Chat Highlights
Technology & Glaucoma
December 20, 2000

Norma Devine, Editor

On Wednesday, December 20, 2000, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Technology & Glaucoma." 

Moderator:  Tonight's topic is "Technology and Glaucoma."  Dr. Rick, how is technology affecting the diagnosis and treatment of glaucoma?

Dr. Wilson:  Technology is moving forward on almost all fronts.  The ability to sequence genes is key to our understanding the relationship of genes to disease, and later inserting corrective genes into the eye.

Moderator:  Sounds like science fiction.  Could inserting a corrective gene correct a badly damaged glaucomatous eye?

Dr. Wilson:  Yes, it might.  It is truly promising.  The nerve regeneration work I have seen is startling.  Please write your national legislators that you strongly favor stem cell research.

P:  Are there other truly promising developments or small improvements?

Dr. Wilson:  Technology continues to help us refine our surgery, and we hope that a better antifibrosis drug with fewer long-term side effects will come along soon.  The continual improvement of the disc topographers and nerve fiber layer analyzers allows these machines to help the general ophthalmologist and optometrist with the least interest in glaucoma.  I look forward to when this technology will become a non-subjective way for me to analyze discs and find it helpful.

P:  I am very optimistic about biotech developments that will help resolve a number of diseases, but at age 64, I am not sure that I will live to benefit from them.

Dr. Wilson:  I think yes.

P:  This sounds encouraging.  How long before you can try this on patients?

Dr. Wilson:  Can't tell for sure.  Probably five to ten years away, but the first genetic treatments for glaucoma will occur in my lifetime.

P:  Dr Wilson, what can you tell us about telemedicine?

Dr. Wilson:  As the bandwidth of the data pipes and digital cameras improve, so does our ability to diagnose and suggest treatment over the Internet.

P:  Since blood circulation to the optic nerve is suspect, at least with normal-tension glaucoma, has anyone tried a bypass in the blood supply to the eye and optic nerve?

Dr. Wilson:  The vessels to the optic nerve (itself only 1 x 1.5 mm in diameter) are very small. It is not possible at this time to bypass them.

P:  Nerve regeneration would certainly be better than putting electronics in the eye.

Dr. Wilson:  Absolutely, and maybe closer than we think.

P:  Have you already seen or used telemedicine?

Dr. Wilson:  Yes, we have two telemedicine stations at Wills.

Moderator:  Please tell us more about telemedicine.

Dr. Wilson:  Telemedicine depends strongly on the doctor or technician obtaining the images.  If the images are good, then a correct diagnosis can be made and treatment suggested.  Conversely, if they are bad, the consult may be worthless.

P:  Are the images good nowadays?

Dr. Wilson:  They can be quite good.

P:  Given a genetic predisposition, are there preventive treatments available to manage eye health before any neural damage is evident?

Dr. Wilson:  There are no real preventive treatments besides a healthy lifestyle and exercise.  Diagnosis is crucial, as you can imagine.  We at Wills are working on ways to screen for glaucoma in the inner-city health clinics and provide information to people at risk.

P:  I am on the board of the FreeStore/FoodBank in Cincinnati and we are developing a partnership with dental organizations for examination and treatment for those who cannot afford it, and a clinic with the University of Cincinnati for general medicine for the homeless.  Perhaps an eye clinic would be good, too.

Dr. Wilson:  Great!  My wife is the director of the Greater Philadelphia Coalition Against Hunger.  Our local food bank is one of the members of the coalition.

Moderator:  What can you see with telemedicine?

Dr. Wilson:  What I see with telemedicine is either a video or still pictures picked up by a digital camera.  At the same time I see the video I am talking to the doctor or technician sending me the information and he or she can see my face in their monitor.

P:  Who is involved in taking this video, and sending it on to Wills?

Dr. Wilson:  Usually the referring doctor or a technician from the doctor's office.

P:  Is special equipment needed to send Wills the video and photos?

Dr. Wilson:  To send it real time, you would need software.  To forward a picture via e-mail would really take nothing more than what you have now and would be telemedicine.

P:  Is there any progress in the technology of the various surgeries that could be used to reduce intraocular pressure?  The bad surgical reactions that I have heard about in this chat room are certainly discouraging.

Dr. Wilson:  Yes, a lot of work is being done, especially with anti-scarring medications.

P:  I have heard of hearing tests that can determine hearing loss in a person with the patient being passive.  Is there any new technology that allows the visual field to be tested without requiring the patient to respond? Might thisimprove the reliability?

Dr. Wilson:  Yes, there are.  The science, and especially the art, are not perfect yet.

P:  I had a similar test for hearing.  Sound was provided to each ear, and brain waves checked for receipt of the message.

P:  We need something better than visual field testing to indicate progression of glaucoma. Is there any hope for that?

Dr. Wilson:  Pattern electroretinograms are a possibility.

Moderator:  What are pattern electroretinograms?

Dr. Wilson:  A checkerboard pattern of various sizes and variable flash patterns are shown to patients whose brain waves are analyzed to see whether they are seeing the pattern.

Moderator:  Does Wills have one of those machines?

Dr. Wilson:  Yes.

P:  Is this test reliable?

Dr. Wilson:  It is getting better, but is not that reliable yet.

P:  Is it used effectively for children?

Dr. Wilson:  Yes. That is one of its main uses.

P:  Wouldn't that test be more for showing damage to the optic nerve than to the visual field?

Dr. Wilson:  No.  Both happen concurrently.  Only at least 1/3 of the optic nerve needs to be damaged before the visual field changes.  Pattern ERG is no more sensitive at this time than the visual field test.  There is also a learning curve, so that patients often get better with practice.

P:  I have had only one visual field test and found it hard to know if I was cheating or not by moving my eye to look for the light.

Dr. Wilson:  The test can usually tell.  You need to be very conscientious about staring at the fixation light.

P:  What is the status of an improved Mitomycin C (anti-scarring) drug?  Anything in trials yet?  You told us that they're working on one in California, for example.  (Among others here, I reacted to Mitomycin-C.)

Dr. Wilson:  It's still being worked on, but not ready for prime time yet.  We have learned a lot about Mitomycin and have fewer side effects with it now.

P:  Although I'm glad progress is being made, I have begun to believe that Mitomycin C and perhaps other new bio/ technological advances are brought to market too soon.  I now have a silicone intraocular lens (IOL) that holds pigment, diminishing my sight.  Something new again.  My older IOL is still wonderful.  Now, Doctor, I want to say that cataract surgery is one of the all-time most successful, low-risk surgeries ever devised.  It's a shame to leap to a new product and harm vision.  Are you using the silicone intraocular lens?

Dr. Wilson:  Yes, and I have used it for about seven years. I love the kind made by Allergan Medical Optics, a second generation silicone that Tom Samuelson studied and found to have less inflammatory and pigment precipitates on it than the older and newer materials.

On January 3rd, Dr. Wilson discussed "Glaucoma Medications" in the Chat room. Click here for highlights of that meeting.

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