Volume 10, Number 3
December 2001
Celebration
of Forty Years of Glaucoma Fellowship Training Planned
The Annual Wills Eye Hospital
Glaucoma Conference and a gala celebrating 40 years of fellowship
training on the Glaucoma Service at Wills Eye Hospital/Jefferson
Medical College are being planned for September 26–28, 2002.
The Conference will take place on Friday and Saturday, followed
on Saturday night by a gala celebration at the Perelman Theater
of the new Kimmel Performing Arts Center. In addition to
a stellar lineup of speakers, a ballet has been commissioned for
the occasion, the costs of which are being underwritten by long-time
Wills Eye Hospital patient and supporter, Mr. Jack Wolgin.
It is expected that those coming to the Glaucoma Conference will
come to the gala, but it is anticipated that the gala will draw
a much larger group.
Foundation President Dr.
George Spaeth explained, “We are proud of our Fellows. Many
are leaders: one is the president of a medical school, one is
the director of medical affairs at a medical school, many are
private practitioners, chairs of departments of ophthalmology,
and chiefs of glaucoma units.” Recipient last year of the
Wills annual award for teaching, the Golden Apple Award, Dr. Spaeth
continued, “We wish to celebrate what we believe is a significant
achievement that has changed the way patients with glaucoma around
the world receive their care. We believe that we on the
Glaucoma Service and those we have trained have played a role
in changing the basic concept of what glaucoma is, how it is recognized,
and how it is best treated. We would like to think that
the mentoring we have done serves as a model for other departments.”
| Foundation Board member Bonnie Long,
chair of the gala celebration, is in the process of forming
the gala committees. Volunteers are needed. Please call Foundation
Managing Director Nancy Petrongolo for details (215-503-2986). |
The Challenge of Detecting Glaucoma Early
Dr. Jeffrey Henderer examines the optic disc
of a member of the North City Congress Senior Center at a recent
glaucoma screening. Assisting at the screening were Glaucoma
Service Clinical Fellow Dr. Tara Uhler and Research Fellows Dr.
Atilla Bayer and Dr. Undraa Altangerel. See story below.
Photo by Dr. Atilla Bayer
Dr. Henderer Builds
on Nettie Taylor Screening Project
The Foundation’s screening programs were initiated
in 1998 by Foundation Board member Ms. Nettie Taylor in response
to the fact that the incidence of glaucoma is seven to eight times
higher in the African-American community than in the general population.
Working with the Penn Towne Links, an African-American service
organization, Executive Director Ken Parker, and a number of Glaucoma
Service doctors, 8 screenings were carried out at local, predominantly
African- American churches. Dr. Henderer, who worked at
some of those screenings while he was still a Clinical Fellow
on the Glaucoma Service, is now spearheading the Foundation’s
screening programs.
After his Wills Fellowship, while on the staff
of the Temple University Department of Ophthalmology, working
mainly through the Philadelphia Corporation for Aging (PCA), Dr.
Henderer screened 140 persons during the academic year 1999–2000
and identified approximately 6–7 new cases of glaucoma, 2 or 3
cases of poorly controlled glaucoma, and about 10 persons suspicious
for glaucoma. Far more patients were referred to an optometrist
or ophthalmologist for nonglaucoma eye disease (most often cataract)
and glasses.
Appointed to the Glaucoma Service staff in July
2000, Dr. Henderer continued screenings at PCA centers.
Through August of 2001, with help from the Borkee- Hagley Foundation
in Wilmington, Delaware, Dr. Henderer has performed 18 screenings
at approximately 12 different centers, a total of some 327 exams.
Five more screenings have been done since then, but the data have
not yet been entered into the database. Approximately 56
persons have been diagnosed with either glaucoma, or as glaucoma
suspects. Thirty-two were unaware of their status. Many
more were found to have cataract or suspected refractive error.
Says Dr. Henderer, “I am pleased with the results
of my project so far and I am very excited about the prospects
for glaucoma screening in the future. I feel that this past
year has been an important one to lay the groundwork for some
very important work to come. The most important next step
is to gather information on patient follow-up after the screening.
This project will be done by one of the clinical glaucoma fellows
at Wills and PCA. I sincerely appreciate the support of
Ms. Nettie Taylor and the Penn Towne Links, who established the
framework for this crucial activity in the battle against glaucoma.”
Pharmacia
Corporation Funds Dr. Rhee’s Molecular Pharmacology Study
Pharmacia Corporation has generously agreed
to fund Glaucoma Service physician Dr. Douglas Rhee’s molecular
pharmacology initiative, “Prostaglandin Cell Signaling and Regulation
of Extracellular Matrix in Trabecular Meshwork and Ciliary Body.”
The primary goal of this project is to investigate the mechanism
of action of the prostaglandin analog, latanoprost (a commonly
prescribed drop used to lower eye pressure), at the genetic, biochemical,
and cellular level. “In doing so,” says Dr. Rhee, “I hope
to further elucidate one of the fundamental questions in glaucoma—what
controls intraocular  pressure
(that is, what causes glaucoma)? By understanding the pathways
that drugs use to lower intraocular pressure, we can learn how
intraocular pressure is controlled. In turn, this will enable
us to develop new and better ways of treating glaucoma.
I am quite hopeful that this project has the prospect for further
elucidating one of the fundamental and unanswered questions in
glaucoma.”
Glaucoma Service physician Dr. Douglas Rhee in his laboratory
at Jefferson Medical College, Thomas Jefferson University.
Photo by Jamie
Nicholl
Dr. Wilson Discusses “Exercise and Glaucoma”
with Chat Support Group
On Wednesday, October 3, Dr. Richard Wilson
of the Glaucoma Service staff discussed “Exercise and Glaucoma”
with the Chat Support Group. Here are some highlights from that
session:
Participant (P): Are there exercises that are bad
for glaucoma?
Dr. Wilson: Yes, avoid any exercise that puts your
legs higher than your head for any length of time. That
raises the pressure of blood in the veins around the eye. The
fluid in the eye cannot leave the eye unless its pressure is higher
than the pressure of blood in the veins.
P: Is there a time limit on exercises that require
lowering the head below the heart, or should such exercises be
avoided? I’m thinking of a Yoga exercise.
Dr. Wilson: I wouldn’t do that for more than 10
seconds or so, unless you have something that is so worth it that
it counterbalances the risk of raising your IOP (intraocular pressure).
For instance, Yoga headstands for any prolonged period would seem
too risky to me.
P: Last year I was still doing hamstring stretches
and sometimes abdominal exercises with my legs straight up for
much longer than 10 seconds, until I learned from Dr. Wilson in
this chat room about that causing an increase in intraocular pressure.
I’m grateful. I wish everybody “out there” knew.
P: Neither my glaucoma doctor nor my ophthalmologist
ever said anything about exercise!
P: I did housework two days after my trabeculectomy.
I had to have it stitched up because of that. I’ll never
do that again! Next time, I will listen to doctor.
Dr. Wilson: Did you pop a stitch?
P: Yes, four times.
P: I’m curious about the effect of strenuous exercise
on my normal-tension glaucoma. I race bikes and ski cross-country.
I often push my heart rate close to 90% of maximum for extended
periods. Also, I’ve heard that strenuous exercise may produce
free radicals, which I understand may adversely affect the optic
nerve. I try to take antioxidants.
Dr. Wilson: I think that any effects of increased
free radicals would be counterbalanced by the improvement in circulation
to the optic nerve and the lowering in IOP inherent in aerobic
exercise.
P: Is walking probably a better exercise for us
than aerobics?
Dr. Wilson: No. Any aerobic exercise is good. “Aerobic”
means exercise that uses oxygen. So consistent movement
for 20 minutes —such as walking, biking, swimming—would be good.
P: How about aerobic exercise classes?
Dr. Wilson: Aerobic exercises are good. They
usually get your heart rate up for 20 to 30 minutes, and being
with a group will help keep you motivated.
P: I am 32 years old, have congenital glaucoma,
and I run three miles a day, four to five times a week.
That should be okay, right?
Dr. Wilson: That should be terrific. Wow!
Moderator: Do you have any suggestions about how
to start an exercise program and stick to it?
Dr. Wilson: Yes. You should work it into a convenient
time of the day. However, it always takes will power to
do it. I swim at 6:30 in the morning, but in the winter I really
have to force myself out into the cold to go to the “Y” and hop
in the pool.
P: Is there any difference between exercise that
generates sweat, and exercise that doesn’t, besides the obvious?
Dr. Wilson: No. Oxygen consumption is what
counts.
P: How about swimming in a pool after you’ve had
a trabeculectomy? Is the pool water safe?
Dr. Wilson: Usually, unless your conjunctiva is
very thin. Your doctor can tell you whether you should use
goggles or not swim at all.
P: What about weight training? I use the
weight machines.
Dr. Wilson: Weight training is good for the body,
but does little that I know of for glaucoma. It counts toward
your general health, muscle tone, weight control, etc., but does
not lower IOP or increase circulation much.
P: Can weightlifting raise IOP?
Dr. Wilson: Yes. Holding one’s breath and
straining also raises the venous blood pressure. However,
most people cannot heave huge weights for very long.
Click here for
chat room schedule of events.
“The chat room is extraordinarily useful.
Keep up the good work; it’s appreciated.”
Henry Greenspan,
Ann Arbor, Michigan.
Seven Glaucoma Service Studies Presented at
American Academy of Ophthalmology Meeting
Seven Glaucoma Service studies were presented
at the Annual Meeting of the American Academy of Ophthalmology
in New Orleans the second week of November.
- Patterns of Optic Disc Damage in Patients with Glaucoma
And Average Intraocular Pressure: Relation to Risk Factors
Tarek M. Eid, MD; George L. Spaeth, MD; Augusto Azuara-Blanco,
MD; Atilla Bayer, MD; William C. Steinmann, MD, MSc
- Therapeutic Monocular Trial of Unoprostone 0.12% in Glaucoma
Patients on Maximum Tolerated Medical Therapy
Leslie S. Jones, MD; Undraa Altangerel, MD; L. Jay Katz, MD
- Reliability of a New Optic Disc Staging Scale: Inter-
Observer Agreement
Muge Kesen, MD; Jeffrey Henderer, MD; Undraa Altangerel, MD;
Atilla Bayer, MD; George L. Spaeth, MD; William C. Steinmann,
MD, MSc; Joann Fontanarosa, PhD
- Long-Term Results of Baerveldt Tube-Shunt Surgery with
Mitomycin-C Use
Inci Irak, MD; Marlene R. Moster, MD
- RADAAR Detects Glaucoma and its Severity
Paul Harasymowycz, MD; Gang Xu, PhD; Jonathan Myers, MD; Atilla
Bayer, MD; George Spaeth, MD
- Clinical and HRT Optic Disc Size (ODS) Measurement: Correlation
with Glaucoma Severity
Paul Harasymowycz, MD; Gang Xu, PhD; Jonathan Myers, MD; William
Steinmann, MD, MSc; George Spaeth, MD
- Influence of Patient Data on Cup/Disc Ratio Measurement
and Optic Nerve Interpretation
Muge Kesen, MD; Jeffrey Henderer, MD; Richard Wilson, MD; Marlene
Moster, MD; Jonathan Myers, MD; G. H. Davids, MD; Tara Uhler,
MD; S. Donnelly, MD; K. Han, MD; Joann Fontanarosa, PhD; William
Steinmann, MD, MSc; George Spaeth, MD
2001–2002 Clinical Fellows: Glaucoma Specialists
of the Future
Dr. Mary Jude Cox
Dr. Cox, Chief Resident at Wills last year, graduated with a distinguished
record and numerous honors and awards from the Medical School
of the University of Virginia. She has 17 publications to
her credit.
Speaking of her choice to specialize in glaucoma,
she explained: “I value the close relationships with patients
that being an ophthalmologist allows, as patients trust us with
their cherished eyesight. My experience in the glaucoma
clinic has reinforced the idea that patients need a friend as
well as a doctor. Frightened and confused, uncertain of
their condition or what the future holds, patients often do not
know where to turn. After spending a few extra minutes with
a glaucoma patient and her son explaining the reason for using
eye drops, I received a thank you note in the mail, thanking me
for making clear something that had been ‘mysterious for so long.’
I continue to see them both every few months, once again feeling
that I gain more from these interactions than they.”
Dr. Tara Uhler
Dr. Uhler, Resident at Wills last year, graduated magna cum laude
in biology from Harvard College, received an A.M. degree summa
cum laude for her thesis on neuroprotection in rat models, and
then completed her medical degree at Harvard Medical School, where
she was a Harvard Graduate National Scholar. She has performed
research at the Tumor Immunology and Biology Laboratory at the
National Cancer Institute of the National Institutes of Health.
She works with Esperanza, an ophthalmology clinic serving the
Hispanic population of North Philadelphia.
She explained her choice to specialize in glaucoma:
“My decision to enter ophthalmology was the result of my intense
interest in the eye, its challenging diseases, and the opportunity
to perform both medical and surgical treatment, as well as my
desire to enter into long-term patient-doctor relationships.
These same characteristics are the principal reasons I am particularly
attracted to the field of glaucoma. Glaucoma demands a long-term
relationship with patients, includes surgery which can be complicated
and challenging, and promises new advances in both pharmacologic
and surgical management. This field is also fertile ground
for research topics ranging from basic mechanisms to therapeutic
options.”
Dr. Rajesh Shetty
Dr. Shetty received a B.S. in Economics, working in a dual major
in Health Care Systems and Finance at the Wharton School of Finance
at the University of Pennsylvania. He took his medical degree
from the Indiana University School of Medicine, where he received
the Special Recognition in Student Program in Academic Medicine
award. His ophthalmology residency was at the University
of Texas Southwestern Medical Center in Dallas. Most recently
Dr. Shetty served the Ben S. Fine Fellowship in Ophthalmic Pathology
at the Armed Forces Institute of Pathology in Washington, D.C.
His research interests range from a comparison of the fundamental
histopathologic changes found in chronic and acute neuropathy
of the optic nerve in glaucoma, the surgical results of various
glaucoma drainage implants, and the common systemic side effects
of glaucoma medications.
He explained his decision to specialize in glaucoma:
“My clinical exposure in the public hospital setting of Dallas
revealed the chronic devastating impact that glaucoma has on our
society, especially on the African American population.
The combination of medical and surgical complexity in these difficult
cases provides some of the greatest challenges in clinical ophthalmology,
particularly in the face of a poorly understood disease.”
Photos by Ken Parker, PhD
Practical Information for the Glaucoma Patient
What to Expect After Trabeculectomy
by Jeffrey Henderer, MD
Glaucoma surgery is a complex subject.
It can offer very effective treatment for the disease but can
also have very serious side-effects. Surgery is not a decision
to be taken lightly, and an understanding of some of the symptoms
and follow- up care needed can be very helpful to patients.
Although technically laser treatments for glaucoma
are a form of surgery, when glaucoma specialists say glaucoma
surgery, they are usually referring to a trip to the operating
room to essentially manufacture a new drain for the eye.
This article deals with one type of glaucoma surgery, trabeculectomy.
What is a Trabeculectomy?
Trabeculectomy is the name of a surgical procedure designed to
create a hole in the wall of the eye to allow the aqueous humor
in the front of the eye to drain out of the eye and thereby lower
pressure. A simple hole in the eye would let too much fluid
out and the eye would collapse, so the hole is made in the bottom
half of a “trapdoor”-like incision.
This hole is created in the far periphery of
the cornea, usually under the upper eyelid. The trapdoor is then
replaced over the hole and sutured back into place in such a way
as to allow some aqueous to leave the eye, but not too much. The
size of the hole and the tension and number of sutures can regulate
this outflow.
The aqueous then collects under the skin of
the eye, or conjunctiva, adjacent to the trapdoor (usually located
under the upper lid) and forms a cyst, or bleb. This cyst acts
as a reservoir for fluid to leave the eye and thereby lower the
eye pressure.
Possible Problems
The sensations that can be experienced after trabeculectomy are
the direct result of the way this surgery is performed.
Obviously, the goal of surgery is to lower the eye pressure.
Unfortunately this does not always happen according to plan.
In the evening after trabeculectomy, often the eye is sore.
I instruct patients to take Tylenol. If the pain is not
controlled with Tylenol, then call the office.
Between postoperative day one and many weeks
after surgery, defined as the immediate postoperative period,
the eye pressure can be very low, can remain the same as before
surgery, or can even be higher. If the pressure is very low, the
patient may well experience blurred vision. If the low pressure
is accompanied by swelling of fluid or blood in the choroid (under
the retina), there will likely be feelings ranging from soreness
to extreme pain. High pressure is often asymptomatic unless
it is very high. Very high pressures can give pain and blurred
vision.
Addressing the Problems
Your doctor will take steps to address each of these symptoms
by treating their cause. If your pressure is low, drops
or an injection of viscoelastic (used commonly in cataract surgery
to maintain the shape of the eye) may be indicated. If it
is high, you will likely have sutures removed or cut to try and
increase flow out through the surgery site. In the late postoperative
period, defined as several months after surgery, other sensations
can arise as a result of the surgery.
- One of the most common is a dryness of the eye. This
is often caused by a large bleb interfering with the upper eyelid
function and therefore the even distribution of tears coating
the eye.
- Rarely, the bleb can grow so large that it can cover the central
cornea and blur the vision.
- Sometimes the bleb can be too effective and cause the pressure
to be too low. As in the immediate postoperative period,
this can be associated with blurred vision.
- Alternatively, the bleb can grow very large, with a thick
wall of scar tissue and an associated high pressure. This
is known as encapsulation. Your doctor may want to treat
this with medication or a surgery known as bleb needling.
Despite these symptoms, most persons with
functional blebs have no serious side effects.
Perhaps the most disconcerting problem in the
late postoperative period (although it can occur immediately after
surgery) is a bleb leak. This typically happens in eyes
that have received anti-scarring medicine at the time of surgery
to prevent the scarring that often causes the trabeculectomy to
fail. Some patients are unaware of the leak, others notice
tearing from the eye. Usually there is a low pressure.
Such leaks are often treated fairly aggressively as there is a
chronic risk of infection.
These are some of the many symptoms that patients
can have after trabeculectomy. But if you remember nothing
else, I want to give you a mnemonic device to describe symptoms
that might indicate trouble after glaucoma surgery. I learned
this from Richard K. Parrish II, MD, at the Bascom Palmer Eye
Institute in Miami. Although he did not invent it, he has
helped to popularize it. The mnemonic device is RSVP.
- R for Redness
- S for Sensitivity to light
- V for blurred Vision and
- P for Pain.
If you have any of these symptoms, call your doctor.
Because the surgery does not always go according
to plan, the follow-up care needed after surgery can vary greatly.
You will certainly need to be seen the first day after surgery.
From there the visits are tailored to the appearance of the surgery.
If things look fine, perhaps the next appointment will be in a
week. If things are not quite perfect, you may need to be
seen sooner— perhaps even the next day. Subsequent visits
are extremely variable depending on the physician and the progress
of surgery, but you will likely be closely monitored for the first
two months or so. If the surgery goes well, and depending
on what type of job you have, you should be able to return to
work within a week or so.
You will be asked to use eye drops after the
surgery. Almost certainly they will be different than the
ones you had been using before surgery. Generally the postoperative
medications are a combination of anti-inflammatory and antibiotic
drops. Each doctor has his or her own drop regimen to try
to prevent infection and reduce the scarring that can occur after
surgery. This is one time when high-dose steroid drops can
be used. At other times such high doses may be associated
with elevated pressure, but after surgery they help keep the pressure
low.
Glaucoma surgery requires a significant investment
from the doctor and the patient. Often the surgery is only
the first step. Frequent visits postoperatively are typically
needed to adjust medication, cut sutures, or perform other manipulations
to try to maximize the long-term success of the procedure.
 Understanding
what is entailed can help foster a good doctorpatient relationship
in which they work together as partners through this event.
Dr. Patricia Krzyzanowska, from Wroclaw, Poland,
recently spent 6 weeks as an observerresearcher on the Glaucoma
Service of Wills Eye Hospital. While here she presented a paper
on her research concerning reversibility of optic disc cupping
after trabeculectomy, and had the opportunity to work with Dr.
Spaeth on his new optic disc and field staging systems. Dr. Spaeth’s
participation in conferences in Poland has led several young Polish
ophthalmologists to visit the Glaucoma Service over the past two
years.
Photo by Ken Parker, PhD
Parents of Children
with Glaucoma Find Help in Support Group
Norma Schlossberg works with children with glaucoma
and their siblings while their parents attend the first meeting
of the new Foundation-sponsored support group for parents of children
with glaucoma. Approximately 25 parents heard Glaucoma Service
doctor Courtland Schmidt speak on “An Overview of Glaucoma in
Children” on September 30 in the Wills auditorium. The second
meeting of the season will take place in the auditorium on Sunday
January 13th, from 1:30 to 3:00 PM, with Dr. Richard Wilson speaking
on “Medical Treatment of Children with Glaucoma.” Mrs. Schlossberg
and her husband Jack are long-time members of the Foundation sponsoreda
dult glaucoma patient support group. Nancy Petrongolo, Managing
Director of the Foundation, instrumental in setting up the group
for parents, notes she now has 337 people on the mailing list
for the group.
Photo by Jamie Nicholl
Glaucoma Treatment: On the Frontier
Alternative Treatments for Glaucoma? Part I
by Douglas J. Rhee, MD
In the United States, alternative medicine is
becoming more and more popular. However, one should use
great caution when considering the use of an alternative treatment
for any reason. For a select few conditions, there is good
scientific evidence that alternative (or nontraditional) treatments
are beneficial (for example, gingko biloba for improvement
in mental function in patients with Alzheimer’s). There
are nearly an equal number of alternative treatments that have
been shown to be harmful [for example, Stephania tetrandra,
Magnolia officinalis, Aristolocia fangchi (herbs in some herbal
weight loss preparations) causing kidney failure and bladder cancer;
gingko biloba causing cerebral hemorrhage, etc.]
What about alternative treatments for glaucoma?
We have recently written a review of this subject which was published
in the ophthalmologic journal Survey of Ophthalmology (see Rhee
et al 2001:46:43-55). Oftentimes, the articles that are used to
support the claims of alternative medicine make conclusions that
are not supported by the data in their studies, i.e., bad science.
In a multi-part series, I hope to review some of the evidence
about various alternative treatments and their possible use for
glaucoma.
Acupuncture
Those who practice acupuncture believe that health is determined
by a balanced flow of vital life energy (called qi or chi) present
in all living organisms. This energy circulates in the body
along twelve major energy pathways called meridians. Each
meridian contains over a thousand acupoints that can be stimulated
to alter the flow of qi. With the use of special needles
inserted just under the skin at these acupoints, an acupuncturist
attempts to correct or rebalance the flow of energy to treat disease.
Acupuncture for glaucoma has been studied in
Europe and in China. In all studies, there was no effect
on intraocular pressure or visual field. There is no evidence
to support the use of acupuncture at this time.
Diet
Foods contain vitamins and nutrients important in the prevention
or treatment of disease. By altering diet, one could potentially
change the balance between beneficial and harmful factors.
For example, it has been proven that serum cholesterol levels
can be lowered by decreasing the amount of ingested cholesterol.
In some alternative medicine books I have encountered
are claims that a dietary change could have a beneficial effect
on glaucoma —specifically a high rutin (a compound isolated from
cured tobacco and buckwheat) diet or a “rice diet.” I would like
to address each of these independently.
In 1948 an ophthalmologist noted that the “rice
diet,” a low-salt, lowprotein, and high carbohydrate regimen,
lowered intraocular pressure in 11 of 12 individuals. However,
all of the patients had massively uncontrolled high blood pressure
because of end-stage kidney failure (none of these 12 patients
had glaucoma). When they started the low-salt diet, their
systemic blood pressure decreased as did their intraocular pressure.
This was in an era before blood-pressure medications and dialysis
were available. Massively elevated blood pressure can increase
eye pressure because it increases pressure around the brain.
Since the eye is connected to the brain, eye pressure rises.
It is important to note that the blood pressure
needed to elevate the pressure around the brain enough to elevate
the eye pressure is fatal 100% of the time. We know that
a low-salt diet for individuals with kidney failure will help
their systemic blood pressure. As I hope was clear from
my description, the only reason the low-salt diet worked to lower
eye pressure was that it lowered the massively elevated blood
pressure and intracranial pressure. In modern times, it
is an extremely rare individual who has a blood pressure that
high. If they do, an elevated eye pressure is obviously
not the most important concern.
A few years later, the same ophthalmologist
reported that eating rutin along with the drug pilocarpine lowered
intraocular pressure. Again, this ophthalmologist mistakenly
concluded that the rutin was responsible for lowering the eye
pressure. We now understand that the drug pilocarpine was
the reason why his patients had a lower eye pressure.
Obesity
What about weight loss? In recent large epidemiologic studies,
the investigators looked at the BMI (body mass index)—a method
of grading the level of obesity which is more accurate than just
looking at the number of pounds) in people with glaucoma or without
glaucoma. No difference was found. At this time, there
is no evidence that diet or obesity plays a role in the pathogenesis
or treatment of glaucoma.
In conclusion, there is no evidence that diet
or acupuncture is beneficial for glaucoma. At this time, it would
be improper to conclude that all alternative treatments may be
useful for the treatment of glaucoma. In the next issue, we will
review some treatments which may have some promise.
In Perspective
“I Know It’s in my Best Interest.”
by George L. Spaeth, MD
The other day I was impressed with how wonderful
one of my patients looked. She has been a diabetic on insulin
for many years. She looks 15 years younger than her 74 years.
She has no complications of diabetes. She is energetic and
attractive. In answer to my query about how she kept herself
in such great shape, she responded that she was extremely disciplined
with control of her blood sugar. How could she bring herself
to do that? I asked. She answered, “I know it’s in
my best interest.”
A careful analysis of that deceptively simple
statement may be instructive.
“I”
She stated that she herself thought it was in her best interest—
not her husband, or her doctor or anybody else. She had
come to the conclusion herself—a critically important part of
being healthy. Health is the perception of being whole.
While things external to the individual affect the individual’s
health—things such as bombs and germs and doctors—nothing can
make a person healthy except the person himself or herself.
The recognition that I am primarily responsible for whether or
not I am healthy is the first step towards my being healthy.
“Know”
“Know” is a strong word: “I know that my Redeemer liveth” for
the Christian, or “I know that two and two equals four.” There
are not a whole lot of things we can say in a declarative sentence
in which we use the word “know”! What she was saying was that
she was certain that how she lived would affect whether she would
be healthy. Many people, in contrast, consider their health
to be the consequence of ill fortune or bad karma.
“It’s in my best interest.”
But what is our “best interest”? For some it’s health, for
others wealth, or self-indulgence, or comfort, or fame.
It behooves us to be careful about what we consider our “best
interest,” because it is what we are most likely to be successful
in achieving.
It is both wonderful and discouraging to have
practiced medicine for 38 years. It is wonderful because
I have been able to see with increasing clarity that what a person
does with the genes he or she is given is a major determinant
in whether that person will be healthy. Somehow, that seems
just and fair and wonderful. It is frustrating in that I
also have seen with increasing clarity that people who already
understand that how they live affects them do not need to have
it told to them, and those who need to have it told to them rarely
benefit from having it told to them. That may be fair, but
it certainly is not wonderful.
The three most important things that determine
whether a person with glaucoma maintains good vision and good
health are: (1) their genes, (2) uncontrolled things such
as war, and (3) how they manage their lives. Though we do
not have complete control of our lives, each individual can do
a great deal to assure that glaucoma does not decrease his or
her quality of life.
Glaucoma Patient Support Group Meetings
All meetings are on Sunday afternoons from 1:30
to 3:00 pm in the Wills Eye Hospital Auditorium on the first floor
of the Hospital. Please call 1-215-503-2986 a week before
the scheduled meeting to confirm.
January 13 — Dr. Richard Wilson
For Parents of Children with Glaucoma
“Medical Treatment of Children with
Glaucoma”
February 17 — Dr. Marlene Moster
“What Patients Need to Know about Glaucoma
Surgery”
March 17 — Dr.Tara Uhler
“Lasers and the Glaucoma Patient”
 Reception
Honors Glaucoma Pioneer
Glaucoma Service physician Dr. Anne Chan with
Wills Ophthalmologist-in-Chief Dr. William Tasman at a reception
in her honor September 25th. Dr. Chan began seeing glaucoma patients
at Wills Eye Hospital in 1963 with the famed glaucoma specialist
Dr. Irving Leopold. Dr. Spaeth, who became Director of the newly
established Glaucoma Service in 1968, praised Dr. Chan’s years
of dedicated service to the Glaucoma Service and Wills Eye Hospital:
“Dr. Chan’s long record of meticulously teaching residents and
providing her patients the highest standard of care has been and
continues to be an inspiration to us all.”
Photo by Jamie Nicholl
Annual Fund
You CAN Make a Difference!
By now you should have received our year-end
mailing for the Foundation’s 2001 Annual Fund. If you have
already made a donation, many thanks for your generous support!
If you haven’t yet, we hope you will take a
moment and contribute today.
The Annual Fund this year is particularly important.
It will help us staff our new Glaucoma Research Center, and we’re
especially excited about the many new research initiatives now
underway. It will help us provide information to patients
and families through our web site and this newsletter, which now
has an international constituency. And it will help us train
a new generation of glaucoma specialists, so important for the
future.
All these activities are critical in our effort
to better understand and eventually eradicate glaucoma, and that’s
why we’re asking for your support. Please help us reach
our goal of $200,000 before the end of the year. Your gift
will truly make a difference.
Genes and Glaucoma
Carla Wolbach of Schnecksville, PA writes:
I am interested in learning more about genes
affecting glaucoma. My son was born with congenital glaucoma.
His paternal grandmother, her sister and both her brothers have
adult onset glaucoma. I’m not sure about all of them, but
my mother-in-law has normal tension glaucoma. What can you
tell me about their situation? Is there a blood test that
family members can take to know if they carry the gene?
Dr. Douglas Rhee, a glaucoma specialist
on the Glaucoma Service as well as a molecular biologist who has
done extensive work on the genetics of glaucoma, answers:
Based on our current knowledge of genetic markers for glaucoma,
it appears that the genes for congenital glaucoma are different
than those for the adult onset types. Two genetic loci,
that is, places where the genes exist, have been identified. However,
the responsible genes have not yet been identified. Therefore,
there is no test to see if any other member of a family is a carrier.
There are seven loci or places that have been identified for juvenile/adult
onset glaucoma, but only one responsible gene has been identified,
a gene referred to as the TIGR gene.
At this time there is no commercially available
test to see if an individual has the mutation. It may be possible
to test for some of the mutations for that gene, if the family
has the right genetic linkage. Just because several family members
are affected does not mean that they all necessarily carry the
gene.
There may be labs that can test for some
of the mutations, but it would require a very significant amount
of effort to get all this taken care of.
In Memoriam
The Foundation was saddened to learn of the
death of Jesse Roffe Wike 2d on Monday September 10th. A
long-time patient of Dr. Spaeth, Mr. Wike was a member of the
Foundation’s Board of Trustees and one of the Foundation’s major
benefactors. Mr. Wike was head of the investment firm Cooke
& Bieler, Inc. until his retirement in 1993. Before joining
the company in 1965, he taught as an associate professor at the
University of Pennsylvania and served as a research associate
with the Foreign Policy Research Institute, a nonprofit organization
devoted to advanced research and public education on international
affairs. In addition to his work on the Glaucoma Service
Foundation board, Mr. Wike served on the boards of many cultural
and educational institutions, including the Pennsylvania Academy
of the Fine Arts, the Curtis Institute of Music, the Philadelphia
Museum of Art, and the Southwest Community Enrichment Center.
MEETING THE CHALLENGE OF GLAUCOMA
THROUGH EDUCATION AND RESEARCH
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