Volume 12, Number 1
April 2003
Glaucoma Screening Project Combines Outreach
and Science
Ken Parker, PhD
Community Outreach to Help Prevent Blindness
from Glaucoma
On a cold Friday in January, Foundation Managing
Director Nancy Petrongolo along with Glaucoma Service doctor Jeffrey
Henderer and Research Fellows Drs. Tara Uhler and Undraa Altangerel
arrive at 10:00 AM at the North Broad Street Senior Center to
screen for glaucoma. To promote January as National Glaucoma Awareness
month Mrs. Petrongolo has invited WPVI (Channel 6, ABC), WCAU
(Channel 10, NBC), and WHYY for the occasion.
Against a background of cardplaying and dancing
(one man is teaching some others country line dancing!), the Glaucoma
Service folks start the screening process: Drs. Henderer, Uhler,
and Mrs. Petrongolo help those waiting fill out forms. Dr. Altangerel
begins giving quick visual field tests with a portable machine,
Dr. Uhler checks visual acuities with an eye chart, and Drs. Henderer
and Uhler take eye pressure readings and examine optic nerves
with an ophthalmoscope.
Funded by the Congressional Glaucoma Caucus Foundation
in New York, this scenario, minus the media, was repeated 28 times
in 2002, 20 times in senior citizen centers sponsored by the Philadelphia
Corporation for Aging, eight times in local churches. The goal
is to screen those with the highest risk factors for glaucoma
who ordinarily would not be screened (older individuals in poor
neighborhoods, especially African-Americans) and provide them
information about getting a comprehensive examination and, where
necessary, appropriate care.
If individuals do not have an ophthalmologist,
they are provided with phone numbers for the nearest ophthalmology
clinic. Also, some people with likely or definite glaucoma and
other eye diseases are provided with $10 vouchers to cover transportation
costs to see an eye doctor.
In 2002 a total of 519 individuals were screened;
of these 80 were either glaucoma suspects or had definite glaucoma;
80 had cataract, and 62 had other eye diseases. Forty-seven people
were identified for the first time with glaucoma and advised to
have a follow up with their ophthalmologist.
Science to Help Prevent Blindness from Glaucoma
These screenings also present a golden opportunity
to get scientific answers to questions that can help us more effectively
prevent blindness from glaucoma.
- How can we best get to thosepeople with the highest risk factors
for glaucoma?
- How can we best determine quickly and accurately if an individual
may have a glaucomarelated problem?
- How can we help ensure that those who may have a glaucomarelated
problem receive appropriate care?
This effort to base our approach to preventing
blindness from glaucoma on scientific evidence rather than on
expert opinion, experience, or impression alone is an example
of a broad movement in medicine for approximately the last 20
years known as evidence based medicine.
As the first person to hold a Merck Research Fellowship,
Dr. Uhler, working with Dr. Henderer and Glaucoma Research Center
Director, Dr. William Steinmann, is charged with this scientific
aspect of the Glaucoma Service Screening Project.
Initiated by Dr. Steinmann and Glaucoma Service
doctors Richard Wilson and L. Jay Katz, working with Myles Jaffe,
PhD, Manager, Medical Education, US Medical & Scientific Affairs,
at Merck & Co., Inc., the Merck Research Fellowship program is
a pilot program to promote the practice of evidencebased medicine
among clinicians.
Dr. Steinmann explained: “The central tenet in
evidence-based medicine is that clinicians should question the
evidence that supports their clinical practices. This requires
an understanding of how to use scientific studies to assess the
validity and utility of the results of studies, and then use this
information in the care of individual patients.”
“The strength of the scientific evidence that supports
clinical practices varies. For example, the evidence that supports
cardiology practices for ischemic heart disease, which, while
still lacking in many ways, is much stronger than the supportive
evidence for glaucoma practices.”
With the vital help of the Congressional Glaucoma
Caucus Foundation and the Merck Research Fellowship Program, the
Wills Glaucoma Service is not only finding and helping individuals
in the Philadelphia area avoid blindness from glaucoma. It is
also working to answer questions crucial to achieving this goal
world-wide.
Foundation Managing Director Nancy Petrongolo assists
a gentleman waiting to be screened for glaucoma at the North
Broad Street Senior Center. WCAU (Channel 10, NBC) presented
a clip of the screening on the 5:00 PM News.
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Myles Jaffe, PhD, Manager, Medical Education, US Medical
& Scientific Affairs, at Merck & Co., Inc. (left) chats with
Merck Research Fellow Dr. Tara Uhler following his presentation
to Wills fellows and residents, "Clinical Protocol Development,"
on January 17th, one of a series of lectures sponsored by
Merck on research topics. Photo
by Ken Parker
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Celebrating the Life of Jamie Nicholl
On March 12, 2003, we lost a very special friend.
Jamie Nicholl, beloved photographer of the Glaucoma Service, passed
away quietly surrounded by friends and family. Many of us who
have had the good fortunate to know Jamie will greatly miss her
unique spirit and dynamic personality.
A Memorial Service in her honor was held March
28th in the Wills Eye Hospital Auditorium. Well over 100 people
attended — her family, her “Wills family,” fellow photographers
(for many of whom she served as a mentor), and business leaders.
Those who knew her best spoke of her kindness to patients, professional
competence (she was President of the national Ophthalmic Photographers
Society), dry sense of humor, keen intelligence, intuitive understanding
of science, and her rare ability to light up a room with her presence,
building bridges and making people feel better.
Jamie used to say that “Searchlight on Glaucoma” was her favorite
publication. Indeed, she took almost all the photographs in the
publication’s early years.
In celebration of Jamie’s life, a memorial fund
in her name is being established by her husband.
If you would like to find out more about this
fund, please contact Joe Leive in the Wills Eye Hospital Development
Office at 215-440-3159.
Jamie’s passing is a great loss to us all. Her
exuberance, her extraordinary love for others, and her joy of
living life to its fullest are what we all will keep in our hearts
when we think of her.
Results of Home Tonometer Study Mixed
A year and a half ago in Searchlight on Glaucoma
Wills glaucoma specialist Dr. Marlene Moster described a new “home
tonometer” that would allow patients to check their own intraocular
pressures (IOPs). The Proview phosphene eye pressure monitor,
marketed by Bausch and Lomb, is portable and requires no anesthetic
or skilled technician. Suggested possibilities for improved care
the device might provide include:
- A more accurate picture of a patient’s IOP (Since IOP tends
to vary throughout the day and night, and the pressure the doctor
measures in the office, maybe every month or even every week,
cannot reflect this variation, the Proview could permit a more
accurate picture without the patient having to spend all day
in the office, having the pressure checked at regular intervals.)
- Reduction of patients’ anxiety about their glaucoma
- A convenient reminder for patients to use their glaucoma medications
more closely as prescribed
The Glaucoma Research Center’s 10-month, randomized, prospective
study of the device conducted by Dr. Moster with the help of Research
Fellows Drs. Sushma Rai and Muge Kesen, Clinical Fellow Dr. Oluwatosin
Smith, and Clinical Coordinators Anne Helbe, Fillis Samuel, and
Sheryl Wizov found that 92% of the 100 patients in the treatment
group described the device as easy to use and 74% learned the technique
within 4 days. The key conclusions of the study were that:
- There was considerable variation as to its accuracy among
the 100 treatment patients studied. Patients with intraocular
pressures (IOPs) between 10 and 20 mm Hg as measured by the
standard office tonometer, the Goldmann, had Proviewmeasured
pressures which most closely matched these officemeasured pressures.
Patients with IOPs less than 10 mm Hg or greater than 20 mm
Hg had the greatest number of discrepancies with the Goldmann.
- The treatment group reported significantly less anxiety after
1 month’s use.
- A majority of patients reported being compliant with their
ocular medications at the start of the study and continued being
so.
According to Dr. Moster, these results show, most
of all, that if a physician believes home tonometry might be valuable
for a particular patient, the accuracy of the Proview readings
would first have to be verified for that patient.
“Meanwhile,” she concluded, “The concept of the
Proview is an important advance, potentially giving patients a
significant opportunity to participate in their own care. Our
study, as well, is a good example of how patients can contribute
to their own care by participating in research. I am looking forward
to more generally accurate models of this potentially very useful
device.”
Drs. Marlene Moster (right) and Sushma Rai after presenting
the results of the Proview tonometer study at the Wills
Eye Hospital Annual Conference held at the Adams Mark Hotel,
March 14, 2003. The study also will be presented at the
Annual Meeting of the Association for Research in Vision
and Ophthalmology in May.
Photo by Ken Parker
Glaucoma Research Center Clinical Coordinator Sheryl
Wizov demonstrates use of the Proview tonometer. The IOP
is measured through a half-closed eyelid by applying gentle
pressure with the monitor in the upper portion of the eye
near the nose. The indentation is stopped as soon as the
patient sees a “pressure phosphene ring,” a bright central
area surrounded by a dark ring with an outer bright halo,
caused by the mechanical pressure on the eye. The IOP can
then be read directly off the scale.
Photo by Roger Barone
|
 Wills
Eye Hospital Glaucoma Service Scientific Symposium and Celebration
Planning for the Wills Eye Hospital
Glaucoma Service Scientific Symposium and Celebration Event on
October 4, 2003 is right on target! Serving as Co-Chairs of the
Honorary Committee for the event celebrating 40 years of fellowship
training on the Glaucoma Service are Mrs. Dorrance Hamilton and
Mr. Ray Perelman. The Committee is comprised of many influential
individuals, including Former President George H.W. Bush.
The Steering Committee is now placing its main
focus on inviting individuals to be Patrons for the event. Patrons
will be recognized in the official Invitation and Celebration
Program and will receive two tickets to all of the evening’s activities
— starting with a black-tie cocktail reception and dinner in the
new Kimmel Center, followed by the program portion of the evening,
which will take place in the Perelman Theater of the Center.
Highlighting the program will be the presentation
of a new ballet dealing with sickness and healing, a rare if not
unique theme in the ballet repertory. Just as the international
aspect of the fellows and their activities is one of the major
themes of this meeting, so also is the idea that the practice
of medicine is an art involving the same types of knowledge, technical
excellence, dedication, and attention to spirituality that are
essential in the other arts, including ballet. Dr. and Mrs. Spaeth
have been working with the Pennsylvania Ballet and one of their
choreographers, Meredith Rainey, in the development of the ballet.
The program will be followed by an international dessert reception
and dancing.
Patrons will also be honored and thanked at a
cocktail reception on June 5th at the home of Foundation Board
member Mr. Stan Tuttleman and his wife Edna. The Tuttleman home,
with its magnificent international art collection and exquisite
gardens, will provide an elegant setting for this event.
For more information about becoming a Patron for
the 2003 Glaucoma Celebration, please contact Nancy Petrongolo
in the Foundation office (215-928-3283) by May 15th.
Chat Room Participants Share Tips on Eye Drops
On Wednesday, March 5, chat room participants
on the Foundation website shared tips with each other.
Moderator: Does anyone have any tips on
remembering when to put your eye drops in?
P: I have a tip for the morning. In the
morning I use the snooze to help time my drops. First ring, first
drop, second ring, second drop.
P: I keep them with the toothbrush so I
can‘t get to my teeth without seeing the drops, which I use before
bed.
Moderator: How about tips for remembering
which one you have put in, that is if you need to take more then
one drop?
P: Day drops, rubber band to the coffee
pot, night drops, rubber band to the tooth brush or whatever your
pre-bed ritual is. Moderator: I like the coffee pot reminder!
P: Biggest to smallest for me.
P: I remember mine by colors. They have
an order. Blue, then red. Every time the same order. I also keep
mine in my pockets. Left side means I did not put the drop in
yet. Right side means I put the drop in.
P: It‘s easy for me — just one drop first
thing in the morning. I keep it on the bedside table and do it
as soon as I wake up.
P: I no longer use drops, but when I did,
I always used them in the same order.
P: I have a problem with keeping track
when there are several things to do. I just put everything at
one end of the counter. Then after use, set it down at the other
and keep going until everything is at the same end.
P: You can put them toward the back of
the counter after instilling and then move them closer toward
you. This way you know which one you put in.
Moderator: Any tips on telling the difference
between bottles of eye drops if you have decreased vision?
P: I remember Dr. Rick Wilson saying he
told patients with decreased vision to use rubber bands around
the bottles to distinguish them.
Chat Support Group
www.willsglaucoma.org Wednesdays, 8:30–9:30
pm
hosted by a Wills glaucoma specialist
Mondays, 8:00–9:30 pm
patient and family members only |
2002 — Another Successful Fundraising Year!
We would like to express our sincere appreciation
to the many friends and supporters of the Glaucoma Service Foundation
who helped make 2002 our most successful year yet. More than 1500
individuals, foundations, corporations and estates donated a total
of $704,576.62 to support our work. Our Annual Fund total was
down slightly this year at $197,006.48, while our Glaucoma Research
Center Special Appeal yielded $23,067.98. An additional $484,502.16
was restricted to glaucoma screenings, Searchlight on Glaucoma,
salary support, and the website.
During these times of financial uncertainty, support
of this magnitude is vital if we are to keep pace with the ever-growing
need for the many Foundation-sponsored programs that give hope
to the thousands suffering from glaucoma – cutting-edge research,
community screenings, patient support, physician training programs,
an informative newsletter, and a website packed with useful information,
featuring weekly chat sessions with a Wills Eye Hospital glaucoma
physician.
To all of our donors, THANK YOU FOR YOUR EXTRAORDINARY
GENEROSITY!
You are truly making it possible for us to meet
the challenge of glaucoma through education and research.
SPECIAL THANKS
We are especially grateful to the donors listed below for
their generous support during 2002:
| Richard Gilder, Esq. |
For salary support |
| InSite Vision |
For support of genetics research
|
| Mr. and Mrs. James J. Kim |
For salary support |
| Mr. and Mrs. Raymond Perelman |
For unrestricted support |
| Pharmacia Corporation |
For support of a research fellow and
unrestricted support |
| Mr. Nat C. Robertson |
For unrestricted support |
| T. J. Kavanaugh Foundation |
For unrestricted support |
| The Congressional Glaucoma Caucus Foundation
|
For support of screening program
|
| The Estate of Mathilde Wasley |
For unrestricted support |
| The Scholler Foundation |
For ongoing support of Searchlight
on Glaucoma |
| Mr. and Mrs. Chris J. Witting |
For unrestricted support |
|
For Donor List please
click here to view Searchlight on Glaucoma in PDF format.
New Planned Giving Opportunities Announced
Nancy Petrongolo
The Glaucoma Service Foundation is pleased to
announce the creation of our Legacy Builder program. Not a capital
campaign, but rather an IRS-approved planning technique, the Legacy
Builder Program will provide donors with significant tax and financial
incentives when incorporating the Glaucoma Service Foundation
into their personal estate planning.
This program has been developed in response to
inquiries made by grateful patients and their families regarding
how they can help support the Glaucoma Service Foundation at Wills
Eye Hospital. As we go through these financially troubled times,
we need to secure the long-term financial condition of our Foundation.
We want to assure patients and their families that we will be
there for them with the best research, treatment, and staff available
anywhere.
I would like to personally invite you to attend
a special introductory presentation of the Legacy Builder program
to be held on May 20 and May 28 at 10:00 AM and 2:00 PM. Our speaker
will be the noted author and creator of the Legacy Builder program,
Daniel G. Nigito, CFP. Mr. Nigito’s new book, Don’t Die Until
You Read This! is an entertaining work that “outlines the
steps Americans can take to create a meaningful legacy for our
families and society.”
For more information or to R.S.V.P., please call
the Foundation office at 215-928-3283.
 Spreading
the Word
- On January 4, 2003 Foundation Managing Director, Nancy
Petrongolo guest-hosted the “Ed Hitzel Table for One Radio
Show” to promote Glaucoma Awareness Month. Mr. Hitzel’s show
is broadcast from the Jersey shore area and is heard throughout
the tri-state area. Mrs. Petrongolo explained to Mr. Hitzel
and his listeners that because many types of glaucoma are without
symptoms, routine dilated eye examinations are necessary for
early detection and treatment of the disease.
- On January 12th, Dr. Elliot Werner gave a talk, “Can
Eye Drops Prevent Glaucoma Damage? The Ocular Hypertension Treatment
Study (OHTS)” to over 40 folks at a meeting of the Glaucoma
Patient Support Group in the Wills Eye Hospital Classroom.
- On January 29th, Dr. George Spaeth spoke about eye
disease, and particularly glaucoma, to over 100 residents of
the Dunwoody Village retirement community in Newtown Square.
- On February 16, 2003, through an educational program sponsored
by Pharmacia, Glaucoma Service doctors Dr. Jeffrey Henderer
and Dr. Douglas Rhee were featured speakers on WPEN’s
“The Doctor‘s In” show. Dr. Henderer and Dr. Rhee spoke about
treatment for increased intraocular pressure and answered questions
related to glaucoma.
- On February 26, Dr. L. Jay Katz spoke about eye disease,
and particularly glaucoma, to over 100 residents of the Normany
Farm Estate retirement community in Blue Bell.
- On March 23d, Dr. Jonathan Myers spoke on “When Things
Don’t Go As Planned” to over 30 folks at a meeting of the Glaucoma
Patient Support Group in the Wills Eye Hospital Auditorium.
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
• Measuring the thickness of corneas of children
with glaucoma to see how it compares with that of children without
glaucoma.
Funding being sought
Principal Investigator: Dr. Wilson
• A study investigating if a generic form of Alphagan
P works as well as the brand name for lowering intraocular pressure
Sponsor: Alcon
Principal Investigator: Dr. Moster
Dr. Jampel Featured
Speaker
Clinical Fellow Dr. Tosie Smith (left) chats with
Dr. Henry Jampel, Associate Professor of Ophthalmology at Johns
Hopkins, following his presentation, “What to Make of the Early
Manifest Glaucoma Trial” on March 28th. Dr. Jampel was a featured
speaker in the Glaucoma Service’s Visiting Scholars Roundtable
Lecture Series in Glaucoma. His talk was sponsored by Allergan.
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