participant will demonstrate the ability to:
  • ASSESS recent clinical data regarding the efficacy and safety of various MIGS procedures.
  • UTILIZE relevant peer-reviewed data to identify appropriate candidates for MIGS.
  • INTEGRATE evolving clinical evidence into the selection of optimal, patient-specific MIGS procedures.
  • EVALUATE the clinical implications and potential treatment roles of current and emerging drug delivery devices for patients with glaucoma.

The Johns Hopkins School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

accme_logo The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Johns Hopkins School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The estimated time to complete this activity: 60 minutes.

Release date:    April 27, 2020           Expiration date:    April 27, 2021

E. Randy Craven, MD, FACS
Associate Professor
Department of Ophthalmology
Johns Hopkins School of Medicine
Baltimore, MD

Jithin Yohannan, MD, MPH
Assistant Professor
Department of Ophthalmology
Johns Hopkins School of Medicine
Baltimore, MD

Full Disclosure Policy Affecting CME Activities
As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), Johns Hopkins School of Medicine Office of Continuing Medical Education (OCME) requires attested and signed global disclosure of the existence of all financial interests or relationships with commercial interest from any individual in a position to control the content of a CME activity sponsored by OCME.

Policy on Faculty and Provider Disclosure
It is the policy of the Johns Hopkins School of Medicine that the presenter and provider globally disclose conflicts of interest. The Johns Hopkins School of Medicine OCME has established policies that will identify and resolve conflicts of interest prior to this educational activity. Detailed disclosure will be made prior to presentation of the education.

The following relationships have been reported for this activity:

E. Randy Craven, MD, FACS, reports receiving a consulting fee from Aerie Pharmaceuticals, Inc., Allergan, Inc., Ivantis, Inc., Novartis AG, Santen Pharmaceutical Co., Ltd., and W. L. Gore and Associates, Inc.

No one else in a position to control the content of this educational activity has disclosed a relevant financial interest or relationship with any commercial interest.

Note: Grants to investigators at the Johns Hopkins University are negotiated and administered by the institution which receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of Johns Hopkins School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.

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The Office of Continuing Medical Education (CME) at the Johns Hopkins School of Medicine is committed to protect the privacy of its members and customers. Johns Hopkins SOM CME maintains its Internet site as an information resource and service for physicians, other health professionals, and the public. Continuing Medical Education at the Johns Hopkins School of Medicine will keep your personal and credit information confidential when you participate in a CME Internet based activity. Your information will never be given to anyone outside of the Johns Hopkins School of Medicine’s CME activity. CME collects only the information necessary to provide you with the services that you request.

Confidentiality Disclaimer For CME Activity Participant
I certify that I am participating in this Johns Hopkins School of Medicine activity for CME-accredited training and/or educational purposes.

I understand that while I am participating in this capacity, I may be exposed to "protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the “Privacy Regulations”). Protected health information is information about a person's health or treatment that identifies the person.

I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential. I agree not to post or discuss this protected health information, including pictures and/or videos, on any social media site (eg, Facebook, Twitter, etc.), in any electronic messaging program or through any portable electronic device.

I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is: Johns Hopkins Privacy Officer, telephone: to 410-614-9900, e-mail:

“The Office of Continuing Medical Education at the Johns Hopkins School of Medicine, as sponsor of this activity, has relayed information with the CME attendees/participants and certify that the visitor is here for training, education and/or observation purposes only.”

For CME questions, please contact the CME Office at 410-955-2959
or e-mail

Johns Hopkins School of Medicine
Office of Continuing Medical Education
720 Rutland Avenue/ Turner 20
Baltimore, Maryland 21205-2195
Reviewed & Approved by:
General Counsel, Johns Hopkins Medicine (4/1/03)
(Updated 4/09 and 3/14)

Hardware & Software Requirements
Pentium 800 processor or greater, Windows 98/NT/200/XP or Mac OS 9/X or later, Microsoft Internet Explorer, Safari, Firefox, Windows Media Player 9.0 or later Flash player, 128 MB of RAM Monitor settings: High color at 800 x 600 pixels, Sound card and speakers, Adobe Acrobat Reader.

Activity Instructions
The following is an web-based symposium archive activity designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited preassessment, a video-based archive of material presented during a live symposium, and a CE post-assessment and evaluation. All 3 sections must be completed to receive CE credit. A certificate of participation will be available online immediately following successful completion of the activity.

Table of Contents

The Glaucoma Surgical Armamentarium in 2020:
Finding the Right Balance Between Safety and Efficacy

E. Randy Craven, MD, FACS, and Jithin Yohannen, MD, MPH

The Glaucoma Drug Delivery Armamentarium in 2020:
Finding the Right Balance Between Safety and Efficacy

Jithin Yohannen, MD, MPH, and E. Randy Craven, MD, FACS

Postassessment and Evaluation

This activity was developed in collaboration with ASiM.

procced to pretest

Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by ASiM CE, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2017 by ASiM CE, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of ASiM CE LLC.