Volume 10, Number 1
April, 2001
Glaucoma Conference Spells Hope For Patients
The latest advances in the diagnosis and treatment
of glaucoma were presented at the 24th Annual Wills Eye Hospital
Glaucoma Conference in early February. Four national glaucoma
experts joined seven Glaucoma doctors to share encouraging news
with the 60 specialists and general ophthalmologists gathered
for the event.
Dr. M. Bruce Shields, Chairman of the Yale Department
of Ophthalmology, in his keynote lecture reviewed the changes
in our understanding of the potentially blinding disease over
the past 150 years -- from the time doctors were actually able
to look into the eye with the newly invented instrument, the ophthalmoscope,
to the present. Advances over the past 20 years have been particularly
encouraging, and this momentum continues as researchers at Wills
and other major centers work in the intriguing new areas reported
at the Conference.
New Ways to Diagnose and Track
One of the central and most difficult problems
glaucoma specialists face is finding out if a person actually
has glaucoma and tracking its course. Even as recently as 20 years
ago most eye doctors believed diagnosing glaucoma was simply a
matter of measuring the pressure in the eye. If a person's pressure
was above "normal," that individual had glaucoma. But doctors
began discovering people with glaucoma damage whose pressures
were normal or even below normal, and still others who had above
normal pressures but with apparently no adverse effect on their
vision.
This startling conclusion led doctors to focus
their attention on the optic nerve itself. While the ophthalmoscope
remains a mainstay in looking at the optic nerve, more advanced
technologies now permit doctors to examine the nerve and other
retinal tissues more precisely, understanding in far greater detail
the changes the optic nerve undergoes when a person has glaucoma.
Dr. Joel Schumann, Director of the Glaucoma
Unit at the New England Eye Center in Boston, reviewed the latest
instruments used to detect glaucoma and glaucoma progression,
among them, the Heidelberg Retinal Tomograph (HRT), the Optical
Coherence Tomograph (OCT), and the GDx -- all being intensively
studied at Wills. These technologies promise a greatly improved
level of care for patients with glaucoma and those suspected to
have it.
Another method used to determine if someone
has glaucoma and to follow its course of development is more familiar
to glaucoma patients -- visual field testing. Wills doctors Jeffrey
Henderer and Jonathan Myers, and former Glaucoma Fellow Mark Lesk,
now at the University of Montreal, explored advances in this area
-- testing that is less tedious for the patient but at the same
time provides more accurate results. Evaluation of these new instruments
is ongoing at Wills and other major centers.
New Medications
This progress in the diagnosis and monitoring
of glaucoma is matched in many ways by advances in treating it.
Doctors now know that intraocular pressure is not the only factor
responsible for glaucoma. Nevertheless, controlling a glaucoma
patient's pressure remains an important means to limit damage
to the optic nerve. The pharmaceutical industry, working with
doctors at Wills and other national centers, has developed eye
drops that are easier to use, more effective, and have fewer side
effects. Drs. Richard Wilson and Jay Katz of the Wills staff spoke
about several of the newer eyedrops, including Merck’s CoSopt,
Pharmacia’s Xalcom, CIBA’s Rescula, Alcon’s Travaton and Betaxon,
and Allergan’s Lumigan and Alphagan with Purite.
Studies of these agents are ongoing at Wills.
Also, Wills researchers are addressing more specific questions
regarding these and other widely used medications. For example,
since determining which eye drop is best for a particular patient
is so important, a study is now under way aimed at determining
whether Timoptic or Alphagan is best for patients with low-tension
glaucoma.
Rescula is a good example of recent hopeful
findings that some medications developed to control eye pressure,
also may be beneficial to glaucoma patients in ways other than
lowering pressure. In particular, early studies have suggested
that Rescula also may increase retinal and optic nerve blood flow.
This is good news to glaucoma patients, since, as highlighted
in a talk by Dr. Peter Netland, Director of the Glaucoma Department
at the University of Tennessee, increasing attention is being
paid to the theory that insufficient blood flow to the optic nerve
is an important cause of damage to optic nerve cells in glaucoma.
Other agents may also perform another highly
pertinent function -- protecting optic nerve cells from becoming
damaged and dying. Some of these medications, originally used
to protect nerve cells in other areas of the body -- as in Parkinson's
and Alzheimer’s disease -- are now being studied with specific
reference to the optic nerve. One of the most promising of these
-- memantine, manufactured by Allergan specifically for the eye
-- is currently being intensely studied at Wills and other major
centers. In this regard, Dr. Henderer briefed participants on
his research on other potentially neuroprotective agents he is
studying in an animal model.
Dr. Douglas Rhee, former Chief Resident at Wills,
who will join the Glaucoma Service in July after spending a year
at the National Institutes of Health, spoke about his findings
regarding "alternative" treatments for glaucoma, including bilberry,
ginkgo, and other proposed herbal remedies. Although none of these
as yet has been proved beneficial to glaucoma patients, hopes
remain high, with studies ongoing at Wills and elsewhere.
New Laser and Surgical Techniques
Surgical methods to control intraocular pressure
were also highlighted at the Wills Conference. Dr. Katz spoke
about a new laser procedure to control intraocular pressure --
selective laser trabeculoplasty. The instrument used to perform
this operation is designed to focus laser energy more precisely,
and therefore theoretically more safely, on the tissues that need
to be altered to increase aqueous outflow. Dr. Katz is collaborating
with Dr. Jorge Alvarado of the University of California at San
Francisco to determine precisely how this promising new technology
lowers intraocular pressure.
Drs. Katz, Wilson, Henderer, along with another
Glaucoma specialist, Dr. Courtland Schmidt, also reviewed the
latest advances in glaucoma surgery -- the use of tube shunts
to drain excessive aqueous from the eye, improved filtering surgery
(trabeculectomy), and better ways of combining cataract and glaucoma
surgery.
In concluding his talk, Dr. Shields affirmed
that advances in genetics will eventually fundamentally change
the diagnosis and treatment of glaucoma. Dr. Rhee talked about
this exciting new area in more detail. Although these changes
will not come in the near future, Wills and other leading centers
around the world are intensifying their efforts to develop this
understanding as quickly as possible in order to benefit glaucoma
patients everywhere.
Glaucoma Research Center Expands To
New Site
Staff has been hired and
equipment is now in place at the new Glaucoma Research Institute
at Wills. Under the direction of Research Director for the Glaucoma
Service, Dr. William Steinmann, the Institute is housed on the
second floor of the familiar "Hand Building" on the West side
of 9th Street across the street from the Hospital. Here the research
team is hard at work -- on-site coordinator, Diana Meashey, scientific
coordinator Joanne Fontanarosa, administrative assistant Madeline
Vasquez, clinical coordinators Troy Bolgen, Cheryl Wizov, and
Fillis Samuel, research fellows Undraa Altangerel, Muge Kesen,
and Atilla Bayer, and screener-enroller Nataliya Harasymowycz
The research is clinical,
drawing on the Glaucoma Service's huge patient base to answer
questions the Service's specialists believe most urgently need
answering in order to improve the care of glaucoma patients, not
only at Wills Eye Hospital, but world-wide. The resources are
now in place and centralized to carry out the research process
-- from formulating the initial question, to the design of a study
to answer the question, enrolling appropriate patients, actual
performance of the study, and finally interpreting and publishing
the results.
The studies are divided into
well-defined categories, headed up by groups of Glaucoma Service
doctors, in which Dr. Steinmann and the glaucoma specialists believe
the Research Center has the best chance
of establishing pre-eminence world-wide. The most active areas
at present are:
- Evaluation of the Optic Disc - Drs. Spaeth,
Henderer, and Schmidt - 8 Studies
- Surgical Treatment of Glaucoma - Drs. Moster,
Katz, Wilson, and Schmidt - 13 Studies
- Medical Treatment of Glaucoma - Drs. Myers,
Katz, Henderer - 22 Studies
- Genetic Basis of Glaucoma - Drs. Rhee,
Myers, Spaeth - 3 studies
Dr. William Steinmann, Director
of the Glaucoma Research Center (left), discusses research project
with Research Fellows Dr. Undraa Altangerel (center) and Dr. Atilla
Bayer.
Photo by Robert
Curtin
Construction
Begins On The New Wills: Patient-Friendly and State-of-the-Art
In January, Wills Eye Hospital began construction
of a new medical center on top of the Walnut Towers building at
9th and Walnut Streets in Philadelphia. When completed in December
2002, it will be one of the most advanced eye hospitals in the
world.
The new Wills will be an eight-story structure
designed to deliver the full range of eye care services in a patient-friendly
environment. The hospital will include an ambulatory surgical
center, physician offices, clinics, and state-of-the-art facilities
for ophthalmic education and research.
The Glaucoma Service and all other clinical
activities now in the present building will be relocated to this
ultra-modern setting. The Glaucoma Service space is being specifically
designed to promote a seamless integration of research and clinical
areas. "We are all excited about this move," said Dr. George L.
Spaeth. "The new facility is a dramatic step forward that will
allow us not only to serve our patients better, but also to fulfill
our research and teaching responsibilities more effectively."
The construction of the new facility is made
possible by Wills’ sale of its existing building at 900 Walnut
Street to Thomas Jefferson University. The eight-story 230,000
square-foot facility has served as Wills Eye Hospital’s home since
1980.
Until the new facility opens, Wills will continue
to operate in the current building and its physicians will continue
to see patients and perform surgeries there. The Wills Emergency
Service (treating over 12,0-00 people each year) will remain in
its present location, and when patients require a hospital stay
they will be cared for in the existing facility.
“Inpatient hospital beds, for the most part,
are obsolete in modern ophthalmology,” said D. McWilliams Kessler,
Wills Executive Director and CEO. “By selling the current building
we are able to design and build a world-class clinical, educational
and research facility to meet the outpatient needs of the 21st
century.”
The new facility will include many leading-edge
advancements, including state-of-the-art education and conference
facilities with broadband capabilities, a fully automated auditorium
and breakout classrooms. The building plan also includes telemedicine
potential and building-wide video links.
Support Group For Parents
The Foundation is pleased to announce the formation of a support
group for parents of children with glaucoma. Glaucoma specialist
Dr. Courtland Schmidt, who initiated the idea, explained: “Pediatric
glaucoma is a rare disease and our present Glaucoma Patient Support
Group does not meet the special challenges these parents face.”
The meetings will include an informal talk by
one of the Glaucoma Service doctors, a question and answer session,
and an opportunity for parents to speak with one another. For
more information, please call the Foundation office at 215-503-2986.
2000 Gift Report - Thank You For Your Wonderful
Support
We are enormously grateful to the many friends
and supporters of the Glaucoma Service Foundation who helped make
2000 the most successful fundraising year in our history. During
calendar 2000, more than 1400 individuals, foundations, corporations
and estates donated a total of $477,620 to support the Foundation's
work.
Of special note was the substantial growth of
the Annual Fund, which in 2000 raised $212,172. This was a 67%
increase over the $127,044 raised in the 1999 Annual Fund. The
number of individuals contributing to the Foundation between 1999
and 2000 also increased an impressive 39%.
We value each and every gift, since each contribution--regardless
of its size-- reflects confidence in our efforts to better understand
and treat glaucoma. To all of our donors, thank you for your extraordinary
generosity
Dr. Wilson ‘Chats’ About Nutrition And Glaucoma
On January 17 Glaucoma specialist Dr. Richard
Wilson “chatted” with visitors to the Foundation Web-Site on the
topic "Nutrition and Glaucoma." Click
here to read highlights from that interchange:
Chat Support Group
willsglaucoma.org/support
Wednesdays 8:30 - 9:30 pm
Hosted by a Glaucoma specialist.
Mondays 8:00 - 9:30 pm
Saturdays 10:00 am
Patient and family members only.
Glaucoma
Patient Support Group Meetings
- All programs are on Sunday afternoons from 1:30 PM to 3:00
PM in the Wills Eye Hospital auditorium on the first floor of
the Hospital.
- Please always call the Foundation office, 215-503-1986, during
the week before the scheduled sessions to confirm that they
will still be taking place.
April 22d: Why Some People Go Blind From Glaucoma
& How to Prevent It
Dr. George Spaeth
May 20th: Understanding Glaucoma Medications
Dr. Jonathan Myers
June 10th: What is Angle-Closure Glaucoma?
Dr. Marlene Moster
Risk Factors for Glaucoma
Age:
1. Less than 50 years old (no points).
2. 50 to 64 years old (1 point).
3. 65 to 74 years old (2 points).
4. over 75 years of age (3 points).
Ethnic heritage:
5. African American (2 points).
Family History:
6. None of my immediate family (i.e., parents or siblings)
have glaucoma (0 points).
7. One or both of my parents have glaucoma (2 points).
8. One or more of my siblings have glaucoma (3 points).
9. One or both of my parents and one or more of my siblings
have glaucoma (3 points).
10. My last medical eye examination was:
a. within the past two years (0 points).
b. two to five years ago (1 point).
c. more than 5 years ago (2 points).
Add up your score: more than four points is high risk;
three is moderate risk; two or less is low risk. All relatives
of anyone diagnosed with glaucoma should be examined.
Share Your Experiences
with Other Searchlight Readers
Do you have a story about dealing with glaucoma
that might be helpful to others? Have you discovered ways of coping
with everyday problems resulting from your glaucoma that others
might find useful? The Searchlight wants to be a forum
for glaucoma patients to speak to each other. If you have something
to say but need help writing it, let us know and we will work
with you. Email us at parker@willsglaucoma.org
with your story.
Please let us know the kinds of things you would
most like to read about. Would you like to know about the latest
research, how others are coping with living with glaucoma, practical
tips (putting in eye drops, for example), what to expect with
glaucoma surgery or something else? Email us at parker@willsglaucoma.org
with your suggestions.
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