Volume 11, Number 3
December 2002
 Meet
Dr. Jonathan Myers
By Ken Parker, PhD
Dr. Jonathan Myers, currently Associate Attending
Physician on the Glaucoma Service at Wills Eye Hospital, Assistant
Professor of Ophthalmology at Jefferson Medical College, and partner
in the Spaeth/Katz/Myers private practice, joined the Wills Eye
Hospital Glaucoma Service in 1997. After graduating magna cum
laude from Princeton University, Dr. Myers received his medical
degree from the University of Pennsylvania School of Medicine,
was Co-Chief Resident at Wills Eye Hospital, and, just before
joining the Wills Glaucoma Service, served a oneyear fellowship
in glaucoma at the Duke University Eye Center.
I spoke with him about his approach to helping
glaucoma patients, both through his clinical activities and his
research.
Q: Do you have a general philosophy about
treating glaucoma patients that guides how you present treatment
options to them and defines what you expect from them?
Dr. Myers: My goal in working with patients
is to tailor treatment and follow-up to their needs, while minimizing
risk to their vision. Patients vary in their needs and concerns,
and these will influence choices in medication and surgery. Ideally,
the patient and the doctor form a partnership, where the doctor’s
main role is to educate patients regarding their level of risk,
their treatment options, and the benefits and risks of these treatments.
For this partnership to work, patients need to
be willing to share their concerns and to participate in the decision-making
process. Some patients choose to be actively involved in very
detailed decisions, for example the frequency of visual field
testing; others prefer to concentrate on major issues only, such
as a choice between surgery and additional medications.
Q: What factors do you take into account
in suggesting a treatment?
Dr. Myers: Choosing the best treatment
starts with the patient’s own concerns and needs. Some patients
prefer to avoid surgery if at all possible, others wish to minimize
daily eye drops. The patient’s medical condition — current medications
and general health issues — are important. The ability and willingness
of the patient to pay for and reliably use medications is a crucial
element. Of course, the exact type of glaucoma and any other ocular
conditions have major impacts on treatment choices.
Q: Can you outline the kinds of emotional
problems diagnosis and treatment may cause in glaucoma patients?
Dr. Myers: Glaucoma patients experience
a range of emotions throughout their treatment. Some are relatively
unaffected by the diagnosis and treatment. For others, being told
they have glaucoma is extremely troubling. Often these patients
have firsthand knowledge of the devastating potential of the disease
through experiences with family or friends. For some patients,
ongoing treatment and office visits are troubling because of financial
burdens or the impact on their job or home life. Some patients
fear the impact glaucoma may have on their job performance, family
relations, or independence. Rarely, the medications themselves
may trigger depression or other problems, especially in predisposed
patients.
Q: How do you deal with these problems?
Dr. Myers: The most important action I
take is to talk with my patients. Most patients do adjust and
cope well, but for many it is crucial that they share their concerns
with their doctor. Often, addressing the issues directly resolves
much of the potential for fear and depression. Most patients overestimate
the risk to their vision once the glaucoma is controlled. Communication
between patient and doctor is crucial to this process. Occasionally
counseling is helpful to deal with these types of problems.
Most patients overestimate the risk to their
vision once the glaucoma is controlled.
Q: Is there such a thing as “the best treatment”
for glaucoma?
Dr. Myers: There are many types of glaucoma,
and each of these may range dramatically in severity and in the
stage at which it is diagnosed. There is tremendous diversity
in concerns, needs, and preferences among patients. These factors
prevent any one treatment from being “best” across the board.
Although some treatments are used more commonly than others, no
single treatment is good for every patient or for every type of
glaucoma, and certainly none is “best.” Like a good suit, good
therapy is tailored to the individual.
Q: What are the general shortcomings of
each of the major kinds of treatment?
Dr. Myers: Medications are often effective
but require daily, consistent use, are costly, and are often associated
with side effects such as blurred vision, discomfort, or non-ocular
symptoms such as fatigue, shortness of breath, dry mouth, and
many others. Laser treatments also can control glaucoma in many
patients but are not applicable to all, fail in some, and create
inflammation or pressure spikes in a few. Surgeries such as trabeculectomy
and tube-shunt have high success rates but may require additional
medications or surgery if the eye fails to heal properly, and
can have, though rarely, devastating results such as loss of vision
from bleeding or infection.
Q: Can you say what in general is being
done to improve each of these kinds of treatments?
Dr. Myers: The major pharmaceutical companies
spend billions of dollars each year on research to improve medications.
As a result, more medications for glaucoma have been released
in the last decade than in the previous 50 years. Newer laser
treatments are constantly being developed. Many fail to reach
widespread use, but progress is gradually being made. Currently
Dr. Katz at Wills is launching a national, multicenter study of
the newest laser treatment, selective laser trabeculoplasty, an
in-office procedure for certain types of openangle glaucoma. Trabeculectomy
has improved over the last 30 years thanks to the advent of releasable
sutures to prevent extremely low pressures and anti-metabolites
to reduce scarring. Newer surgeries may become available in the
next 5 years which utilize new technologies that may simplify
and speed the surgery while reducing the risk of complications.
Q: What areas of research to improve treatments
are you involved with?
Dr. Myers: Currently I am assisting Dr.
Katz on the Selective Laser Trabeculoplasty Study, which will
begin recruiting patients in the next few months. I was fortunate
to receive a grant last year allowing us to study the efficacy
of some of the newer glaucoma medications in 700 patients. The
first part of this research should be submitted for publication
later this year. This year I also worked to complete a study of
how doctors evaluate visual field data to decide if patients are
getting worse.
Another important focus for me has been the training
of the next generation of ophthalmologists. I am fortunate to
be able to work with the residents in their training and care
of patients. I also serve on the Wills Residency Education Committee,
the American Academy of Ophthalmology’s Online Education Committee,
the American Academy of Ophthalmology’s Basic and Clinical Science
Course Glaucoma Section (which is now re-writing the glaucoma
textbook given to all American ophthalmology residents each year),
and the American Board of Ophthalmology, which tests and certifies
American ophthalmologists. These activities present the opportunity
to help make sure that the best possible care is given to all
patients.
Dr. Spaeth “Chats” About The Ocular Hypertension
Treatment Study
Dr. George Spaeth was the featured glaucoma specialist
in the Foundation’s website ”chat room” on October 30, fielding
questions about the Ocular Hypertension Treatment Study.
Introduction
Can topical intraocularpressuring- lowering medications
prevent or delay vision loss and optic nerve damage in patients
with an intraocular pressure (IOP) above 21 mm Hg (ocular hypertension)
who do not appear to have optic nerve damage or visual field loss?
Answering this question was the primary purpose
of an ongoing, randomized, multicenter, controlled trial known
as the Ocular Hypertension Study (OHTS), the five-year results
of which were recently published. Prior studies were conflicting
and had not definitely confirmed or negated the efficacy of IOP-lowering
medications in preventing or delaying vision loss and optic nerve
damage in individuals considered at risk for glaucoma.
The 1,636 patients enrolled in the OHTS (all between
the ages of 40 and 80 years, with a mean age of 55 years and a
mean baseline IOP of 24.9 mm Hg) were split into two groups: those
who received treatments with topical medication for ocular hypertension
and those who did not. IOP and visual fields were evaluated every
6 months.
The cumulative probability of developing primary
open-angle glaucoma 60 months after beginning treatment was 4.4%
in the group receiving medication and 9.5% in the group not receiving
medication.
The published study itself concludes, ”Although
this result does not imply that all patients with borderline or
elevated IOP should receive medication, clinicians should consider
initiating treatment for individuals with ocular hypertension
who are at moderate or high risk for developing primary open-angle
glaucoma.”
The OHTS data also were helpful in identifying
such individuals. Factors found to increase the risk that an ocular
hypertensive individual will develop openangle glaucoma were advanced
age, a thin cornea, and a large cup-to-disc ratio.
Questions and Answers with Dr. Spaeth
Moderator: Did you participate in the Ocular
Hypertension Treatment Study?
Dr. George Spaeth: I was involved in its
design; we were not a participating center. The study was beautifully
designed and implemented. I wish I had been a participant.
Moderator: In an earlier chat you said,
“Ninety percent of those with elevated IOP never get damage. Fifty
percent of those with damage never have elevated IOP!” Have the
results of the OHTS changed your thinking about that?
Dr. George Spaeth: No.
Moderator: Do you also still think as you
have stated earlier, ”The only reason to treat an ocular hypertensive
is if the pressure is high enough (say, 50 mm Hg or so) that it
may cause rapid damage, or to prevent other damage, such as a
retinal vein occlusion?”
Dr. George Spaeth: Yes. The OHTS showed
that the overwhelming majority (over 90%) of patients with elevated
IOP do not get worse.
Moderator: Were the treated patients in
the OHTS better off or worse off than the untreated patients?
Dr. George Spaeth: The treated patients
all had inconvenience and some side effects from the treatment.
Were they any better off than the untreated patients? No, because
an early field defect probably doesn’t hurt anybody. Side effects
do. If you have an IOP of 28 mm Hg, you may need no treatment
or you may need immediate surgery. It all depends on factors other
than just the IOP. The point is, it is not the absolute level
of IOP alone that determines the need for treatment. The determinant
is what the IOP has been doing in the way of producing or not
producing damage, and the way you tell that is by looking at the
optic disc and measuring the visual field.
The OHTS showed that the overwhelming majority
(over 90%) of patients with elevated IOP do not get worse.
P: Are you saying that the 4.4% on medications
who got worse got worse because of the treatment?
Dr. George Spaeth: No, they got worse because
1) they were not treated adequately, or 2) they would have gotten
worse no matter how well they were treated, or 3) they really
did not get worse. Regarding the third point, determining that
someone is a little bit worse is very tough. For example, in this
study, 88% of the patients who were thought to have gotten worse
on the basis of a change in visual field were found not to have
gotten worse when the field was repeated!
A very important question that OHTS has not
yet answered, and may not be able to answer in the future, is
whether the development of early field damage is of any importance.
P: If only 9.5% of the subjects not receiving
medications sustained damage, and 4.4% sustained damage with medication,
doesn’t that mean the medication failed to prevent glaucoma half
the time? Does the OHTS give any clues to why that is? Is it better
to treat some patients differently from the outset, with trabeculectomies,
perhaps?
Dr. George Spaeth: Good question. But again
I ask, did any of the patients, whether they were receiving medications
or not, really get worse? As mentioned earlier, some probably
really didn’t get worse. Some probably were worse because they
already had started to have a serious type of glaucoma that may
need very vigorous treatment to prevent it from worsening. The
problem is, we can never say definitively that a person does not
have glaucoma. We can say only that a person does not appear
to have glaucoma, recognizing that our ability to detect glaucomatous
changes is limited by the imperfect means at our disposal to detect
them.
P: Are you saying that glaucoma patients
do not benefit from medication?
Dr. George Spaeth: No. Glaucoma patients
can definitely benefit from medications. Medications can prevent
people with glaucoma from going blind, and that is a huge benefit.
However, the OHTS did not study whether treatment of elevated
IOP can prevent people from going blind. It studied whether treatment
can prevent them from developing very early visual field loss.
Other studies have shown that treatment can prevent some people
with glaucoma from going blind. But that is not what OHTS was
looking at. A very important question that OHTS has not yet answered,
and may not be able to answer in the ments. We will pay even more
attention to the nature of the optic disc, because the nature
of the optic disc, even when supposedly normal, was the second-best
predictor of who would get worse.
P: As a result of the OHTS, will all new
glaucoma patients now have their central corneal thickness measured?
Dr. George Spaeth: Probably not now. But
my hunch is that in about five years the answer will be yes. And
not just new patients. Measuring corneal thickness may give a
clue as to whether a person will get worse. That is what we really
need to know.
P: Are you saying that even after visual
field damage is sustained, further damage can be identified by
examining the optic nerve even before the visual field gets any
worse?
Dr. George Spaeth: Even after field damage
has occurred, the optic disc may still be the best predictor of
who will get worse. Once the optic disc has become very severely
damaged, then it is hard to see a change, however. But, before
field damage has occurred, the nature of the optic disc can be
a good predictor of who will get field damage in the future.
P: Few people have ocular hypertension,
but the consequences of developing glaucoma are a large concern
for those of us who may progress to that point.
Dr. George Spaeth: In fact, the number
of people with ocular hypertension is relatively large — probably
around 2 million or more in the U.S. But of those, only about
5% actually will get glaucoma. For that 5%, it is of course terribly
important. Moderator: Thank you for helping us understand the
results of OHTS.
Dr. George Spaeth: Thank you all for being
here. The interpretation of the OHTS study is a really important
issue. I would like to leave you all with some simple but important
thoughts.
Glaucoma is important only because it can decrease
the quality of people’s lives. It does that by causing pain in
some people or decreased vision. It also does that as a result
of the inconvenience and side effects caused by taking medications.
Furthermore, merely telling a person that he or she has glaucoma
is likely to cause a decrease in that person’s quality of life.
The proper goal of treatment is to try to keep
people healthy. It is to try to prevent any functional damage
from occurring, or to repair any damage that has occurred. Very
early visual field defects are not associated with a decrease
in ability to function. However, those very early visual field
defects may well be a sign that the affected person is going to
get worse and will in the future lose the ability to function
because of loss of vision. Thus, those very early visual field
defects are tremendously important to detect. However, whether
there is any importance at all in preventing those early defects
is a totally different story.
Andrew Medcalf Named New Foundation Board Chair
Andrew Medcalf, PhD, was named Chairman of the
Board of Trustees of the Glaucoma Service Foundation at a Board
meeting November 11th, as Mr. S. Stoney Simons, the Foundation’s
first Board Chairman stepped down after over five years of devoted
service. A patient of Dr. Spaeth, Dr. Medcalf has served for over
two years as Chair of the Foundation’s Long-Range Planning and
Development Committee, a position to which he has brought not
only his wisdom gained as a cancer researcher and financial advisor
but also his infectious British warmth and humor. While expressing
its deep regret and gratitude to Mr. Simons, the Board enthusiastically
welcomed Dr. Medcalf as its new leader.
Mr. S. Stoney Simons (left) and Andrew Medcalf,
PhD, at the November 11th Foundation Board meeting.
Photo by Ken Parker
Three New Clinical Fellows Assume Responsibilities
Simultaneous with the move to the “new” Wills
Eye Hospital in July, three new clinical fellows arrived to begin
their training on the Glaucoma Service.
Dr. Oluwatosin Smith
Born in Nigeria, Dr.
Smith (known affectionately as “Tosie”) received her Bachelor
of Medicine and Bachelor of Surgery from the University
of Ibadan, where she also completed an internship. Following
that, she was a Senior House Officer in General Surgery
in Dewsbury, England, a surgical intern at the Washington
Hospital Center in Washington, DC, and completed a residency
in ophthalmology at Howard University Hospital in Washington,
DC, where she was Chief Resident.
Her interest in ophthalmology
started while she was growing up in Northern Nigeria, where
a significant portion of the population was blind from reversible
causes such as trachoma (severe, chronic, contagious conjunctival
eyelid and corneal infection, caused by a virus) and cataracts.
“As I lived in other southern Saharan African countries,
moving around with my family, I found glaucoma was a significant
cause of blindness among these people. I decided then that
the treatment of glaucoma would be both fulfilling and useful
for these people who I will serve some day. I continually
look forward to returning at some point to the people who
kindled the interest I have had in this profession. Knowing
each patient deserves the very best, I apply myself to acquiring
as much knowledge as possible so that I will not fall short
of their expectations of me.” |
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Dr. Oluwatosin
(“Tosie”) Smith
Photo by Ken Parker |
Dr. Audrey Seligsohn
Dr. Seligsohn received
her Doctor of Osteopathy degree from the University of Medicine
and Dentistry of New Jersey School of Osteopathic Medicine,
and completed an internship at the University of Connecticut
in Hartford, and an ophthalmology residency at Albert Einstein
College of Medicine/Montefiore Medical Center, Bronx, New
York. At Albert Einstein she was Chief Resident and received
an award for Outstanding Achievement in Neuro-Ophthalmology.
Her interest in glaucoma
stems from her view of the field as “the perfect combination
of medicine and surgery.” “I enjoy educating patients about
their disease, discussing medical treatment options, and
when appropriate, performing laser procedures and surgery.
Additionally, because glaucoma is often chronic, I know
that I will have the chance to develop long-lasting relationships
with my patients. I recall diagnosing my first case of blebitis
(infection of the bleb created by glaucoma filtering surgery)
while on call as a first-year resident. Though at that time
I was not well acquainted with glaucoma filtering surgery,
I was thankful that I had cajoled the mother of a three-year-old
to bring her child in immediately for an examination. She
had initially wanted to dismiss what she called her daughter’s
‘pink eye’. After this experience, I realized that close
post-surgical follow-up is essential and equally as important
as the technical skills required of the surgery itself.”
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Dr. Audrey Seligsohn
Photo by Ken Parker |
Dr.
Shawn Khan
Dr. Khan, a Canadian citizen and Permanent
Resident of the United States, received his MD from McGill
University. He began his ophthalmology residency training
at McGill University, where he was Assistant Chief Resident,
and completed his training at Albany Medical College, where
he served as Chief Resident.
His interest in glaucoma comes partly from
the intellectual challenges it holds to answer basic questions
such as “Why do people get glaucoma?” and “How does a high
intraocular pressure damage nerve cells?” On an emotional
level he is attracted by the fact that patients with glaucoma
are often older. As he puts it, “There is a special sense
of gratification in treating those who have contributed
to our society for many years and are now in need of medical
assistance.” He explained further, “One of my earliest attendings
in ophthalmology instructed me many years ago to ‘not forget
that attached to that optic nerve that you are so intently
studying, describing and drawing, there is a person.’ I
do attempt to remember this concept every day with every
patient at every visit, keeping in mind that each patient
has his/her own beliefs, fears, and expectations.”
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Dr. Shawn Khan
Photo by Ken Parker |
Dr. Katz Launches Major Study Of New Laser
Dr. L. Jay Katz recently received a major grant
from Lumenis, the largest therapeutic laser company in the world,
to lead a multicenter study involving the use of the Company’s
Selective Laser in glaucoma patients. This study is being coordinated
through the Wills Eye Hospital and a team at the Tulane University
Medical School, headed by Dr. William C. Steinmann, Research Director
of the Glaucoma Research Center here at Wills. Presently, 15 other
sites are slated to participate. In the following interview, Dr.
Katz talks about this study in the context of the general use
of lasers to treat glaucoma.
The laser provides
a wonderful way of helping glaucoma patients, both diagnostically
and therapeutically.
Q: In a nutshell, what is a laser?
Dr. Katz: Basically, a laser is a device
that amplifies light by producing light that, unlike light from
ordinary sources, is all one wavelength, that is to say, it is
all exactly one color. Different types of lasers, for example
the argon, diode, and Neodymium:YAG, use different wavelengths
of light.
Also, the waves or photons of laser light are
said to be “coherent.” Unlike ordinary light, these don’t work
at cross purposes with each other. The result is that laser light
is extremely intense, highly directional, and very pure in color
(frequency). In a laser procedure, then, intense light is delivered
to a very small, defined area for a very short, specific time
— durations such as a tenth of a second to less than a billionth
of a second. By varying the duration and the wavelength of the
light that is used in the laser system, vastly differently objectives
can be achieved in the treatment of glaucoma.
Q: Specifically, how are lasers used to
help glaucoma patients?
Dr. Katz: The laser provides a wonderful
way of helping glaucoma patients, both diagnostically and therapeutically.
For example, laser scans have been developed that can examine
in minute detail the structure of the optic nerve and the surrounding
retinal tissue. Even more importantly, we have been able to use
lasers to treat various problems we encounter with glaucoma patients.
In order to understand how lasers are used to
treat glaucoma, please recall the following basics: Glaucoma is
a disorder in which the pressure in the eye rises to a level that
is damaging to the eye structure, specifically the optic nerve.
We can lower the intraocular pressure by either helping the fluid
exit the eye or by decreasing how much fluid the eye makes. By
either mechanism we can lower the intraocular pressure to a more
satisfactory level.
The laser trabeculoplasty is done with an argon,
diode, or more recently, a selective laser, the laser we will
be studying. “Trabeculoplasty” means “changing the shape of the
trabecular meshwork,” the outflow or drainage system of the eye,
also referred to as the “angle” of the eye. In this procedure,
then, the laser is used to change the shape of this tiny (less
than half a millimeter wide) part of the eye in a way that improves
the outflow of fluid from the eye, decreasing the intraocular
pressure.
The laser can also be used to lower eye pressure
by decreasing the amount of fluid produced. Doing this is useful
in some types of glaucoma, for example neovascular glaucoma, often
seen with diabetes, in which there is no satisfactory way to increase
the outflow of fluid in the eye. We can decrease the production
of fluid by aiming a powerful laser system at the ciliary body,
which resides behind the iris and produces the fluid in the eye.
By directing the laser toward this area we can partially destroy
the ciliary body, thereby decreasing the amount of fluid the eye
makes, lowering the intraocular pressure.
We can lower the intraocular pressure by either
helping the fluid exit the eye or by decreasing how much fluid
the eye makes.
Lasers also can be used to help patients who have,
or are in danger of developing glaucoma because the drainage system
of their eye is narrow, or threatening to close. In these patients,
a laser iridotomy can be done, in which a hole is made in the
iris or color portion of the eye. This does not lower the intraocular
pressure. Rather, it redistributes the proportion of fluid in
the different compartments in the front of the eye, in such a
way that a narrow angle opens up. By doing this, acute or chronic
angle-closure can be relieved or prevented.
More specifically, we will have 150 open-angle
glaucoma patients try medication as a first treatment for glaucoma
and another 150 have a laser procedure with the selective laser
as a first treatment. Then we will see which works best. Also,
as part of the study, we are looking at the success of repeat
applications once the trabeculoplasty is no longer effective.
Q: Are you seeking patients to participate
in this study?
Dr. Katz: Yes, specifically patients diagnosed
with open-angle glaucoma who have not previously been treated
with glaucoma medications for more than 14 days.
Celebrating The Glaucoma Service Fellowship
Program
By Nancy Petrongolo and Lisa Lewis
If you have been reading recent issues of Searchlight
on Glaucoma you may be aware that the Glaucoma Service Foundation
is planning a scientific symposium and celebration of 40 years
of fellowship training on the Glaucoma Service at Wills Eye Hospital
October 3–5, 2003.
Each year the Glaucoma Service receives many applications
from highly talented individuals from around the world seeking
to learn from the best. Many of the fellows who have trained at
Wills are now leaders in worldwide glaucoma societies and medical
schools, as well as chairs of departments of ophthalmology and
chiefs of glaucoma units. Our fellows are practicing, teaching
and involved in research on every continent except Antarctica.
The first glaucoma fellow was appointed by the
Ophthalmologistin- Chief, Dr. Irving Leopold, 40 years ago. Dr.
Leopold had a deep interest in glaucoma and profound knowledge
of pharmacology, especially as it relates to glaucoma. Originally
one fellow trained each year, but the program has grown to include
yearly appointments of three clinical fellows and as many as six
research fellows. Others come from far and wide for shorter periods
to observe and learn.
The International Society of
Spaeth Fellows
The International Society of Spaeth Fellows was
established in the mid 1980’s by ex-fellows who wanted to share
their experiences with each other, to build a support system,
and to continue to educate one another about the latest techniques
for glaucoma diagnosis and treatment. Every year, ex-fellows from
around the world meet at the two major national ophthalmology
conferences. Although informal at first, these meetings are now
well organized programs, including named lectures by Society members.
Further extending its reach, the Society recently agreed to welcome
“Grand Fellows” into their group. These are physicians who received
their glaucoma training from the core Willstrained members.
In a recent note to Dr. Spaeth, Society member
Dr. Silvia Orengo-Nania, Associate Professor in the Ophthalmology
Department at Baylor College of Medicine in Houston, no doubt
speaks for the other members of this illustrious group, when she
writes: “Thanks for your thorough teaching. Every time I do a
complicated case or have a good result, I think of the positive
experience I had at Wills as a fellow. All of you taught me so
much!”
Thanks in large part to the fellowship program
on the Glaucoma Service at Wills Eye Hospital, glaucoma patients
here and around the world are receiving the best care possible.
NOW THAT’S WORTH CELEBRATING!
Former Glaucoma Fellow Speaks At Wills Opening
Celebration
Dr. Roger Hitchings, Fellow on the Glaucoma Service from 1973
to 1975, and presently Professor of Glaucoma and Allied Studies
at the Institute of Ophthalmology, Moorfields Eye Hospital, in
London, England, received an award of honor as one of Wills Eye
Hospital’s most outstanding alumni at the Hospital’s Opening Celebration,
November 1st. Dr. Hitchings spoke at the Scientific Conference
of the  Celebration
about his experiences in setting up what is widely acknowledged
to be one of the most productive glaucoma research units in the
world. His words were an inspiration to those on the Glaucoma
Service at Wills who are striving to achieve the same excellence
with the Glaucoma Research Center.
Dr. Roger Hitchings speaks at the Wills Eye Hospital Scientific
Conference celebrating the opening of the “new” Wills Eye Hospital.
Photo by Roger Barone
Glaucoma Research Center Studies Actively Recruiting
Patients
The Wills Eye Hospital Glaucoma Service is actively
involved in clinical trials that are attempting to improve treatment
strategies for people with glaucoma. If you are interested in
participating in one of the following studies, please call the
Research Center at (215) 928-3123.
• A study comparing medication therapy to laser
therapy with the new selective laser as an early treatment for
patients with glaucoma. Needed are patients diagnosed with primary
open-angle glaucoma who have not been previously treated with
glaucoma medications for more than 14 days.
Sponsor: Lumenis
Principal Investigator: Dr. Katz
• A study to test how well the medication Cosopt
lowers eye pressure in glaucoma or ocular hypertension patients.
Patients who have an eye pressure of 30 mm Hg or higher and who
have not been treated in the last 4 weeks are needed.
Sponsor: Merck
Principal Investigator: Dr. Wilson
• A study to evaluate which of the two medication
combinations, Cosopt (Trusopt + Timoptic) or Xalatan/Timoptic
increases blood flow in the eye more.
Sponsor: Merck
Principal Investigator: Dr. Katz
• A pilot study to learn if there is a genetic
basis for angle-closure glaucoma. We are looking for patients
with primary angle-closure glaucoma who have about 10 blood relatives
who would be willing to come into Wills for genetic testing (a
blood test). The relatives do not have to be diagnosed or suspected
to have glaucoma.
Funding being sought
Principal Investigator: Dr. Spaeth
• A study investigating if the substance Healon
5 1) can increase a patient’s eye pressure after it has fallen
to below-normal levels following eye surgery, and 2) when used
during glaucoma surgery, its effect on a patient’s long- and short-term
eye pressure.
Sponsor: Pharmacia
Principal Investigator: Dr. Moster
• A study to see how much of the drug Lumigan
stays in the eye’s fluid if it is given for 21 days prior to cataract
surgery. Glaucoma patients about to undergo cataract surgery or
a combined cataract/glaucoma surgery are needed.
Sponsor: Alcon
Principal Investigator: Dr. Moster
• A study comparing the IOP-lowering of either
Xalatan or Lumigan alone with a combination of the two medications.
Sponsor: Allergan
Principal Investigator: Dr. Katz
• A study to determine if a type of glue (Tisseel
Fibrin Sealant) can be used effectively and safely to seal bleb
leaks following glaucoma surgery.
Sponsor: Seeking support from the manufacturer, Baxter
Principal Investigator: Dr. Moster
• Measuring the thickness of corneas of children
with glaucoma to see how it compares with that of children without
glaucoma.
Unfunded
Principal Investigator: Dr. Wilson
You Can Still Make A Difference!
By now you should have received our year-end
mailing for the Foundation’s 2002 Annual Fund. If you have already
made a donation, many thanks for your support! If you haven’t
yet, we hope you will take a moment and contribute
today. Your gift will truly make a difference.
One Glaucoma Patient’s Outstanding Contribution
Romana Zbura, known affectionately to the folks
around Wills Eye Hospital, including those on the Glaucoma Service,
as “Aunt Roe” is a volunteer extraordinaire. The aunt of Spaeth/Katz/Myers’
technician Rosemarie Verlengia, Aunt Roe was the Director of the
Pharmacy at St. Mary’s Hospital for 43 years, until her retirement
at the age of 72. Now, at the age of 86, she demonstrates her
devotion to the Hospital every day, helping out in many places,
especially in Day Surgery, the Glaucoma Service Foundation, and
the Glaucoma Research Center.  We
cannot help but marvel at a woman who, despite her glaucoma, seals
each letter she lovingly stuffs with a little prayer for the doctor
who has signed the letter inside. Her role may be minor in the
larger scheme of things, but her spirit is vital to the operation
of Wills Eye Hospital.
Aunt Roe helps with the Foundation Annual Fund mailing.
Photo by Ken Parker
Support Group Talks Scheduled
The following talks are scheduled for the Glaucoma
Patient Support Group in 2003. All the meetings will take place
in the Wills Eye Hospital auditorium, on the 8th floor of the
new Hospital, on Sundays from 1:30 to 3:00 pm. Please double-check
with the Foundation about a week before to confirm that the meeting
you are planning to attend will take place as scheduled.
January 12th
Dr. Elliot Werner
Can Eye Drops Prevent Glaucoma Damage?
The Ocular Hypertension Treatment Study (OHTS)
February 16th
Dr. Jonathan Myers
When Things Don’t Go as Planned
April 27th
Dr. Courtland Schmidt
Glaucoma, The Big Picture: Glaucoma Treatment in General
May 18th
Dr. L. Jay Katz
Normal-Tension Glaucoma
Unfortunately, due to a computer
software glitch, some of you may have received duplicate Annual
Fund letters. We apologize for the error and have taken steps
to correct it. Thank you for your continuing support of the Glaucoma
Service of Wills Eye Hospital.
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