Volume 13, Number 1
April 2004
Screenings Marking
National Glaucoma Awareness Month Bring Together New Resources
To draw special attention to glaucoma during January, National
Glaucoma Awareness Month, Glaucoma Service specialist Dr. Jeffrey
Henderer and several volunteers conducted free community glaucoma
screenings at a shelter for homeless men at Broad & Ridge
Streets, the Juvenile Court at 13th and Ludlow, and the 10th Street
lobby of Thomas Jefferson University Hospital. Individuals helping
with these events included Glaucoma Service Research Fellows Dr.
Undraa Altangerel and Dr. Heryberto Alvim, and an observer on
the Glaucoma Service from Brazil, Dr. Leticia Pletsch.
Congressional Glaucoma Caucus
These free screenings were especially noteworthy in that they
brought together for the first time people and organizations outside
the Glaucoma Service dedicated to addressing the major public
health problem of glaucoma. First and foremost, funding was provided
by the Friends of the Congressional Glaucoma Caucus Foundation,
Inc. The Foundation is dedicated to supporting the activities
of the Congressional Glaucoma Caucus, a non-partisan organization
of members of the United States Congress. Their purpose is to
educate their communities about the risks of glaucoma and other
potentially blinding eye diseases and to provide diagnostic screening
opportunities for high-risk glaucoma population groups in their
home districts across the nation. The Friends of the Congressional
Glaucoma Caucus Foundation has provided major support for Dr.
Henderer’s screenings since 2000.
Allergan’s Partnership for Sight
Making available sophisticated ophthalmic equipment to enhance
the screenings was Allergan representative Mr. Roger Martin, working
through an organization funded by Allergan, Partnership for Sight.
Partnership for Sight sponsors free, public glaucoma screening
events throughout the country as a means of driving awareness
about glaucoma. One dramatic piece of equipment was a camera manufactured
by Topcon that can take sharp pictures of the optic nerve at the
back of the eye without the need to dilate the pupil. Because
it is not practical to dilate eyes during a screening, examiners
without such a camera have to make do with the less than satisfactory
views of the optic nerve obtained through an undilated pupil.
Mr. Martin also made available a hand-held pachymeter (Heidelberg
Engineering),allowing quick measurement of the thickness of the
cornea, an important factor related to accurate assessment of
intraocular pressure.
Jeff HOPE and Student Sight Savers Project
Finally, Jefferson Medical College student Rachel Peck and a number
of other Jeff medical students provided important manpower for
the screenings. Ms. Peck and the Jeff medical students volunteered
as members of Jeff HOPE, a student-run, non-profit organization
of Jefferson Medical College that runs four free medical clinics
each week in Philadelphia. These Jeff HOPE volunteers, in turn,
offered their services in conjunction with the Student Sight Savers
Project, a national, student-staffed organization established
to address vision problems in underserved communities. The Project
is funded by the Friends of the Congressional Glaucoma Caucas
Foundation.
The Importance of Screening
Checking people’s intraocular pressure, giving them a quick
visual field test, and, most importantly, examining the back of
their eyes with an ophthalmoscope, usually can identify those
who may have glaucoma. Arrangements can then be made for them
to have a complete eye examination in the doctor’s office
to determine if they actually do have glaucoma. Even if the screening
doctor finds no evidence of glaucoma, these quick examinations
are still key in the Foundation’s attempt to meet the challenge
of glaucoma. Educating people about glaucoma and encouraging regular
eye examinations are crucial. Also, cataract and other vision
problems can be uncovered.
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.
Dr. Henderer began conducting screenings in earnest at area churches
and senior centers when he joined the Glaucoma Service in 2000.
From 2000 through 2002 the Foundation sponsored 82 screenings
at more than 61 different senior centers, health fairs, and churches.
At these screenings, 1829 people were examined for glaucoma and
other eye conditions. Two hundred and forty of these individuals
were diagnosed with either glaucoma or as glaucoma suspects; 160
had been unaware of having any vision problem. Many more were
found to have cataract or suspected refractive error. In 2003
over 800 people were screened.
Dr. Jeffrey Henderer uses a hand-held pachymeter
to determine the thickness of the cornea of a participant’s
eye at a screening held at a shelter for homeless men at Broad
& Ridge Streets.
Photo by Roger Martin
 Meet
Dr. Courtland Schmidt
By Ken Parker
Dr. Courtland Schmidt has been a member of the
Glaucoma Service since 1990. After receiving his B.A. from Yale
and his medical degree from the Wayne State University School
of Medicine in Detroit, Dr. Schmidt took his residency at Wills
and served a fellowship in glaucoma on the Glaucoma Service.
Q: Can you say a few words about
your approach to treating glaucoma patients?
A: Each patient’s glaucoma is unique to that individual.
Even if two patients have the same kind glaucoma, the history
of the disease in those two individuals is always different. Additionally,
quite apart from their glaucoma, each patient has a unique personality
that determines how they react to their diagnosis and handle their
treatment. I believe it’s very important for me to try to
be as sensitive as possible to the uniqueness of each of my patients.
I believe it’s very important for me to
try to be as sensitive as possible to the uniqueness of each of
my patients. For example, the emotional work that it takes for
a patient to get used to the idea of having a chronic disease
comes easier to some than others, as does the ability to recognize
that, although the doctor can treat their glaucoma, he or she
cannot simply make it go away. Some of my patients are intent
on finding out everything they can about their condition. They
ask me questions. They seek information on the internet. They
want to be an active participant in their care. On the other hand
there are those who are unwilling or unable to be informed and
tend to leave the decision making up to me. Another difference
involves patients’ acceptance of standard medical treatment.
Some patients are much more able than others to take their medications
as prescribed. But this is not a simple matter either. Different
medications cause different side effects in different individuals.
For some the high cost of glaucoma medications these days is an
important factor. Some patients with arthritis and other conditions
are physically unable to take drops.
Fundamentally, I try to take as many of these factors into account
as I can and lay out the patient’s options with respect
to, first, deciding what the goal is in terms of pressure-lowering,
and then the ways that might reasonably be expected to get there.
It is important to emphasize to patients that all methods of treatment,
whether medications, pills, or surgery, involve risks. Then, ideally,
I work with the patient to figure out how much risk he or she
is willing to take in exchange for the possible benefit.
“Each patient’s glaucoma
is unique to that individual.”
Q: Is there such
a thing as “the best treatment” for glaucoma?
A: Although there may be a best treatment for each patient’s
individual glaucoma, there is certainly no one best treatment
for glaucoma. All treatments fail in some people, and all treatments
can be wonderfully successful in others. What makes it difficult
to care for glaucoma patients is that a cookbook approach cannot
possibly provide the best care.
Q: I understand you presented a
very thought-provoking talk at our Glaucoma Symposium last October.
Can you tell us a bit about that?
A: My talk was based on Dr. Spaeth’s conception of the Symposium,
that is, that patients constitute a world of individuals. As I
thought about my presentation I realized that physicians are individuals,
too, and what each physician brings to the patient interaction
is also unique, just as the patient is unique. The burden is on
the physician to make sure that he or she is as objective as possible
and as knowledgeable as possible, even though no one of course
can be perfectly knowledgeable or objective. I challenged the
physicians in the audience to make sure they were as knowledgeable
about themselves as they are about their patients, for example,
to recognize the biases they have in favor of one form of treatment
or another. I believe, as I have learned from Dr. Spaeth, that
pursuing self-knowledge in this sense is central to becoming a
good physician.
Dr. Rhee Recognized
for his Work in the Genetics of Glaucoma
Dr. Douglas Rhee, Glaucoma Service physician and Director of
the Laboratory for Molecular Biology at Wills Eye Hospital, was
awarded a coveted American Glaucoma Society Clinician/ Scientist
Fellowship at the Society’s Annual Meeting in Sarasota,
Florida, Friday, March 5th. The award was given in recognition
of Dr. Rhee’s continuing groundbreaking work to discover
the molecular biological aspects of intraocular pressure regulation
in the eye.
Dr. Rhee commented, “I believe the most important
aspect of receiving the award was that the internationally recognized
and prominent members of the award committee felt that laboratory
research worthy of national recognition and financial support
was occurring at Wills Eye Hospital.”
Dr. Rhee explained his work as follows, “I hope to further
elucidate one of the fundamental questions in glaucoma —
what controls intraocular pressure? By understanding the pathways
taken by drugs used 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.
“The balance of fluid entering and leaving the eye determines
the intraocular pressure. We know that an eye pressure too high
for a particular eye to tolerate may damage the optic nerve of
that eye. That elevation is not due to too much fluid entering
the eye, but rather to a problem with the drains of the eye —
the trabecular meshwork and ciliary body face. The trabecular
meshwork is the more important of the two. In the majority of
cases, the reason for the drainage problem is unknown. In part,
this is because we do not know how the trabecular meshwork and
ciliary body face control fluid drainage.
“Other laboratories have shown that a few enzymes belonging
to the family of enzymes called ‘matrix metalloproteinases
(MMPs)’ may be involved in regulating fluid drainage in
both the trabecular meshwork and ciliary body. The medication
latanoprost [generic name for the glaucoma medication Xalatan
(Pfizer)] increases fluid drainagethrough the ciliary body face
by affecting MMPs. Why does it not also affect the trabecular
meshwork? If we can understand how latanoprost works, we may locate
one of the mechanisms that controls intraocular pressure. Being
able to make the trabecular meshwork behave like the ciliary body
when exposed to latanoprost may enable us to treat glaucoma more
effectively. These are some of the issues we are investigating.
“Our laboratory has shown that the trabecular meshwork and
ciliary body face share the same cell signaling system. We also
have performed a comprehensive survey of all of the enzymes in
the MMP family. We found no difference between the two tissues.
However, we have found tissue-specific differences at the gene/
molecular level of MMPs between the two tissues for the MMPs which
are expressed in these tissues. We are the first to demonstrate
this. The studies that will be supported by the American Glaucoma
Society will further delve into the reasons why there may be this
difference. With each step, we hope we are getting closer to understanding
the regulation of eye pressure.”
Dong-Jin Oh, PhD, working in Dr. Rhee’s Laboratory
for Molecular Biology, transfers media for cultured cells, one
of the many tasks involved in the Lab’s attempt to elucidate
the molecular biological aspects of intraocular pressure regulation
in the eye.
Photo by Ken Parker
Diagram of the front part of the eye depicting the flow of the
fluid (aqueous) through the eye. If the drains of the eye (the
trabecular meshwork and ciliary body face) do not work properly,
the rise in pressure exerted by the aqueous may damage the optic
nerve.
Reprinted with permission from Maus M, Jeffers JB, Holleran DK,
eds. The Clinics Atlas of Office Procedures. Philadelphia, PA:
WB Saunders Co. 2000.
Telling Others
About Your Glaucoma
On March 24th the glaucoma chat group on the
Foundation’s website, www.willsglaucoma.org, met for an
“open chat,” just among themselves, with no glaucoma
specialist present. Among other topics, the participants responded
to questions about discussing their glaucoma with people on the
job, family, and friends.
Moderator: Do you tell friends, co-workers, or employers that
you have glaucoma?
P11: I once had a boss tell me to take my meds in a stall in the
restroom, not at my desk.
P13: I tell everybody I have glaucoma. As bad as it is to have
the disease, it’s also a very inter
esting disease.
P14: I can tell them I have glaucoma, but I but don’t say
how little I can see.
Moderator: How good are family and friends about providing support?
P12: I don’t tell many folks about my glaucoma. I don’t
have coworkers and I don’t think it’s an appropriate
conversation topic with my clients. My family is quite supportive.
P2: When I was first diagnosed, my parents drove 600 miles to
take me to Wills in the hope that the other docs were wrong. They
weren’t. My parents were sad, but over time I have come
to terms with my eyes.
P1: My husband goes with me to office visits and writes everything
down. I’m afraid of forgetting what the doc says.
P5: My family was sure I didn’t have glaucoma, that it was
only a temporary condition. It was hard for them to accept that
I had glaucoma.
P8: My close family is very supportive. But one aunt does not
have a clue, and asks if contact lenses gave me glaucoma.
P3: I think it’s hard sometimes for people to understand,
because it’s invisible to them, and they don’t realize
that we are actually losing sight. And they think it will go away
after a while!
P7: My four children know I have glaucoma and get their eyes checked.
P8: Most of my friends have misconceptions and are not sure of
what glaucoma is. They think only old people get it.
P12: I don’t like many folks knowing,
because I don’t want it to define me and I don’t enjoy
it being brought up unexpectedly when someone wants to make conversation.
It’s too personal.
P7: I find that some people like to give unsolicited advice: “This
will cure you.” “Are you sure you’re drinking
enough water?” etc.
P9: I am one of seven children. Four of my siblings are on glaucoma
medication, two are older and two are younger than I. So far,
I am the only one who has developed glaucoma. I just assumed I
would be the same, that drops would work and I would be okay.
P1: When I returned to work after my glaucoma surgery, I was amazed
at how many people thought all eye surgery was the same. Many
assumed it was something like LASIK (using a laser to correct
refractive errors).
Moderator: Thanks, everyone! What do you think
about this kind of “open” chat?
P9: This was a great chat for me.
P9: I, too, thought it was very helpful.
Moderator: Let’s try to do one every couple of months.
2003 — A
Fundraising Success!
All of us at the Glaucoma Service Foundation to Prevent Blindness
would like to express our sincere thanks to our many friends and
supporters. Nearly 2,000 individuals, foundations, corporations,
and estates donated a total of $785,198 to support our efforts
to meet the challenge of glaucoma — cutting edge research,
community screenings, patient support, physician education, and
patient education. Our Annual Fund total was $145,558. The Scientific
Symposium/ Celebration yielded $401,749; the funds remaining after
expenses will provide important additional support for our programs.
An additional $140,579 was restricted to glaucoma research, and
$97,312 was earmarked specifically for screenings, the Foundation
website, educational programs, and salary support. This level
of giving is essential if we are truly to make a difference in
the lives of all those who suffer from glaucoma. With your continued
help, our goal — to end blindness from glaucoma —
is within our reach!
To all of our donors, THANK YOU FOR YOUR EXTRAORDINARY
GENEROSITY. We could not do it without YOU!
For complete
list of donors please click here to download Searchligth in PDF
format.
 (Left
to right) Alcon Laboratories representative John-Paul Mount, Glaucoma
Service physician Dr. L. Jay Katz, and Glaucoma Service Foundation
Executive Director Nancy Petrongolo at the dinner in connection
with the annual lecture presented under the auspices of the E.B.
Spaeth Clinical Research Foundation, a foundation established
in honor of Dr. George Spaeth’s father, a well-known ophthalmologist.
Wills Ophthalmologist-in-Chief Dr. William Tasman presented the
lecture titled: “Leadership in Medicine.“ The event
was sponsored by Alcon Laboratories and Allergan.
Photo by Ken Parker
SPECIAL THANKS
We are especially grateful to the donors listed below for their
generous support during 2003:
Mr. and Mrs. Raymond Perelman For support of glaucoma research
Mr. Gary Stevenson For support of the Celebration of 40 Years
of Glaucoma Fellowship
Merck Co. Inc. For support of the Scientific Symposium
Estate of Tamara K. Hareven For support of patient education
Mr. and Mrs. James Kim For salary support and support of the Celebration
of 40 Years of Glaucoma
Fellowship
Mr. and Mrs. Stanley Tuttleman For support of the Celebration
of 40 Years of Glaucoma Fellowship
Mr. Jack Wolgin For support of the ballet for the Celebration
of 40 Years of Glaucoma Fellowship
Hirtle Callaghan & Co. For support of the Celebration of 40
Years of Glaucoma Fellowship
Alcon Laboratories, Inc. For support of the Scientific Symposium
Allergan For support of the International Society of Spaeth Fellows
Yearbook and the Reception Honoring the International Society
of Spaeth Fellows
Pfizer Ophthalmics Support of the website, the Scientific Symposium
and education
Mr. and Mrs. H.F. Lenfest For support of the Celebration of 40
Years of Glaucoma Fellowship
Mr. and Mrs. Louis P. Pipi For support of glaucoma research
Mr. Nat Robertson Unrestricted support
Mrs. Ellen Krause-Taylor Unrestricted support
Mrs. Bruner H. Strawbridge Unrestricted support
Pharmaceutical
Representatives “Go to School” on the Glaucoma Service
Alcon Laboratories representative Pamela Burrell (right)
with Glaucoma Service physician Dr. Douglas Rhee at a dinner following
two days spent by six Alcon representatives observing Glaucoma
Service doctors the clinic and operating room. Such “preceptorships”
are becoming an important way for pharmaceutical companies to
provide their representatives first-hand experience of the settings
in which their products are used.
Photo by Nancy Petrongolo
(Left to right) Dr. Marlene Moster’s patient, Dolores
Quigley, Dr. Moster, and Pfizer Ophthalmics representatives Robert
Draper and Harold Bertrand after Mr. Draper and Mr. Bertrand had
observed Dr. Moster examine Ms. Quigley in the Glaucoma Service
clinic. Both of these Pfizer representatives and four others participated
in a preceptorship, observing not only on the Glaucoma Service,
but on the Retina and Cornea Services as well.
Photo by Ken Parker
Special Thanks
to Roger Barone
The Searchlight extends its special thanks to Wills photographer
Roger Barone for his expert assistance in providing and editing
images for us. His help has enabled us to tell our story much
more clearly and interestingly than we otherwise would ever have
been able to do.
Spreading
The Word
Spreading The Word Glaucoma Service doctors gave some special
presentations during National Glaucoma Awareness Month in January:
Dr. George Spaeth spoke January 24th on CN8 News about what glaucoma
is, how it is diagnosed, and how it is treated.
Dr. Richard Wilson spoke on February 9th on Sunny 104.5 about
glaucoma, especially glaucoma in children.
Dr. Jeffrey Henderer spoke on February 29th on WNJ radio (Newark)
about glaucoma and the importance of early detection and screenings.
Patient
Support Group Meetings
Patient Support Group Meetings Meetings are from
1:30 to 3:00 pm on Sundays in the 8th floor auditorium of the
“new” Wills Eye Hospital, southeast corner of 9th
and Walnut Streets, with the entrance on Walnut Street, near 9th
Street.
May 23 — Dr. Courtland Schmidt
Glaucoma Medications
June 6 — Dr. Christopher Rapuano (Cornea Service of Wills
Eye Hospital)
What Glaucoma Patients Need to Know about the Cornea
 Dr.
George Spaeth Helps Resident Romania
Dr. George Spaeth works on a paper with Adriana Paula Grigorian,
a third-year resident in Ophthalmology visiting from the Central
Clinical Emergency Military Hospital in Bucharest, Romania.
Photo by Ken Parker
|
