[Nfbf-l] {Spam?} Prof Molteno glaucoma drainage implants

[Alan Dicey]

Prof Molteno

I thought you might be interested in this very long article  a friend of 
mine sent me from New Zealand.

A little-known Dunedin medical company celebrated the 50th anniversary of 
the invention of the Molteno glaucoma drainage implant this month, an 
implant which has changed thousands of lives worldwide since the mid-1960s.
health reporter and now senior business reporter Simon Hartley profiles the 
family company Molteno Ophthalmic Ltd.

Glaucoma is commonly known as "the thief of sight'', a buildup of pressure 
in the fluid of the eyeball, which if left unchecked leads to blindness.

For some sufferers the pain can be excruciating.
Treatments, albeit not always hugely successful, have been around since the 
late - 1800s.

To say that Emeritus Prof Anthony Molteno has "flown under the radar'' for 
the past half-century is a huge understatement, unless you are a follower of 
the art of ophthalmology or a Molteno implant has saved your eyesight.

Much of this has been going on from a Dunedin address during the past 39 
years.

Between 1966 and 2016, Prof Molteno (78) and wife Tess, as company managing 
director, pioneered, developed, refined and marketed their implant to save 
eyes from the devastating effects of glaucoma by draining off the excess 
fluid.

Their business, which exports to markets around the world, is now being 
handed over to daughter, and GP, Nina Molteno (52) who has just taken up the 
reins.
DR Molteno, who graduated from University of Otago and was until recently 
practicing in Auckland, credits her father's thirst for knowledge in 
general, with enabling him to develop the drainage device.
"He has been, and still is, an extremely productive researcher, with a lot 
of collaboration which has included physicists, biologists and even 
zoologists,'she said.
Cape Town born and educated, Prof Molteno took an early interest in 
ophthalmology, working around the poorer areas of Cape Town as a student, 
where he first came across severe cases of glaucoma.
"Africans have a naturally high incidence of glaucoma. Conventional 
operations of the day were not always successful. It just seemed ridiculous 
they couldn't be fixed,' Prof Molteno said.
While still a trainee ophthalmologist, he became acting supervisor in a 
64-bed eye hospital with 30,000 outpatients annually.
There was plenty of scope to help older patients, but initially helping 
youngsters was not as successful.
"We took on hopeless glaucoma cases, starting then to develop an implant,' 
he said.

While tubes of various materials had been trialled since the 1900s, they 
often failed by forming a tough cap of scar tissue over the tube's outflow 
end.
Prof Molteno decided to design a new implant, in an era where the starting 
point was using plastic tubes from inside a ballpoint pen, heated and 
stretched to make the ultra-fine drainage tube required.
His breakthrough idea was to use a small plate for the fluid to drain on to, 
so that if scar tissue formed it would be spread out over a wider area.
After the implant was tried successfully in rabbits, he inserted the first 
new-style glaucoma implant into a human patient in July 1966, a toddler in 
South Africa with bilateralbuphthalmos, a congenital glaucoma causing 
enlargement of the eyes due to high pressure.
By 1969, he was able to publish the encouraging results of the first 47 
surgeries in 42 patients with very severe glaucoma.
After a failed attempt to outsource to a manufacturer in 1973, Prof Molteno 
and his family manufactured all the implants to meet growing demand for the 
devices from his colleagues.
During that time he achieved an Ophthalmology Fellowship of the Royal 
College of Surgeons of Edinburgh, then worked at Stellenbosch University for 
eight years.

The family came to New Zealand in 1977, when Prof Molteno took up a position 
as a consultant ophthalmologist, tackling a backlog of glaucoma cases.
"There were major advances in drugs at that time and new man-made compounds 
were coming along,'' he said.
At Dunedin Hospital he was involved in setting up the Otago Glaucoma Surgery 
Outcomes Study.
It was to be a combination of emerging drugs, new materials and the 
public-spirited patients in Otago and Southland who participated in the 
research which led to improvements in the implant design and surgical 
techniques, which in turn continued to improve success rates and reduce 
complications.
"We improved the outcomes by using [then new] dissolving sutures to tie off 
the tube, which made it [the glaucoma implant] a very safe operation,' he 
said.

There are now more than 2000 cases in the Otago Glaucoma Surgery Outcomes 
Study, making it one of the largest studies of glaucoma surgery in the 
world.
More than 1000 cases with Molteno implants have the longest follow-up data 
of any glaucoma implant.
Successful recipients over the years have included a 4-day-old baby with 
congenital glaucoma through to a woman of 92, which lasted her beyond 105.

Collaborative research between Prof Molteno, colleagues at the University of 
Otago, Southern Community Laboratories and several international centres has 
helped work out why some surgeries are successful and some fail.

Prof Molteno is visibly moved when he recounts the generosity of many 
recipients and their families, when after death, the eye is donated for 
further study.

Prof Molteno, whose family origins go back to Italy, had since operated or 
overseen surgeries around the world, including in New York, Buenos Aires, 
Sydney, Turkey, Rome and Uppsala.

In 1992 Molteno Ophthalmic custom-built a factory with a Class 350 
"cleanroom' in Dunedin, and brought the entire production process 
in-house,where the company still manufactures the implants, with six 
employees.

Molteno exports 85% of the glaucoma implants manufactured each year.

While a Molteno drainage device can be inserted shortly after diagnosis, 
each device can take four to six weeks to make, under strict manufacturing 
conditions and with multiple checks throughout the process to meet 
international standards.
Once inserted alongside the eyeball, it is virtually invisible and can be 
expected to last for the rest of the patient's lifetime.

While in most cases "one size fits all'', some drainage devices have been 
designed for particularly large adult eyes, or for children with abnormally 
small eyes.

Dr Molteno said sales at present were "modest'' but she hoped to double that 
by 2018.
When the Molteno technique was understood and had gone global, other 
companies replicated the technology and Molteno subsequently lost some 
market share, she said.
However, Dr Molteno said the company was focusing on spreading the word 
about the high success rates of Molteno glaucoma implants.

The company would continue to support glaucoma research, while also working 
on new research and development projects in complementary areas, such as 
developing bone grafting material, which could also have applications beyond 
ophthalmology, in dentistry or orthopaedic surgeries.

_______________________________
About glaucoma

Glaucoma is a group of blinding conditions where there is a build-up of 
pressure in the eye.
Congenital glaucoma in children may cause enlargement, pain, extreme light 
sensitivity and eventually the eye can turn opaque.

. Patients with glaucoma can go blind if left untreated.

. Causes include eye trauma, age or family disposition.

. Some populations have higher or more aggressive types of glaucoma.

________________________________

The implants

Molteno glaucoma drainage implants are made of a polymer plate about the 
size of a thumbnail and have a fine silicon tube attached.
Inserted into the front part of the eye near the iris, the tube drains 
excess fluid away to the plate, which forms a cavity which naturally 
disperses the fluid into the body's tissues.

________________________________

The beginning

Emeritus Prof Anthony Molteno began his career by implanting the first 
effective glaucoma implant into a toddler with buphthalmos (congenital 
glaucoma) in 1966, in South Africa.
He published the results of his first Molteno glaucoma implant surgeries in 
47 eyes of 42 patients in September 1969 in the British Journal of 
Ophthalmology.

Eye implants are now the most common surgical treatment for severe and 
complex glaucoma in some countries, such as the US.

>From the early 1970s, Prof Molteno manufactured the implants himself, then 
in 1982 he and his wife established Optomat Supplies Ltd in Dunedin (since 
renamed Molteno Ophthalmic Ltd). In 1992, Molteno Ophthalmic custom built a 
factory with a Class 350 ''cleanroom'' in Dunedin, and brought the entire 
production process in-house from where the company still manufactures the 
implants and trades, with six employees.
Molteno exports 85% of the glaucoma implant devices manufactured each year.
The major export markets are America,Europe, the Middle East, Russia, 
Australia, with a presence in South Africa.
New markets are opening up in South America, distributors recently picking 
up the product in Argentina and Bolivia. Molteno Ophthalmic was one of New 
Zealand's first medical implant exporters.

________________________________
Prof Molteno's awards
American Glaucoma Society's innovator of the year award in 2015.
International Society of Glaucoma Surgery's medal for outstanding 
achievement in 2014.
Emeritus Membership of the Glaucoma Research Society in 2011.

? Royal Australian and New Zealand College of Ophthalmologist'
distinguished service award in 2009.

Lion Clubs International Foundation's Melvin Jones Fellowship in 2008.
Awarded an Officer of the New Zealand Order of Merit in the 2006 New Year's 
Honours.
Received the Goldmann Medal from the International Glaucoma Association in 
1998, for his significant contribution to understanding and treatment of 
glaucoma.

With Best Regards,
God Bless,
Alan
Plantation, Florida