Volume 16, Number 1A
March 2008
REGISTER NOW!
Announcing the 2nd Annual CARES Conference A Year of Progress
Through Research
As you may know, Glaucoma is the most common
cause of irreversible blindness in the world, however, if detected
and treated early, Glaucoma-induced blindness can almost always
be prevented.
That is why the Glaucoma Service Foundation to Prevent Blindness
is hosting the 2nd Annual Glaucoma Service Foundation CARES* Conference
(*Committed to Awareness through Research, Education and Support)
on Saturday, September 20, 2008, at Wills Eye Institute from 9:00
AM to 2:30 PM - to further educate those suffering from Glaucoma
and those at risk.
This exciting event will be held on the 8th floor of Wills Eye
Institute and will once again provide information sessions and
lectures by physicians on the Wills Eye Glaucoma Service, as well
as resources available to patients living with glaucoma. Each
session will end with questions and answers. Representatives from
pharmaceutical companies with patient assistance programs, Low
Vision Services, Associated Services for the Blind, The Glaucoma
Research Center and assisted living facilities with low vision
services, will all be on hand.
The day will begin with a continental breakfast and exhibition.
Topics include: An Overview of Glaucoma, Quality of Life Issues,
Adherence/ Compliance, New Medications and New Surgical Trends,
Results of Population Studies, Pediatric Glaucoma, and Intraocular
Pressure Reconsidered.
We look forward to seeing you there! If you have
any questions, please call the Foundation office at 215-928-3283.
Register by:
• Calling: 215-928-3283
• E-mailing: Nancy Petrongolo at npetrongolo@willseye.org
• Mailing your information to:
Nancy Petrongolo,
Executive Director
Glaucoma Service Foundation
840 Walnut Street, Suite 1130,
Philadelphia, PA, 19107
2nd Annual Glaucoma Service
Foundation CARES Conference
Saturday, September 20, 2008
Wills Eye Institute, 8th Floor
9:00 AM Registration
www.willsglaucoma.org
There is no charge to attend, but space is limited so please register
early.
Letter from the Executive Director
Happy New Year! I hope this issue of Searchlight
on Glaucoma finds you well.
We are busy preparing for the 2nd Annual CARES Conference.
The conference will be held on Saturday, September 20th from 9:00
AM to approximately 2:30 PM. We are excited with the program and
hope to see you there! Please remember to register early.
There have been a few changes here at the Glaucoma Service Foundation
that I would like to share with you. We are sad to report that
our Program Director, Ms. Kathy Kuzmanich, has left the Foundation.
Kathy was an asset to the Foundation and her contributions will
be sorely missed.We certainly wish her well with her future endeavors.
As many of you know, long-time Glaucoma Service physician, Dr.
Richard Wilson retired from his private practice. Dr. Wilson recently
resigned as the Secretary/Treasurer of the Foundation and we are
happy to report that Dr. L. Jay Katz has agreed to fill that position.
In closing, I would like to thank the Foundation’s many
friends who have so generously supported the work we do. It is
with that help, that we continue to make a difference in the lives
of glaucoma patients locally, nationally and internationally,
through programs such as the CARES Conference,
the Foundation’s website, Searchlight on Glaucoma and our
clinical and research fellowship training. We couldn’t do
it without you!
Sincerely,
Nancy Petrongolo
Glaucoma and Obesity,
Is There a Connection?
By: George L. Spaeth, MD
Many years ago, a relationship was found between body weight
and the likelihood of people with glaucoma having progressive
damage due to glaucoma. In the latest issue of the Journal of
Glaucoma, the study by Akinci and colleagues from Turkey showed
very clearly that overweight children have an intraocular pressure
which is markedly higher than children of normal weight.
It took years for the damaging effects of cigarette smoking to
be sufficiently accepted that laws were passed to prevent smoking
in places where the cigarette smoke could affect those who were
not smoking. Thank goodness those laws were passed. The world
is better off because of them.
However, it seems both unlikely and unwise to pass laws that make
it illegal to be overweight. That is not the solution! However,
there is a virtual epidemic of obesity in the United States, and
indeed other countries as well. The causes for this have been
studied by many, but in the simplest terms the only cause for
being overweight is eating more than the body needs. It is a remarkable
truth that the overwhelming majority of those I see in the office
who are seriously overweight deny that fact. They say something
like, “Well it could not be that I eat too much because
I eat like a sparrow.” And it may indeed be true that they
do eat like a sparrow, but whatever it is they are eating is too
much. The amount of food one metabolizes varies with one’s
genetic nature, one’s level of activity, and the types of
foods that one eats. Protein, for example, as is found in milk
or beans or meats, requires carbohydrates for it to be metabolized.
Thus, 1,000 calories of protein presents less of a caloric load
to the body than 1,000 calories of carbohydrates.
Furthermore, certain foods, such as sugars, cause
a secretion of agents such as insulin, which tend to stimulate
the appetite. But how foods are metabolized varies hugely from
culture to culture and person to person. The undeniable fact,
however, is that people who are overweight are eating more than
their body is metabolizing.
The recent study by Lee in the Journal of American Medical Association
showed that it was possible to predict life expectancy very accurately
on the basis of a few measures, one of the most important of which
was “body mass index” (BMI) which is calculated as
the weight in kilograms divided by the height in meters squared.
Many other studies have found BMI to be correlated with illness:
hypertension, various cancers, shortness of breath, diabetes,
kidney disease and many others.
For many years I have considered a responsibility as a physician
caring for patients with glaucoma to speak with those patients
who are overweight and indicating to them that for health reasons
they should lose weight. The major reason for this is that losing
weight is likely to improve their quality of life.
There are many things in the world that we cannot control, but
how much we weigh is not one of those things. Unfortunately, many
people continue to believe that how much they weigh is not related
to how much they eat. It is long past time for that untruth to
continue to unfold.
Yoga, good for your health… bad
for your glaucoma?!
Authors:
Daniela S. Monteiro de Barros, MD;
Sheila Bazzaz, MD;
Moataz E. Gheith, MD;
Ghada A. Siam, MD;
Marlene R. Moster,MD
 Yoga
exercises have increased in popularity as a part of an active
lifestyle. In addition to physical fitness, yoga has been promoted
as an alternative form of therapy for chronic illnesses. Nevertheless,
recent studies have described an elevation in intraocular pressure
following Sirsasana (headstand) yoga posture, particularly in
patients with glaucomatous optic neuropathy. Would that rise in
the intra ocular pressure be harmful?.We report our experience
with a case of progressive glaucomatous optic neuropathy in a
patient with a history of congenital glaucoma that has been performing
the Sirsasana headstand posture during yoga exercises for the
past 5 years. She was a 47-year -old Caucasian female with a history
of congenital glaucoma, presented with progressive optic neuropathy
and decreased visual acuity in the left eye. She had undergone
goniotomy in both eyes in the first year of life and filtration
surgery on the left eye 17 years prior to presentation. She recently
had cataract extraction on her left eye. At presentation, her
best-corrected visual acuity was 20/20 in the right and 20/80
in the left eye. The intraocular pressure was 13mmHg in the right
and 24mmHg in the left eye with medical treatment. , The IOP was
unchanged after dilation in both eyes. The optic nerve showed
a small healthy cup in the right eye and larger shallow cupping
with a full healthy rim in the left eye. Despite the fact that
her intra ocular pressure was apparently controlled in all her
check-up visits, there was evidence of progressive optic neuropathy
and visual field defects in the left eye. Knowing that she performs
yoga exercise, the IOP was measured with the Tonopen XL before,
during and after the headstand position. The patient’s IOP
rose significant from 13 mmHg before the headstand position to
35mmHg in the right eye and from 24 mmHg to 50mmHg in the left
eye, during the headstand position. The intraocular pressure after
the headstand position decreased to 18 mmHg. The patient reported
that she would routinely continue this position for ten minutes
approximately three times a week. It is difficult to make a direct
causal relationship between the headstand posture and glaucomatous
progression, but in patients with pre-existing glaucomatous optic
neuropathy, the dramatic change in intraocular pressure is potentially
harmful. The sudden increase in pressure may cause ischemic as
well as mechanical pressure related damage to the optic nerve
fibers. So we would like to raise the attention of the physicians
and patients to the possibility of having the Yoga exercise as
an underlying factor that may cause worsening of the condition
in the predisposed glaucoma patients.
Three New Clinical Fellows on the
Glaucoma Service
 Dr.
Scott Fudemberg received his Medical Degree with a Distinction
in Research from St. Louis University School of Medicine. Following
an internship at St. Louis University Group of Hospitals, he completed
an ophthalmology residency at the University of Kansas School
of Medicine and was a co-chief resident. Dr. Fudemberg is interested
in glaucoma because of the opportunity to develop close, long-term
relationships with his patients. When asked to comment on his
choice, he replied, “I am encouraged by prospects of what
glaucoma specialists will be able to offer patients in the near
future. Increased application of new technology in glaucoma management,
such as retinal nerve fiber layer analysis, illustrates the significant
advances taking place in glaucoma. I am particularly excited by
the potential of research in both neuroprotection and the role
of central corneal thickening that will provide insight that will
help glaucoma patients in the future.”
 Dr.
Anand Mantravadi received his Medical Degree from Indiana
University School of Medicine, Indianapolis. After finishing an
internship at the University of Illinois Medical Center in Chicago,
he completed his ophthalmology residency at The Eye Institute,
Medical College of Wisconsin in Milwaukee, where he was a chief
resident. Dr. Mantravadi recently commented on his reasons for
becoming a glaucoma specialist. “My interests in glaucoma
simultaneously began with a research opportunity with Dr. Louis
Cantor at Indiana University. As a resident, what began as a curiosity
regarding a fascinating disease, became a strong desire to pursue
a career in the sub-specialty as I gained exposure to clinical
and surgical glaucoma of adults and children, and had the opportunity
to establish long-term relationships with my patients.”
Dr. Mantravadi is pursuing an academic career with ambitions to
combine teaching, research, clinical, and surgical practice at
Loyola University in Chicago, IL.
 Dr.
Arun Prasad received his Medical Degree from Keck School
of Medicine of the University of Southern California, Los Angeles.
He then went on to Detroit Medical Center/Wayne State University
for his internship, followed by his ophthalmology residency at
Kresge Eye Institute, Detroit Medical Center/Wayne State University.
Dr. Prasad became interested in ophthalmology at first as a medical
student while assisting anesthesiology residents with cataract
extractions, extraocular and intraocular trauma. His interest
remained steadfast and after a particular glaucoma case, his desire
to pursue this area of sub-specialty heightened. “I saw
a patient with primary open angle glaucoma who came into the clinic
after several missed appointments over the past year. She complained
of decreased side vision over the past several months. Upon examination
we realized that she had a small central window of visual field
in both eyes. When I presented our findings to her, she was visibly
distraught. She told me if she had only known the the consequences,
she would have taken her medications as directed and would have
made a greater effort to keep her appointments. That experience
was powerful and taught me a valuable lesson.”
A Piece of My Mind
By: George L. Spaeth, MD
Many patients in my practice today are elderly, a good proportion
of them are comfortable from a financial point of view and many
live in retirement homes. The overwhelming majority previously
had a productive vocation. In response to a question that is a
routine part of my history taking, specifically, “What are
you doing with your time now?” the answer is almost always,
“Nothing.” Many feel bored, and almost none are involved
in activities directed toward the wellbeing of others. These individuals
could be doing a great deal that would help our world’s
needs. Other people have had a similar thought, as a result of
which there are a variety of opportunities for “retired”
individuals to be active in a constructive way.
Several months ago, I asked an 85- year-old, vibrant, well-dressed
woman, “What are you doing to make the world better?”
Her response was one of stunned amazement. Why would I possibly
ask that question? The issue seemed never to have crossed her
mind. There was no answer. She immediately started describing
her visual symptoms. For the rest of the day, I asked every patient
the same question, interposed amongst other routine parts of history,
such as, “Are you having any trouble using the eye drops?”,
“Do you think your visual ability is the same, better or
worse than it was when I saw you last?” and other routine
and expected questions. The query, “What are you doing to
make the world better?” was presented just as if it were
a usual part of history taking.
A few people were so dumbfounded that they simply ignored the
question. Most were doing nothing that they thought was making
the world better; they justified this by detailing the difficulties
they were having in just taking care of themselves. A small portion
mentioned volunteer work such as being “active in my church,”
but on further questioning this involved arranging flowers, counting
the money in the collection boxes, cooking for the parish get-togethers,
etc.
What was certain was that none of those 30 or so patients that
day were thinking beyond themselves, or in some cases their immediate
families, or in a few others their parochial community. The day
left me discouraged. Here was a group of relatively wealthy, intelligent,
productive people who were for all practical purposes essentially
ignoring the current state of the world. The hundreds of thousands
of Iraqi citizens dying as a result of an ill-conceived and probably
unnecessary war were just too far away to be of concern, the millions
of abused woman too distant, the millions of undernourished, sick
children with no reasonable hope for things getting better just
too remote. Periodically, since that day, I have asked occasional
patients the same question, but not in a systematic way. I have
difficulty keeping up to schedule and therefore was reluctant
to add something to slow me down.
One month later, when at the same office, I saw several of the
patients again. One told me that, as a result of the question
I had asked, she had signed up to go work with Habitat for Humanity
in New Orleans. “It was the best week I have ever spent,”
she added. Another, Mrs. B told me that she had decided to use
extra land she had for a camp to which she would invite young
Palestinian and Israeli boys and girls to come spend a month together
in order to get to know eachTwo out of thirty is a relatively
low percentage, but much higher than zero.
Furthermore, if a single incidental question included amongst
many others that are a part of the routine history-taking can
trigger useful action in around six percent of people, the question
would seem to be worth asking routinely.
A major proportion of those who live within the United States
consult a physician at least once yearly. What would happen if
at each one of those visits every physician asked, “What
are you doing to make the world better?” as a routine part
of the examination? My hunch is that it would have a significant
effect on the patients, helping them to get past their fixation
on themselves and their tiny surroundings. That in itself would
probably help them to become healthier, happier people. Probably
such a question would help broaden the physicians and their staffs
as well.
Additionally, the medical profession would come to be perceived
as a group of people sincerely concerned about the wellbeing of
the world, as well as their individual patients.
A well-done study seems appropriate, designed to determine if
a simple question from a physician can affect the way patients
behave on a broad scale. Until that question is answered, I think
it is worth spending an additional 30 seconds or a minute with
each patient asking, “What are you doing to make the world
better?”
References
Action Without Borders (www.idealist.org)
American Red Cross (www.redcross.org)
America’s Promise – The Alliance for Youth (www.americaspromise.org)
AmeriCorps (www.americorps.gov)
Elderhostel (www.elderhostel.org)
The Executive Service Corps (www.escus.org)
Experience Corps (www.experiencecorps.org)
Generations United (www.gu.org)
Habitat for Humanity (www.habitat.org)
Mentor (www.mentoring.org)
National Retiree Volunteer Coalition (www.nrvc.org)
Peace Corps (www.peacecorps.gov)
Points of Light Foundation & Volunteer Center National Network
(www.pointsoflight.org)
Service Corps of Retired Executives (SCORE) (www.score.org)
Senior Corps (www.seniorcorps.org)
United Way of America (www.unitedway.org)
USA Freedom Corps (www.usafreedomcorps.gov)
Volunteer Match (www.volunteermatch.org)
Volunteers in Medicine (www.vimi.org)
Volunteers of America (www.volunteersofamerica.org)
The 29th Annual Wills Eye Institute
Glaucoma Conference
By: Jonathan Myers, MD
Last week, two dozen glaucoma specialists and comprehensive ophthalmologists
from across the United States and Canada joined together to discuss
current issues in the diagnosis and management of glaucoma in
the 29th Annual Wills Eye Institute Glaucoma Conference. The meeting
followed the new format initiated last year in which every doctor
was a participant: not just listening to talks by experts, but
also presenting their own issues and discussing the other talks.
In this active format each doctor presented a case or issue in
the management of glaucoma, and after each presentation there
was spirited discussion of the issues involved by the entire group.
The topics discussed included current clinical challenges- such
as patients with progressive glaucoma at low pressures- as well
as more academic subjects such as the current knowledge of genetic
causes of glaucoma. There were great discussions about medical
therapy- how to choose regimens which are easier for patients,
how good patients are at remembering to take their drops, and,
given the costs and inconveniences of eye drops, how much medication
it is reasonable to ask a patient to take before moving on to
laser or surgical treatments. On the last day, physicians shared
and compared their surgical techniques for cataracts and glaucoma.
The meeting’s greatest strength was the discussion that
came out of busy clinicians listening to their colleagues’
experiences and frustrations.
Although there were few points on which everyone agreed, all of
the participants found it valuable to hear what was and was not
working for other physicians as they treated their patients, and
I think we each took away more than a few ideas from the others
that may help us to best take care of our patients with glaucoma.
BOARD OF TRUSTEES
Stephen Harmelin, Esq.
Chairman
George L. Spaeth, MD
President
L. Jay Katz, MD
Secretary/Treasurer
|
Judge Phyllis Beck
Charlotte Bonmartini
Francesco Bonmartini
Bonnie Carr Long
Jeffrey Henderer, MD
Thomas Henderer, Esq.
L. Jay Katz, MD
James Kim
Zeff Lazinger, DC
Hyman Lovitz, Esq.
Andrew Medcalf, PhD
Jonathan Myers, MD
Leonard Rosenfeld, PhD
Irvin Schorsch
George Strimel
Tricia Thomas, MD
Chris Urban
Elaine Watson |
|
