Volume 14, Number 3
December 2005
Appreciating Vision
- Celebrating the Arts - A Fundraising Success
Approximately $25,000 was raised to support the Foundation's
research and education programs.
Guests braved torrential rains to attend our
fundraising event at the Pennsylvania Academy of the Fine Arts
on October 8, 2005. The elegant evening of cocktails, concert
and confections began with a private tour of the Tuttleman Sculpture
Gallery followed by a warm welcome from Foundation Board member,
Mr. Stan Tuttleman. Guests learned more about the Foundation's
activities and programs in a presentation by Foundation President,
Dr. George Spaeth. The Delaware Valley Celtic Harp Orchestra then
performed 17th and 18th century Irish and Scottish dance music
in the Annenberg Gallery.
This intimate evening afforded guests the opportunity to meet
and speak with Foundation Board members and physicians, to learn
more about the important work being done on the Glaucoma Service
and to better understand the need for the vital Foundation programs
designed to help prevent blindness from glaucoma.
We would like to thank all those who helped make this evening
a success!
Delaware Valley Celtic Harp Orchestra member.
Photo by Nancy Petrongolo. |
(left to right) Mrs. Elaine Watson, event co-chair Mr.
Joseph Watson, Mr. Stan Tuttleman, Mrs. Rosa Lazinger and
event co-chair, Mr. Zeff Lazinger.
Photo by Nancy Petrongolo. |
(left to right) Foundation Board member Mr. Louis Esposito,
Mrs. Ann Esposito, and Mr. and Mrs. Anthony Petrongolo.
Photo by Greg Petrongolo. |
(left to right) Event co-chair, Mr. Joseph Watson, Board
member Mrs. Bonnie Carr Long, Mr. Gerald Long, and Foundation
Chairman, Dr. Andrew Medcalf.
Photo by Nancy Petrongolo. |
The Glaucoma Service Physicians
Educate Pharmaceutical Representatives
Four representatives from Pfizer Ophthalmics
participated in a preceptorship on the Glaucoma Service in November.
These preceptorships are an important way for pharmaceutical companies
to provide their representatives first hand experience of the
settings in which their products are used.
The representatives spent two and a half days observing the Glaucoma
Service physicians in both the clinic and operating room, in addition
to attending a lecture given by Dr. Jonathan Myers.
Dr. Jonathan Myers with Luke Cicco from
Pfizer.
Photo by Nancy Petrongolo. |
Glaucoma Service Clinical Fellow, Dr. Kalpana Jatla explains
using the slit lamp to the Pfizer representatives. (Standing
left to right) Luke Cicco, Rob Cafaro, and Dr. Jatla (Sitting
left to right) Mike Langan and Mike Williams.
Photo by Nancy Petrongolo. |
The Four Paths to Good
Health: (1) Listening With Your Inner Ear,
(2) Living Like a Neanderthal, (3) Learning, and (4) Loving
by George L. Spaeth, MD
Why People Get Sick
People get sick for two reasons. The first relates to how we are
made: some people are made so they tend to stay healthy—some
are made so they are predisposed to illness. The second reason
we get sick is because something damages us—influenza virus
from a person coughing, an automobile accident, a diet with too
many calories, etc.
We cannot determine how we are made, that is, what genes we were
given and how we are cared for in childhood. Also, we cannot directly
ourselves control many of the things in our environment, such
as air quality and water quality. But we can control how we take
care of ourselves. How we take care of ourselves is the single
greatest controllable factor determining whether we become sick
or well.
Listening With Our Inner Ear
The first secret to good health is listening with (and to) one’s
inner ear, that part of the body that determines our sense of
balance. The inner ear tells us whether we are up or down or sideways,
and how every one of our motions relates to every one of our other
motions. It is amazing to consider that when we walk our eyes
move up and down, but the world does not seem to move. Our brain
readjusts to the changes in a miraculous way we do not even notice.
The inner ear is concerned with balance in the most literal sense.
But in this discussion think of the terms “inner ear”
and “balance” in a figurative sense. I first heard
the phrase used by Betsy Datner talking to a group of new medical
students, advising them how to maintain balance at a very stressful
time their lives. She was suggesting that most of us are partially
aware when our lives are getting out of balance, but we often
do not heed the warning signs.We do not listen.We see ourselves
getting overweight and feeling less healthy, but we ignore it.We
think we may have lost a little bit of vision, and we wonder if
our glaucoma or some other condition is getting worse, but we
do not listen with that inner ear which is present in all of us.We
need to treasure and nurture that emotional and physiological
inner ear that tells us when we are out of balance. However, it
only tells us that if we listen with it.
Physicians and healers have always known more
about certain things than those not involved in the healing arts.
But only patients know what they want, what they feel, and how
well they are functioning. They know these things by “listening
with their inner ear.” Virtually every day I see patients
who say to me, “I think I’m getting worse, but my
doctor tells me I’m doing fine.” Those patients often
believe their doctor. They do not listen with their own inner
ear. When some physicians do not see a biological cause for a
patient’s perceived deterioration, they frequently write
off the concern. However, physicians never detect all biological
changes that are occurring. The most physicians can do is use
appropriate tests knowledgeably, interpret them carefully, and
then say to the patient, “I can’t find any cause to
explain why you’re feeling worse. The likelihood is that
it can’t be very serious. If it gets more troublesome, make
sure you get back in touch with me right away. Let’s just
watch you carefully and see whether you get better or worse in
the near future.”
Live Like a Neanderthal!
Genes are turned on or off by the way we live.
Genes are said to be “up regulated” or “down
regulated.” A vast amount of research is presently under
way to determine what factors up regulate and down regulate genes.
Additionally, genes change with time. Mutations occur. Genes are
not always passed on to succeeding generations unaltered. Indeed,
evolution is closely related to the changes in the genetic make-up
of species that have occurred over eons. Those who survived were
those best able to live in a way that allowed their genes to function
best.
Physicians and healers have always
known more about certain things han those not involved in the
healing arts. But only patients know what they want, what they
feel, and how well they are functioning.
Dr. George L. Spaeth
We are still today largely made up of those genes
that have developed during the past thousands of years. The lifestyle
most likely to keep our genes happy is the one most similar to
the environment in which those genes developed. The question we
should ask ourselves, then, when we’re trying to decide
whether to do something or not, is, “Would a Neanderthal
have done this?” If the answer is no, we may want to pause.
Neanderthals did not take mega doses of vitamins, nor stay out
of the sun 95% of the time, nor eat huge amounts of refined sugar,
nor drink distilled liquor. They ran, ate fresh meats and roots
and berries and fruits and grains, drank milk (and later, beer
and wine), and went to bed when it was dark and got up when it
was light.
Scientists (one of them are own Glaucoma Service Fellow Ordan
Lehmann) have discovered that the surfaces of our bodies are covered
with “defensins” that help us from getting infected
from the myriad infectious agents that are everywhere. These defensins,
then, are critically important in our remaining healthy. They
are fatty substances that stick on the surface and are not dissolved
or easily washed off by water. But most of us wash them off with
powerful soaps, sometimes daily! Being dirty is probably not conducive
to health, but washing off the natural materials that help keep
us well is also unhealthy.
Though obviously an oversimplification, there is much merit in
using as a second principle for how to keep healthy, “Live
like a Neanderthal.” Our modern brains are smart. But they
are not as smart as Nature.
Learn!
The third “secret” of staying healthy is to learn.Years
ago, for example, many of us loved to stand on the fluoroscope
instrument in shoe stores and watch our toes wiggle. Little did
we know that we were irradiating ourselves with damaging doses
of x-rays. Now that we know more about the damaging effects of
radiation, we know to avoid them if possible. If we do not know
that something is harmful we are not likely to avoid it. Our cells
rely on our brains to protect them. For example, if we do not
know that the eye drops we are using to treat our glaucoma can
cause us to be extraordinarily fatigued, confused, or sexually
dysfunctional, we are not likely to attribute those symptoms to
the use of the eye drops. Consequently, we do not make the relationship
in our own minds between the eye drops and feeling bad. Nor do
we volunteer the symptoms when the eye doctor who ordered the
eye drops asked us, “How are you?” But if we know
those side effects, then we will watch for them and volunteer
them.
If we know that glaucoma tends to get worse because our intraocular
pressure is higher than our eye can tolerate, and that the eye
drop we are using lowers our intraocular pressure markedly, we
are far more likely to use the eye drops. It will seem unbelievable
to many, but the fact is that over one third of patients with
glaucoma do not take their eye drops properly. Work that we have
done has shown that one of the major reasons some people do not
use their eye drops is that they do not know what their eye drops
are for.
If we know that glaucoma is a condition in which the optic nerve
tends to deteriorate, we know that our eye doctor cannot tell
us we are fine unless he examines our optic nerve. Thus, when
the ophthalmologist says to us, “You’re doing well,”
and we know he has not looked at our optic nerve, we need to question
him. Should the eye doctor then ignore the question or disparage
it, we know that we had best seek our care with somebody else.
Knowledge is power. The more we know the more powerfully we can
manage our own lives. The better we manage our own lives, the
healthier we will be.
Knowledge is power.
The more we know the more powerfully we can manage our own lives.
The better we manage our own lives, the healthier we will be.
Dr. George L. Spaeth
Love!
How we feel and how we think strongly affects
whether we are healthy or unhealthy. Health is the
perception of feeling whole. “Whole” does not mean
“perfect.” One does not need to be perfect to feel
healthy. Feeling better makes us become better. On the other hand,
feeling that we are helpless makes us become helpless. Investigators
have now determined in the laboratory what all wise people have
known for eons, that how you think and feel affects your health.
People can depress or enhance their health defense -- such as
their immune systems -- by the way they feel, think, and act.
We predispose ourselves to conditions such as cancer, heart disease,
and tuberculosis by becoming angry or rundown. Perhaps nothing
makes us feel better and think more positively than loving. Like
mercy, loving is twice-blessed, blessing the giver and the recipient.
But loving not only helps keep us healthy, it makes life worth
living. Indeed, perhaps the most responsible thing we can do --
for ourselves and society -- is to love!
Visual Fields & Functional Vision
Norma Devine, Editor
On Wednesday, October 26, 2005, Dr. Rick Wilson, a glaucoma specialist
at Wills, and the glaucoma chat group discussed "Visual Fields
& Functional Vision." Click
here to read highlights.
You Can Still Make a Difference!
By now, you should have received our year-end mailing for the
Foundation’s 2005 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.
Giving opportunities include:
- Cash
- Retained Life Income Gift
- Securities
- Annuities
- Bequests
For more information, please contact the Glaucoma Service Foundation
office at 215-928-3283 or visit our website at www.willsglaucoma.org.
Three New Fellows Train on the
Glaucoma Service
Dr. Kalpana Jatla graduated from University of North Carolina
at Chapel Hill with a BS in Public Health, and received her medical
degree at Wake Forest University in Winston-Salem, NC. Following
an internship at the University of Tennessee in Chattanooga, she
completed a residency in ophthalmology.
Her specific interest in glaucoma stems from her motivation for
pursuing a career in medicine, which is to have the opportunity
to develop doctor-patient relationships and at the same time help
maintain or improve patients’ quality of life. “Taking
care of patients with glaucoma is what I enjoy most about being
a physician. I think effective communication is paramount in helping
patients understand their disease and promote compliance to treatment.
I am enjoying my fellowship year as I am learning how to effectively
diagnose glaucoma and suggest medical and surgical treatments.
I look forward to participating in clinical research. I know that
the clinical and research skills I develop on the Glaucoma Service
will allow me to better serve the community.”
After completing Medical School and an ophthalmology residency
at Ludwig Maximilians University in Munich, Germany, where she
received a grant from the German National Scholarship Foundation,
Dr. Anna K. Junk completed a research fellowship in ophthalmology
at the Eye Radiation and
Environmental Research Laboratory of Columbia University in New
York, sponsored by a grant
from the German Research Foundation. As a principle investigator
she continued to study the
effects of radiation and corticosteroids on the eye in approved
clinical and experimental studies. She participated in obtaining
NIH grant applications and published, reviewed and edited many
scientific papers. She then went on to do an Internship in Medicine
at Montefiore Medical Center, Albert Einstein College of Medicine,
followed by a fellowship in Ophthalmic Pathology Research. Here
she studied the effects of neuroprotection in a model for acute
glaucoma. Dr. Junk then took on her second ophthalmology residency
at Montefiore Medical Center, Albert Einstein College of Medicine.When
asked why she chose to specialize in glaucoma, Dr. Junk replied
“When I decided to pursue a career in medicine, my goal
was to contribute to medical research to help advance our knowledge,
improve therapies, and to provide excellent care to my patients
– not only treating the disease, but helping patients to
understand their condition and learn to live a fulfilled life
despite limitations. Glaucoma is one of the emerging fields in
ophthalmology. We are only beginning to understand the causes
of the disease as we are uncovering associated genes and their
products. Nowadays we have so many more alternatives to offer
our patients, but still, we can only ameliorate the course of
the disease. I have found the challenge of treating a disease
process with variable presentations, therapies, and outcomes to
be most rewarding. Most importantly, I have enjoyed the follow-
up care of patients that glaucoma management entails. In pursuing
glaucoma fellowship training, I want to expand my knowledge of
the diagnosis and treatment of glaucoma, and gain more experience
in surgical techniques and postoperative management. It is exciting
to take an active role in understanding and improving the care
of our patients and I enjoy participating directly in research
and resident teaching. My future professional goal is to provide
excellent glaucoma care to my community and dedicate my time,
knowledge, and experience to research and training future ophthalmologists.”
 Dr.
Jerome Ramos-Esteban received his medical degree from the Universidad
Autonoma de Guadalajara in Mexico, which included a one-year medical
internship at the Universite Renee Descartes in Paris, France.
Prior to his residency in ophthalmology at the Yale University
School of Medicine, he completed a post-doctoral fellowship year
in Glaucoma research at the Mount Sinai School of Medicine in
New York. While at Yale, he was awarded the Yale Alumni in Ophthalmology
Resident Research Prize in 2004, and in June of 2005 he received
an award for his research in corneal thickness in glaucoma by
the Connecticut Society of Eye Physicians. He also completed an
Executive Management Program in Ophthalmology at the Yale School
of Management, and was involved in the creation of NOVUS, a Latin
American student organization officially recognized by Yale University.
Dr Ramos-Esteban has published 18 scientific papers and he has
been an alternate Director of Highlights of Ophthalmology since
2002. He is fluent in Spanish and French. When asked why he chose
to specialize in glaucoma Dr Ramos-Esteban replied: “The
glaucoma fellowship program at Wills under the direction of Dr.
Spaeth and Dr. Katz is recognized as one of the best in the world.
Glaucoma is a leading cause of blindness among Hispanics in the
United States, and yet more than half of patients are unaware
of their glaucoma. My role as a glaucoma specialist is to influence
patients’ behavior by inspiring them to take care of themselves.
Due to the chronic nature of this disease, treating glaucoma is
very attractive to me because it allows me to create long term
relationships with patients - which is why I became a physician.”
FROM THE “CHAT HIGHLIGHTS”
OF THE GLAUCOMA SERVICE WEBSITE
What Should Patients Ask Before Surgery?
Participant: What questions should patients
ask their surgeons before agreeing to have surgery?
Dr. Rick Wilson: I feel the best approach is
for the doctor to provide written literature on the procedure,
preferably something he or she wrote. The patients can then read
the brochure several times, so some of it sinks in, despite the
adrenalin. Then the patients can ask their questions.
I often give patients a pen to use to write down their questions,
before they return from the waiting room. Clearly, they will need
to be assured that the surgery is necessary, to understand how
it works, and to be able to weigh the risks and benefits. If they
have decided to proceed, they need to know what to expect during
surgery and the postoperative period. Usually, the surgical co-coordinator
will be able to answer all the logistical questions.
Vision
Norma Devine, Editor
On Wednesday, October 5, 2005, Dr. Rick Wilson, a glaucoma specialist
at Wills, and the glaucoma chat group discussed "Vision."
Click here to read
highlights.
Information from the Department
of Motor Vehicles for the State of Pennsylvania and the State
of New
Pennsylvania Department of Transportation, Driver and
Vehicle Services
1101 South Front Street
Harrisburg, PA 17104-2516
www.dot.state.pa.us
(800)932-4600 (within state)
(717)391-6190 (out of state)
Visual Acuity
Each eye with/without correction
Both eyes with/without correction
If one eye blind
– other with/without correction
Absolute visual acuity minimum
Are bioptic telescopes allowed? |
20/40
20/40
20/40
20/40 in better eye for unrestricted
license; up to 20/100 binocular vision
for a restricted license.
Not permitted for meeting acuity
standards; however, they are permitted
for driving. Must have acuity of
20/100 or better with carrier lens only. |
| Visual Fields
Minimum field requirement
Visual field testing device
|
120° both eyes
PENNDOT does not regulate the kind
of testing device used.
|
New Jersey Motor Vehicle Commission
PO Box 160
Trenton, NJ 08666
www.state.nj.us/mvs
(609)292-6500
Visual Acuity
Each eye with/without correction
Both eyes with/without correction
If one eye blind-other with/without correction
Absolute visual acuity minimum
Are bioptic telescopes allowed?
|
20/50
20/50
20/50
20/50
Yes, with acuity of 20/50 through telescope |
Visual Fields
Minimum field requirement
|
None |
|
