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November 2023 Newsletter
MESSAGE FROM THE PRESIDENT
Dear Readers,
During this special season of Thanksgiving, I want you to know how grateful we at TGF are for you, our friends and supporters, who make our research and educational initiatives possible. You are vital to our work and deeply appreciated!
We have just concluded our Fourth Annual TGF Art Challenge to Celebrate Vision and we are excited to announce that donations exceeded our goal. With the addition of a matching gift, we raised $106,332 that will help fund glaucoma research in our next grant cycle. Thanks to the 29 artists who participated and to their friends, families, colleagues and others who honored their artistic visions with contributions. We were delighted that this year 10 glaucoma patients were among the participating artists. You will read about one of them in this issue.
This month our Scientific Advisory Board will be reviewing research grant applications, assessing which projects, including two donor directed grants, are ready for funding. In our next newsletter, we will tell you about the new grant recipients, including five new minority Fellows, and the science we will be supporting in 2024.
2024 will be a milestone year for The Glaucoma Foundation as we will be celebrating the 40th anniversary of TGF’s founding. We’ve already begun planning a gala event on April 18th to mark that occasion. Stay tuned for details!
For these final months of 2023, the Foundation and I wish you and your families a very happy and healthy holiday season.
With all best wishes,
Elena Sturman
DOCTOR, I HAVE A QUESTION.
My glaucoma doctor uses different imaging devices during my eye exams. What does each of them do?
Question answered by Gregory K. Harmon, MD
Board Chairman of The Glaucoma Foundation
Dr. Gregory K. Harmon is Chairman of The Glaucoma Foundation since 1999, and a Board Member since 1993. Dr. Harmon is in private practice in Manhattan, specializing in glaucoma and cataract surgery. His voluntary faculty positions include Clinical Associate Professor of Ophthalmology at Weill Medical College of Cornell University/New York Presbyterian Hospital and Associate Adjunct Surgeon at NYEE.
Your eye doctor has a range of sophisticated tools to help diagnosis glaucoma and measure its progression. Since optic nerve damage cannot be reversed, detecting glaucoma and its progression as early as possible is key to keeping glaucoma under control and preserving sight.
The optic nerve is composed of over one-million individual nerve fibers. By imaging your optic nerve over time during multiple visits to your eye doctor, these machines can help monitor and detect loss of optic nerve fibers.
Your eye doctor may be using one of these optic nerve computer imaging techniques as part of your glaucoma examination: GDx Analyzer (short for Glaucoma Diagnosis Analyzer), Heidelberg Retinal Tomography (HRT) and Optical Coherence Tomography (OCT).
The Nerve Fiber Analyzer (GDx) uses laser light to measure the thickness of the nerve fiber layer. When thinning, this layer gives important clues to physicians about the presence of glaucoma.
The Heidelberg Retina Tomograph (HRT) is a special laser that produces a three-dimensional high-resolution image of the optic nerve. This test provides clinicians with measurements of nerve fiber damage (or loss).
Optical Coherence Tomography (OCT) is currently the most popular technology used by glaucoma specialists for optic nerve fiber analysis. OCT measures the reflection of laser light much like an ultrasound measures the reflection of sound. It can directly measure the thickness of the nerve fiber layer and create a three-dimensional representation.
Research has shown that damage to the nerve fiber layer and optic nerve often occurs before visual field changes are recognized. After glaucoma is diagnosed, scans taken over time may show progression of the disease and whether your treatment is working.
For the OCT test, you sit in front of the OCT machine and rest your head on a support to position your head correctly. You will be asked to look at a blinking target and the scans will be taken without the machine touching your eye.
OCT is also used for imaging before cataract surgery to detect disease like macular degeneration that might limit the success of cataract surgery in glaucomatous and non-glaucomatous patients.
OCT technology, first introduced in 1991, continues to advance. AI may pave the road for cost-effective glaucoma screening programs, such as detecting glaucoma from OCT images in an automated fashion.
Glaucoma is a women's health issue
Dr. Andrew Feola is Assistant Professor in the Department of Ophthalmology at Emory University and Research Biologist at the Atlanta VA Medical Center, where he studies ocular pathologies from a women’s perspective, with a special focus on understanding how age and menopause play a role in developing these diseases.
During his recent TGF Webinar in September, he talked about a unique area of his lab’s research -- investigating how estrogen and menopause play a role in risk factors related to the onset of glaucoma and to visual function. He presented facts and findings.
The first is that 59 percent of glaucoma patients worldwide are female. While women live longer, and glaucoma prevalence increases with age, there is also a higher percentage of glaucoma in younger women. So, something else must be going on.
He next focused on intraocular pressure (IOP) – the major risk factor for developing the disease. Menopause increases IOP by 1 to 3 mmHg. And that elevation is sustained throughout a person’s remaining lifetime.
“We know menopause affects changes throughout the body – cognitive functions, hair, thermal regulation, cardiovascular and heart health, the pelvic floor, bladder and bone health,” said Dr. Feola. “It’s crazy to think that if menopause affects literally everything from the hair on one’s head to bones in one’s feet – that it doesn’t affect the eye!”
Menopause is a highly researched topic. Dr. Feola explained that much of the research has focused on estrogen loss and the cardiovascular system and spine health and that researchers see comparable impacts of menopause across these fields,
“If we look at these other diseases where women make up a majority of the cases, in each of these diseases menopause is considered a sex-specific risk factor, and in each of those diseases, early menopause is considered a higher risk factor in developing the disease. But while menopause is considered a sex-specific risk factor for cardiovascular disease, bone health and osteoarthritis, this is not true for glaucoma. – at least not yet.”
Dr. Feola shared findings of studies that used rat models with early surgical menopause to illustrate that menopause and estrogen influence multiple factors related to ocular health and vision. Among them: IOP, visual acuity, outflow facility, gene expression, retinal ganglion cell survival and ocular mechanics.
“This knowledge doesn’t yet affect clinical care; a lot more research is needed to bridge our understanding of menopause and glaucoma,” says Dr. Feola. “But given the similarities found with other diseases, I am hopeful that menopause may be a novel sex-specific risk factor.”
“Where does that lead us? More research can help us better understand the disease risk factors, and identify novel target treatments that are not currently being used to treat glaucoma.”
TGF TGF Names Two New Board Members
Two distinguished glaucoma specialists, Drs. John Berdahl and Joseph F. Panarelli, have recently joined The Glaucoma Foundation’s Board of Directors.
Ophthalmologist John Berdahl, MD, is a surgeon in practice in Sioux Falls, SD. In addition to being a leading cataract surgeon, he is fellowship trained in cornea, glaucoma and refractive surgery. Dr. Berdahl has performed more than 25,000 eye surgeries around the globe. He is also the founder of Equinox Ophthalmic, a developer of medical technology. Dr. Berdahl received his medical training at Mayo Medical School and Duke University.
Dr. Panarelli, who specializes in the treatment of glaucoma in adults and pediatric patients, practices at NYU Langone in New York City, where he is Director of Glaucoma Services and Professor in the Department of Ophthalmology at NYU’s Grossman School of Medicine. Dr. Panarelli’s research interests stem from his passion for innovative surgical approaches and primarily include development of surgical devices and techniques. He received his MD from Georgetown University and did his residency at NY Eye and Ear Infirmary.
LIVING WITH GLAUCOMA
Meet Annie Hesse
Photographer Annie Hesse grew up in northern California and has lived in Paris since 1985. One of the 29 artists who participated in this year’s Art Challenge, and one of 10 glaucoma patients to enter the challenge, Annie was born completely blind with congenital cataracts, which were removed at the age of three months, leaving both eyes permanently impaired. She was later diagnosed with glaucoma.
“I did okay in school in Palo Alto,” she says. “I was offered blue-lined paper and books with large type but I refused all that because I didn’t want to appear different from the other kids. At least I could see – if only 20/200 in one eye and 20/800 in the other. Glasses really didn’t help much.”
“Someone offered to teach me Braille, but I wasn’t interested because I thought, ’I can see, I can write.’ Then they introduced me to a typewriter with large letters – that really changed my life.”
“Another turning point was when I was 12 and 13. My parents and older sister and I went to Europe and camped for an entire year. That opened my eyes to the world – I learned bits and pieces of languages and made friends along the way. I’m sure I wouldn’t be the person I am today if it wasn’t for that experience.”
“I was diagnosed with glaucoma at age 14, finished high school and started to go to college in California but dropped out. That was in the ‘60s and I was active against the wars in Southeast Asia. I met other adventurous spirited people; we did street theater up and down the West Coast for a number of years. I lived in a hippie van.”
“There were lots of adventures. I hitchhiked with a partner across Europe and ended up in Cairo, Egypt and then hitchhiked all through Africa. That was another turning point in my life. I returned to California but In December, 1985 I moved to Paris to join a French partner I had met during my travels.”
Annie diligently took her glaucoma eyedrops for 30 years. But in the mid-1990s, her pressures started going up and she thought she was losing more vision. Nothing seemed to lower her eye pressure and the only other option was the traditional trabeculectomy surgery. Unfortunately, there were negative consequences.
“I lost vision in what was my better eye. But ironically, this operation was liberating in a way because it made me realize that for all these years I had been in denial of my disability because I wanted to look normal and be accepted as a normally-sighted person. Suddenly, it was like, ‘Oh, okay, I’ll use a cane, no problem, it tells people that I have this disability.’
“Photographing the cultural milieu around me in black & white was my initial inspiration; the darkroom was magical. But after the eye operation in 1995, developing and printing became too challenging and I migrated to digital photography. Eventually, my desire to show the viewer my perception of the world and also to initiate another way of ‘seeing’ became vital.”
“Color, shape, texture and contrast are the key elements in my photographs. My work has appeared in numerous group shows in the United States including the travelling exhibition, “Sight Unseen – International Photography by Blind Artists,” which just had a showing at the Bedford Gallery in Walnut Creek, CA.”
Annie’s advice to others: “Get on with your life and don’t let your vision loss stop you from doing what you want to do.” Annie recalls all the early devices that helped her, such as a monocular and the pocket magnifier she wore on the belt loop of her jeans, even when she traveled across Africa. She gives a shout out to the SuperNova magnifier and screenreader technology on her computer, and of course to the internet, because it opened a new world to her when she lost sight in 1995, and to the iPhone which has so many assistive functions. More photos at anniehesse.com.
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