Ophthalmology | Minnesota Medical Foundation

Solving vision problems: Where ophthalmologists and neuroscientists converge

2012-10-17T16:37:13Z

Consider the mind-bending truth about the human eye: with an estimated 2 million working parts that allow us to absorb images of the world around us in fractions of a second, the intricate mechanism is second only to the brain itself in complexity.

When things go wrong, however, the impact on a human life can range from annoying to devastating, with total blindness the ultimate insult. But scientists in the University of Minnesota’s recently renamed Department of Ophthalmology and Visual Neurosciences (OVNS) take up the fight daily, battling their way from questions and problems to answers and treatments.

At the forefront of the effort is the department’s new chair, Erik van Kuijk, M.D., Ph.D., who came to the University last October with a clear charge: continue to improve the department’s clinical and education programs and raise the national and international profile of its already outstanding research program.

“I really came here because of the talented faculty that had been recruited by my predecessor [Jay Krachmer, M.D.],” explains van Kuijk. “We have an electrical engineer, an internationally recognized ocular pathologist, one of the country’s preeminent neuro-ophthalmologists… We truly have an impressive roster of talented individuals.”

The clinical experience

That “preeminent neuro-ophthamologist” is Michael S. Lee, M.D., a nationally recognized clinician who is also working on multiple research projects with department colleagues and who recently cofounded the new Center for Thyroid Eye Disease with pediatric ophthalmologist Erick Bothun, M.D., and oculoplastics and orbital specialist Andrew Harrison, M.D.

According to Lee, patients afflicted with thyroid conditions like Graves’ disease often suffer disabling eye symptoms that disfigure and, worse, threaten vision loss.

“Many times in the past, these patients had to see multiple specialists within ophthalmology to finally enjoy some improvement and restoration,” says Lee. “At the center, the three of us assess patients together, which significantly reduces the number of clinic visits for these folks.”

This new center is just one of the many improvements under way, all geared toward improving the experience for the 70,000- plus patients who are seen annually at the University’s six specialty treatment centers. Phase-one renovations on the East Bank clinic, which is now devoted exclusively to adult patients, have just been completed, and van Kuijk hopes to complete a second phase in 2013. The pediatric clinic has moved across the river, near the new University of Minnesota Amplatz Children’s Hospital.

Critical work in the labs

As van Kuijk notes, the University’s OVNS department has long had top-notch researchers. If there was any complaint at all, he says, it was that his outstanding team has been reluctant to toot its own horn—something University President Eric Kaler, Ph.D., has encouraged faculty to do since his arrival over a year ago.

Van Kuijk notes that many recent findings by University faculty members have significant potential for treating debilitating and blinding diseases. Work by Linda McLoon, Ph.D., for instance, has shown that strabismus—a condition often called “lazy eye” in which the eyes are improperly aligned—can be treated in animals with sustained-release insulin-like growth factor-1. This is the first pharmacologic agent, says van Kuijk, shown to increase force and size in strabismic muscles and improve eye alignment.

In addition to letting the public know about important successes in his department, van Kuijk is also connecting researchers across traditional specialty lines to address some of the thorniest problems that affect vision—a mission that’s well reflected in the department’s new, more descriptive name.

Case in point: When Robert Miller, M.D., a professor in the Department of Neuroscience, was stalled on a research project, van Kuijk connected him with Lee and pediatric ophthalmologist C. Gail Summers, M.D.

“Together, they’ve discovered some retinal abnormalities in patients with schizophrenia,” says van Kuijk, “and they may have refined a test that can be used to diagnose the problem.”

Eric Newman, Ph.D., another neuroscience professor, is collaborating with van Kuijk’s team on diabetic retinopathy research that deals with blood flow—or lack of it—to the retina.

“If the retina is deprived of blood flow,” Newman explains, “it ultimately leads to blindness.”

But working with diabetic animals, Newman’s team has discovered that by inhibiting a key enzyme, they can reverse the lack of blood flow. Now they’d like to find out whether they can use this chemical intervention to restore blood flow in diabetic humans.

Lee sees the recent changes in the OVNS department as a boon to research.

“Prior to the change,” he says, “we were in silos of ophthalmology and neuroscience. Now Dr. van Kuijk has opened up more collaborative opportunities, connecting us with our neurosciences colleagues. That enables both sides to bring an important new perspective to the research.”

Lee frequently collaborates with McLoon, a professor in both ophthalmology and neuroscience, on a range of research projects. One current project aims to extend the effect of onabotulinumtoxinA, or Botox, which is administered to patients who suffer from conditions like blepharospasm, which results in excessive, spastic blinking.

“It’s a disabling condition,” Lee explains, “but you can paralyze the excessive blinking with Botox injections. Unfortunately, they’re quite painful and only last about three months. If we can extend the duration of the treatments, it would be important relief for those patients.”

Looking ahead

With significant improvements to clinics already under way and exciting new teaching tools in place—the department has recently added a simulator that helps train residents to do cataract surgery—van Kuijk is focusing on breaking down those specialty “silos” and making better use of the resources on hand.

“A lot of what I do now is look for opportunities and make connections,” he says. “One of the University’s five corridors of discovery is neuroscience, and by bringing the words ‘visual neurosciences’ into our department name, we remind people that ophthalmology at the University of Minnesota is about a lot more than just seeing patients.

“We’re very proud that this is the first ophthalmology department in the country to have this name, which reflects the depth and range of the work we do.”

How vision works

To take in visual information, the eye focuses light on the retina, converts that light into electrical impulses, then sends those impulses to the brain for interpretation—millions of times each day.

When light bounces off an object, the light travels through four surfaces of the eye—cornea, aqueous humor, lens, and vitreous humor—before arriving at the retina.
Ciliary muscles in the eye push and pull to change the shape of the lens, which allows us to focus on objects at various distances.
The iris, or colored area, controls the pupil, expanding and contracting to let in more or less light.
When light reaches the retina, it triggers a complex chemical reaction in light-sensitive rod and cone cells, which send electrical impulses through nerve cells in the retina and through the optic nerve to the visual cortex in the brain.
The brain analyzes the information nearly instantaneously, allowing us to see the objects around us.

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Visionary research

2012-06-07T20:49:39Z

Pediatric ophthalmologist leads first-ever albinism drug trial

There are top-notch researchers, and there are first-rate clinicians. But few doctors have both the scientific chops and the extraordinary bedside manner of pediatric ophthalmologist C. Gail Summers, M.D., says donor Michael Cohen.

Cohen’s in a position to know; he’s a physician himself. The Texas pathologist and his wife, Sandra Cohen, have made two $10,000 gifts to advance Summers’s work. Inspired by the superlative care she’s given their 15-year-old son, Matthew, the gifts are helping to support her current clinical trial, a study exploring a possible treatment for vision problems associated with albinism.

Like others with albinism, Matthew experiences vision difficulties stemming from underdevelopment in the central retina. While the degree of visual impairment in albinism varies (Matthew has oculocutaneous albinism type 2; individuals with this type don’t typically have white hair or eyelashes), it’s the aspect of albinism that poses the biggest challenge. Matthew — a typical teenager who’s into skiing, rock-climbing, and drawing — compensates for his vision difficulties in school by sitting near the front and using large-print materials.

His mother recalls the first time the family visited the Twin Cities for a consultation with Summers. Her clinic waiting room was the first place where Matthew was among kids with albinism, which made the whole family comfortable. Within minutes of meeting Summers, “we knew she was the right choice”— geography notwithstanding, says Sandra Cohen.

Matthew says he could tell immediately that Summers loves her job. “She spends time with each patient … and she’s always included me in the conversation,” he explains. Summers’s genuine warmth and empathy — traits the Florida native ascribes to her late father, a welder — just earned her the Leonard Tow Humanism in Medicine Award from the Gold Foundation.

Summers has studied albinism since arriving at the University in 1985. Along with her mentor, geneticist Richard King, M.D., Ph.D., she cofounded the University’s International Center for Albinism, which she now directs. Past president of the American Association for Pediatric Ophthalmology and Strabismus, she’s published numerous articles on albinism. Summers estimates that she’s seen some 500 patients with albinism over the decades, many Minnesotans as well as others from far-flung places like China, South Africa, and Greece.

The first-ever drug trial for albinism, her study aims to determine whether patients’ vision can be improved by using the substance L-Dopa (levodopa) to turn on a receptor in the retina. The work is supported by the Minnesota Lions Vision Foundation, the Heilmaier Foundation, and by generous individuals and families like the Cohens. Many donors, Summers says, are patients’ grandparents. “A lot of young families don’t have the funds to give, but the grandparents do.”

The precursor molecule for the neurotransmitters dopamine and adrenaline, L-Dopa is currently used to treat Parkinson’s disease. Two-thirds of the study subjects are receiving L-Dopa in liquid form, with the rest receiving a placebo; neither Summers nor the participants know who’s receiving which liquid.

Summers plans to enroll 45 participants in the 20-week, randomized, double-blind study; she has 34 so far, and 29 have already finished. Many of the participants are her own patients, with a handful traveling monthly from other Midwestern states. By this time next year, she hopes to have a better idea of the treatment’s potential. “I have some who are saying, ‘My vision’s better,’ but there’s no way to know yet,” she says.

Summers is cautiously excited about the possibility. “It might make a difference,” she says. But whatever the study’s outcome, she’s already doing that — making a difference — for young patients around the globe.

By Susan Maas

To learn more or to support albinism research at the University of Minnesota, contact Chuck Semrow at 612-624-6313 or c.semrow@mmf.umn.edu, or visit www.mmf.umn.edu/giveto/albinism1.

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Medical School welcomes new ophthalmology head

2011-10-24T14:54:52Z

Fredericus (Erik) van Kuijk, M.D., Ph.D., on October 1 began his new duties as head of the Department of Ophthalmology at the University of Minnesota Medical School. He replaces Jay H. Krachmer, M.D., who retired this fall after a distinguished 49-year medical career that included chairing the department since 1992.

An expert in early diagnosis and nutritional and pharmacological therapies for age-related macular degeneration (AMD), van Kuijk earned both his M.D. and Ph.D. (biochemistry) from the University of Nijmegen, the Netherlands. His research has led to new approaches to preventing the progression of AMD.

“What attracted me here were the quality and diverse talents of the faculty in ophthalmology,” van Kuijk says. “Because the department has clinical faculty that have this basic science background, it provides us an opportunity to initiate more translational research projects.”

Van Kuijk completed his internship, residency, and fellowship at the University of Texas Medical Branch, Galveston, where he was a professor in the Department of Ophthalmology and Visual Sciences before coming to Minnesota. He also completed an additional year of training in retinal degenerative diseases at Moorfields Eye Hospital, London.

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A better future in sight for kids

2010-12-21T18:16:33Z

Minnesota Lions make a $3M pledge to help prevent blindness in infants and children

Six-year-old Kira Rogers doesn’t know much about the Minnesota Lions, but the Lions’ 50-year partnership with the University was intended to help children just like her.

A month after Kira was born, her mother, Michele, noticed something wrong with Kira’s right eye. “Her eyelid looked red. The next day it looked puffier. Each day it looked a little puffier,” she says.

Kira’s doctor soon referred the family to the University of Minnesota. Michele and her husband, Mike, took Kira from their home in Sauk Rapids, Minnesota, to meet with University ophthalmologist Gail Summers, M.D., and later to see pediatric oncologist Marie Steiner, M.D. An MRI confirmed that Kira had a hemangioma — a fast-growing noncancerous tumor.

The tumor’s location in Kira’s eye had serious medical implications. Michele and Mike Rogers learned that as Kira grew older, the tumor would affect her sight, put pressure on her eye, and affect her visual development in that eye. With the help of University doctors, they held Kira’s hand through six years of treatment and surgeries to remove the tumor, improve the appearance of her eyelid, and preserve her sight.

Fortunately, the surgeries were successful. Now the spunky 6-year-old loves going to kindergarten — and giving hugs. Her eye is vastly improved, and her prognosis is excellent.

“I didn’t think it would end like this,” says Mike Rogers, happily. “I felt like these doctors could move mountains for us.”

The Lions’ legacy

Success stories like Kira’s have been the impetus behind the Minnesota Lions’ longtime support of the Medical School’s Department of Ophthalmology.

In July the Minnesota Lions donated $1 million toward a new $3 million pledge to establish the Minnesota Lions Fund to Prevent Blindness in Infants and Children at the University. The money will advance research, education, and care in the Department of Ophthalmology to help children like Kira.

Department head Jay Krachmer, M.D., says the Lions’ recent pledge will have a tremendous impact. “Because of this fund, babies will not go blind due to retinopathy of prematurity, congenital cataracts, congenital glaucoma, and other sight-threatening conditions,” he says.

The pledge represents a milestone in the Lions’ dedication to the University’s work in blindness prevention and marks the 50-year partnership of the Minnesota Lions, Minnesota Lions Eye Bank, and the Department of Ophthalmology.

The Minnesota Lions Eye Bank provides donor eye tissue for transplantation, research, and teaching and promotes donation through education. It has helped restore sight to more than 23,000 people.

Over the years, the Minnesota Lions have launched and sustained several other important initiatives with the University, including establishing the Lions Children’s Eye Clinic, the William H. Knobloch Retina Chair, and the Lions Macular Degeneration Center. They also helped build the Lions Research Building at the University and have garnered community support for correcting vision problems and contributed countless hours of volunteer time.

About 22,000 Lions are working on service- focused projects throughout Minnesota. “Each Lions Club has its own unique way of raising funds,” says Richard Reger, Minnesota Eye Bank, Inc., board chair. “Some have pancake feeds and fishing tournaments, but the dedication and commitment is always there to reach out to the less fortunate.”

Krachmer concurs: “When Lions see that something needs to get done, they are right up there volunteering and doing it before others even know about it,” he says. “Over these 50 years, they have said, ‘How can we help?’ That’s the relationship we have with the Minnesota Lions.”

That legacy has allowed vision experts at the University to do more for families like Kira’s, who say they are grateful that they had access to University doctors’ skill< and expertise.

“They’ve all been compassionate and aggressive — exhausting every possibility,” says Michele. “At the U, they’re finding new solutions and looking for the best treatments for the next Kira.”

By Robyn White

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Minnesota Lions pledge $3M to prevent blindness in infants and children, mark 50-year partnership with the U

2010-07-31T18:43:01Z

Contact: Chuck Semrow, Minnesota Medical Foundation, (612) 624-6313;
Jennifer Marshall, Minnesota Lions Eye Bank, Inc., (612) 626-6081

MINNEAPOLIS/ST. PAUL (July 31, 2010)—Minnesota Lions Eye Bank, Inc., board chair Richard J. Reger presented a $3 million check, representing a pledge to the University of Minnesota to establish the Minnesota Lions Fund to Prevent Blindness in Infants and Children.

The gift, made through the Minnesota Medical Foundation, will advance research, education and care in the Department of Ophthalmology at the University of Minnesota Medical School.

This pledge represents a milestone in the Lions’ steadfast commitment to supporting the University’s efforts in blindness prevention and marks the 50-year partnership between the Minnesota Lions, Minnesota Lions Eye Bank and the University’s Department of Ophthalmology.

Jay Krachmer, M.D., head of the department, says this gift will have a “massive” impact. “Because of this fund, babies will not go blind because of retinopathy of prematurity, congenital cataracts, congenital glaucoma and other sight-threatening conditions,” he says. Krachmer added that department faculty members in every specialty will benefit from this gift, which will help them to better serve patients.

“When Lions see that something needs to get done, they are right up there volunteering and doing it before others even know about it,” Krachmer says. “Over these 50 years, they have said, ‘How can we help?’ That’s the relationship we have with the Minnesota Lions.”

The Minnesota Lions Eye Bank, the first Lions partnership with the ophthalmology department, provides donor eye tissue for transplantation, research and teaching and promotes donation through education. The Eye Bank has helped restore sight to more than 22,000 people. In addition, over the years the Minnesota Lions launched and sustained several other important initiatives with the University, including establishing the Lions Children’s Eye Clinic, the William H. Knobloch Retina Chair, the Lions Macular Degeneration Center and helping build the Lions Research Building. They have also garnered community support for vision issues and contributed countless hours of volunteer time.

“Over the years, I have witnessed firsthand the stories of people who have lost loved ones and donated their organs, and also the people who have received donor tissue. These people are the reason for the Minnesota Lions Eye Bank and the good we have done over the years,” says Reger. “I am very proud of the Eye Bank and the University of Minnesota and its staff for all that they accomplish through the partnership.”

There are approximately 22,000 Lions working on service-focused projects throughout Minnesota. “Each Lions Club has its own unique way of raising funds,” Reger says. “Some have pancake feeds and fishing tournaments, but the dedication and commitment is always there to reach out to the less fortunate.”

The Minnesota Medical Foundation has raised and managed private gifts that expand what’s possible in health and medical research, education and care at the University of Minnesota since 1939. For more information, please visit www.mmf.umn.edu or call (612) 625-1440.

Minnesota Lions Clubs are part of Lions Clubs International, which boasts more than 1.35 million members—making it the world’s largest service organization. Lions members work to empower volunteers to serve their communities, meet humanitarian needs, encourage peace and promote international understanding. For more information, please visit www.lionsmd5m.org.

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U researchers discover new treatment to slow eye damage in people with type 1 diabetes

2009-11-03T19:36:40Z

University researchers led by Michael Mauer, M.D., found that antihypertensive medications commonly used to treat high blood pressure also slow the progression of eye damage in people with type 1 diabetes. They found that the antihypertensives losartan and enalapril slowed the progression of eye damage by more than 65 percent in type 1 diabetics involved in the study.

Eye damage and blindness are common complications of diabetes, which also accounts for nearly half of all cases of chronic kidney failure in the United States each year.

In previous studies of people with type 1 diabetes, antihypertensive drugs were also found to slow the loss of function in the kidneys but not prevent kidney failure. Mauer’s team embarked on the current study to find out whether the drugs could delay kidney injuries in diabetics who had normal blood pressure and hadn’t shown signs of kidney disease.

The team evaluated three participant groups throughout five years. Two of the groups received either losartan or enalapril, and the third group received a placebo.

The results, published in the July issue of the New England Journal of Medicine, showed that the antihypertensive drugs did not delay or prevent kidney injury, but they did impart the unexpected benefit.

“The secondary results of this study showed that people taking these anti- hypertensive medications experienced a substantially positive effect in slowing diabetic eye injury,” says Mauer, who believes the treatment may also hold potential for patients with type 2 diabetes.

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A grateful patient’s mission

2009-10-02T17:55:43Z

In 1991, Arne Divine began losing his sight because of ischemic optic neuropathy (ION), caused by an obstruction of the blood flowing to his optic nerve. The condition ultimately robbed him of nearly half of his vision and has had a profound impact on his life.

“You lose your independence when you have impaired vision,” says Divine, who is 80 years old.

Divine was treated for his ION by physicians in the University of Minnesota’s Department of Ophthalmology, first by the late Jonathan Wirtschafter, M.D. As part of Divine’s treatment, he participated in drug therapy, which stopped further vision loss. “Since then my vision has stabilized,” he says.

Divine now believes that his vision loss has given him a new perspective and has sparked a new mission in his life—rallying support for pediatric ophthalmology.

Divine graduated from the University of Minnesota in 1950 with a degree in accounting. He attended college on the GI Bill of Rights while supporting his mother and sister. Divine says that getting an education was tough but crucial.

And although he retired from his accounting firm in 1995, Divine hasn’t slowed down. He currently serves on four boards and is a partner in four venture capital companies for which he serves as the primary internal accountant.

In recent years, Divine also has become a tireless advocate for causes related to pediatric ophthalmology. In addition to having personally given generously to the Department of Ophthalmology, Divine encourages others to donate and attends lectures and talks to doctors about the importance of pediatric ophthalmology.

“More young people should get a better shot at life,” he says, and he believes that supporting pediatric ophthalmology can make that a reality.

Divine also wants to inspire others to act. He starts by telling them to close their eyes and imagine going about their daily tasks without sight. “I want other people to have the same passion I have,” he says.

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Congratulations, graduates!

2009-04-01T19:32:42Z

Ophthalmology residents

Ophthalmology fellows

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Research to Prevent Blindness partners with department to fund important research initiatives

2009-04-01T18:04:54Z

Blindness is second only to cancer when it comes to health conditions people fear most, according to a Gallup poll.

So it may come as a surprise that funding for eye research was practically nonexistent until the organization Research to Prevent Blindness (RPB) was founded in 1960. Before that,ophthalmology was a second-tier medical specialty in the United States. Eye care was relegated to the division of surgery in most medical schools, and few basic scientists conducted research on eyes and vision.

Since it was established, RPB has been a major force in ophthalmologic research, donating more than $260 million for research into the causes, treatment, and prevention of all diseases that cause blindness. It currently supports more than 50 ophthalmology departments throughout the country, including the University of Minnesota Medical School’s Department of Ophthalmology.

Since 1997, RPB has given a total of $970,000 to the department.

“Unlike the project-specific grants from most organizations, RPB grants are unrestricted, which allows departmental chairs to use the money at their discretion,” says Matthew Levine, director of communications and marketing for the organization. “As a result, the funds are often used in creative and flexible ways to meet critical needs.”

Over the years—thanks to funding from RPB—the department has contributed to significant advances in ophthalmology, such as finding better ways to treat disabling facial spastic disorders and improved treatment for eye injuries caused by chemicals.

RPB support also has allowed the department to participate in important multicenter studies investigating corneal transplantation and alternative therapies to patching in children with amblyopia, sometimes referred to as “lazy eye.”

“Research to Prevent Blindness provides significant funding for our individual research projects and has enabled our department to have a very sizeable basic science and clinical research program,” says the University’s Department of Ophthalmology chair, Jay Krachmer, M.D. “The organization is one of the backbones of our department.”

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Research shows promise for treatment after injury to the retina, optic nerve

2009-04-01T18:04:06Z

Research by Linda McLoon, Ph.D., has shown that retinal ganglion cells previously thought to be beyond rescue might be repairable.

Many types of eye injuries can cause irreversible damage and vision loss. For example, when the eye’s retina and optic nerve are deprived of oxygen, the consensus among clinicians is that nothing can be done to restore the patient’s vision if lost.

Exciting new research in the University of Minnesota Medical School gives hope to those who might have this type of “stroke” of the optic nerve in the future.

After eye injury, whether from trauma, stroke, or blood clot, retinal ganglion cells—which collectively transmit information from the retina to the brain—appear to die quickly.

But some of those cells are simply damaged, not dead, according to Linda McLoon, Ph.D., professor of ophthalmology and neuroscience at the University. “We have found that there is a window of time in which to administer protective molecules that should be able to rescue those damaged cells,” she explains.

The next challenge? Delivering these protective molecules, also called neurotrophic agents, across the blood-brain barrier. (The retina and optic nerve are extensions of the brain.) McLoon’s lab has found that intranasal drops administered in animal subjects can reach the retinal ganglion cells.

“What we have found is exciting, but of course we have much more to learn before this can be applied to humans,” says McLoon. “How soon would these drops need to be administered, and how often? Is one dose enough?”

A 1999 multicenter study found that neither surgery nor corticosteroids restored vision for patients who had suffered compressive or ischemic optic nerve injury. McLoon’s research points in a more promising direction.

“Intranasal delivery is appealing because it is easy for patients,” McLoon says. “I could imagine having intranasal drops available in every emergency room or trauma center and then sending drops home with the patient. Even if a patient had to administer them once a day, who wouldn’t willingly do that in order to save their eyesight?”

The research is still in its early stages, however. Once the first set of experiments is completed, the model needs to be replicated in primates. Then comes a phase 1 clinical trial for qualified patients, to be run by neuro-ophthalmologist Michael Lee, M.D.

“Whenever I undertake a study, I ask myself if I would want my mother to undergo the treatment, or whether I would undergo it myself,” McLoon says. “And if the answer is yes, as it is in this case, then I know we’re using an approach that is reasonable from a clinical point of view.

“These drops we’re using are molecules our bodies already produce, so the study doesn’t bring with it the potential risks associated with some types of drug treatments,” she says.

To learn more about McLoon’s research, visit www.lkmcloon.umn.edu.

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More experience, more confidence: Department opens state-of-the-art microsurgery training lab for residents

2009-04-01T18:03:12Z

Resident education in the Department of Ophthalmology made a huge leap forward in March with the opening of a new microsurgery practice lab.

The lab is now equipped with four stations, each outfitted with an operating microscope that is wired to its own video monitor. Each resident also receives a set of microsurgical instruments to use at practice sessions throughout his or her training.

There are four ophthalmology residents in each of the three years of the department’s residency program.With the new lab’s multiple microsurgery stations, residents get significantly more hands-on training than they did in the past, when all four residents shared one microscope and one set of surgical instruments. In addition, this gives residents more chances to practice their technique on animal or “practice” eye tissue before ever performing surgery on a living patient’s eye.

Martha Wright, M.D., professor and director of the ophthalmology residency program, says the extra practice time will build trainees’ confidence.

“Having access to their own microsurgery stations will make it possible for residents to practice longer, and their surgical skills will advance more quickly,” says Wright, who holds the Haven Glaucoma Professorship. “This additional practice makes everyone confident that patient safety is at the forefront.”

Video monitors in the lab allow the supervising professor to move from station to station, observe each resident’s technique, and offer tips and suggestions. The lab also includes a phacoemulsification machine, which is used to remove cataracts.

The funding for this lab came primarily from resident alumna Nancy Slater, M.D., who has supported resident education and continuing education for practicing ophthalmologists for several years. Slater’s support has enabled the department to construct and equip this lab.

Dozens of other alumni and friends of the department made donations in memory of former resident David Pond, M.D., who died in 2006, to supply microsurgical instruments for current residents.

The microsurgery practice lab’s opening coincides with the start of a greatly expanded microsurgery course offered to first- and second year residents to help develop their surgical skills. In the course, they’ll practice on animal eyes and human donor eyes not suitable for transplant.

“The course exposes residents to suturing and sewing tissue and performing certain steps required in cataract surgery and other types of surgeries,” explains professor and director of cornea and refractive surgery Stephen Kaufman, M.D., Ph.D., who also holds the Elias Potter Lyon Research Chair in Ophthalmology. He is the primary instructor for the laboratory course but will rely on several other faculty members for assistance.

This new course and the enhanced microsurgery practice lab will help residents become skilled surgeons and advance in their careers more quickly,Wright says.

“Practice in the lab will increase their efficiency and speed, and residents who are efficient in their actions tend to get to do more,” she says. “We stress accuracy and precision over speed, but the more skill residents are able to show, the more they will be allowed to do during a case. The greater the experience in training, the more confident the resident will feel entering practice.”

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A new look at corneal transplants: Artificial corneas give people with difficult-to-treat disease another option when donated eye tissue doesn't work

2009-04-01T18:02:23Z

Treatments that are effective in 90 percent of patients are greeted with great acclaim, as they should be. But what happens when you’re in the remaining 10 percent who can’t be helped?

Welcome to Linda Block’s world. Block has keratoconus, a degenerative disease of the cornea that can cause blurring, distorted vision, and sensitivity to light. In its early stages, the condition can be treated with glasses or special contact lenses. But in more severe cases, like Block’s, a corneal transplant may be needed to fix the problem.

Block has had five corneal transplant surgeries to replace the damaged tissue in her left eye with corneas from donors’ eyes. (Block’s right eye is too damaged to repair.) Each time, her body rejected the transplanted corneal tissue, causing visual cloudiness and deterioration.

Block’s vision became progressively worse with each surgery. At 61 years old, she was legally blind, and her options were limited.

But she was an ideal candidate for a new type of prosthetic (or artificial) cornea, according to her ophthalmologist, Stephen C. Kaufman, M.D., Ph.D., a renowned leader in corneal transplantation research.

“Corneal transplants using donated corneas are successful in 90 percent of patients,” explains Kaufman, director of cornea and refractive surgery in the University of Minnesota Medical School’s Department of Ophthalmology. “But patients like Linda, whose bodies reject a corneal transplant, are increasingly likely to reject subsequent transplants. This puts them in a high-risk group.”

An artificial solution

Kaufman, who holds the Elias Potter Lyon Research Chair in Ophthalmology, is one of only a few surgeons in the country to use the Boston Keratoprosthesis, or KPro, prosthetic cornea and is the only Minnesotan ophthalmologist to do so.

Corneal prostheses are generally implanted without the use of donor tissue. However, the Boston KPro prosthesis is attached to tissue from a donor cornea before it is implanted in the eye. The donor tissue serves as a “scaffolding” or bridge between the patient’s eye and the device.

And although some donor tissue is used with the Boston KPro, rejection is not an issue, Kaufman says. Because the prosthesis is made with a special kind of plastic, it provides an exceptionally clear central lens for patients to see through, he says, and the scarring and cloudiness typical of rejection are irrelevant because the Boston KPro cornea always remains clear.

“Tissue takes a long time to heal and can get cloudy if it is rejected by the body,” Kaufman says. “A plastic cornea is more like having a camera lens right in the center of the cornea.”

Most suitable for patients with severely damaged corneas, artificial cornea transplant surgery takes about the same amount of time as conventional surgery using only a donor cornea.

Immediate improvement

Block received a Boston KPro prosthetic cornea in January. The recovery and restoration of vision after a corneal transplant can take up to a year, but just days after her artificial cornea was implanted, Block says she could see better than she had in years.

“My vision got clearer and clearer every day, but I could tell a big difference already by day four,” says Block, who now must use daily eye drops and go in for follow-up appointments with Kaufman every three to six months for the rest of her life.

But these minor inconveniences are a small price to pay for the independence Block now savors after so many years of relying on others, she says.

“It’s just being able to do everyday things, like go to the grocery store by myself,” Block says. “I used to have to ask for help with reading the prices or finding my way down the right aisle.

“Now I can see to clean my house right again. I used to think it was clean and then my husband, James, would come along behind me, cleaning everything I had missed. I didn’t even realize that the kitchen and bathroom tile had a pattern in it until after I had this surgery.”

Artificial cornea transplantation is not used as a primary surgery today; currently it’s used only after multiple transplants with donated corneal tissue have failed. And while central vision improves with an artificial cornea, peripheral vision cannot be corrected.

So while it isn’t the perfect treatment, “for patients like Linda who really have no other options, an artificial cornea is almost a miracle,” Kaufman says.

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Blossoming from a strawberry: A young patient's family gives thanks for life-changing treatment

2009-04-01T18:01:43Z

Suzanne Mundhenke’s first few years of life were ripe with drama.

She was born 12 weeks premature. Under her right eye, she had a large growth called a capillary hemangioma—a fast-growing noncancerous tumor, also known as a strawberry hemangioma. Very soon it began to grow over her eye, obstructing her vision and affecting the eye’s development.

“We were very scared and very concerned for Suzanne,” says her mother, Sharla Mundhenke. “We were afraid she was going to lose her eye and her vision.”

But with life-changing treatment and surgery at the University of Minnesota’s Department of Ophthalmology, Suzanne has become a successful young adult. She’s now 18 years old and excited to start college.

Finding solutions

Sharla and Jeff Mundhenke brought Suzanne to the University’s Department of Ophthalmology as a newborn to see C. Gail Summers, M.D. “She had a suggestion for a treatment that offered us some hope,” Sharla says.

“At the beginning, when I saw Suzanne, she was still premature and hadn’t reached her due date. She was so tiny,” says Summers, adding that Suzanne’s hemangioma was the largest she had ever seen.

To treat the massive tumor, Summers gave Suzanne three long-acting steroid injections, which made the blood vessels contract and the tumor shrink. “We were relieved,” says Sharla, when the tumor simply faded away.

Following the treatment, Summers asked Suzanne’s parents to use an eye patch on her other eye a few hours each day to help the repaired eye grow stronger.

Summers credits the treatment’s success to the diligence of Suzanne’s parents.

“If you don’t have parents who are really involved in the management, you won’t have a result as successful as Suzanne’s,” Summers says. “They were part of the treatment team, as far as I was concerned.”

But although the tumor had disappeared, when Suzanne was 5 years old she developed another eye problem called esotropia, a wandering of the eyes.

“I couldn’t really see much. It was blurry,” says Suzanne, adding that she wasn’t a very active child because of her vision problems.

Summers realized that her work with Suzanne wasn’t done and determined that a bilateral strabismus surgery was needed to correct this new problem.

“Having that surgery and being able to see allowed me to do everything I do today,” says Suzanne, who now only wears glasses and contacts.

A graduating high school senior, Suzanne is involved in music—she plays the French horn and piano—track, the Key Club, Knowledge Bowl, Junior Rotarian, and National Honor Society. She is busy preparing for college interviews and hopes to major in chemistry and premed.

“She just blossomed into this wonderful young woman,” Summers says proudly. “She’s a happy individual and extremely bright. I can say this as a mom—she’s the kind of kid most moms dream of having.”

Saying thank you

Summers says she relishes the chance to see her patients grow into happy adults with great vision. “It is one of the joys of dealing with children,” she says.

The Mundhenkes say they are grateful for Summers’s work and her continued commitment. “Dr. Summers is incredibly kind and very knowledgeable and professional,” says Sharla.

As a way of saying thanks to the department, the Mundhenke family has made regular gifts throughout the years, totaling $5,775.

“There are a lot of little kids out there who need help,” says Sharla. “Suzanne was given excellent health care, and we are very thankful. It’s our family’s way of giving back.”

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Meet ophthalmology's new development officer

2009-04-01T18:01:04Z

Chuck Semrow joined the Department of Ophthalmology’s team in December as a senior development officer with the Minnesota Medical Foundation (MMF), which raises money for healthrelated research, education, and service at the University of Minnesota.

From 2002 to 2004, Semrow raised funds for basic sciences at the Medical School through MMF. Now he’s back at the University after spending several years in development at Hazelden Foundation, the world-renowned pioneer in addiction treatment.

Semrow earned a bachelor’s degree in English and German at the University of Connecticut. He eventually moved to Minnesota, where he met and subsequently married a “Minnesota girl.” He believes this was fate—he grew up in Connecticut cheering for the Minnesota Vikings and had neighbors who were Green Bay Packers fans.

In his first few months as a development officer for ophthalmology, Semrow says he has most enjoyed learning about faculty members’ innovative clinical and translational research and visiting with donors whose lives have been changed by the care they’ve received at the University.

“Our philanthropy is an expression of our most deeply held values,” he says. “I love hearing people’s stories and why they’re passionate about making a difference that is meaningful to them.” Now Semrow wants to hear your story.

Introduce yourself by contacting him at 612-624-6313 or c.semrow@mmf.umn.edu.

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One former patient won't let visual challenges stop him from pursuing his dream—a career in medicine

2008-10-01T17:59:03Z

When Taylor Kahnke’s parents gave him a microscope for his eighth birthday, a whole new world was revealed to him. He used his microscope to look at everything he could lay his hands on— rocks, hair, even a drop of his dad’s blood.

Kahnke has always had to look at things more carefully than most people. Diagnosed with ocular albinism as a baby, he has 20/80 vision and also nystagmus (involuntary to-and-fro eye movement) and astigmatism (a slight abnormality in the curvature of the eye’s surface).

Despite his visual limitations, Kahnke has always set his sights high. “I have always been scientifically oriented, and my parents encouraged me to develop that trait,” he says. “Even as a young boy, I was constantly asking questions about why things were the way they were. My dad remembers discussing atoms and molecules with me when I was 6 or 7 years old. I think my parents gave me a microscope for my birthday because they wanted me to start discovering my own answers. How my body works has always been fascinating to me as well.”

It’s not surprising, then, that becoming a doctor or a research scientist has been Kahnke’s aim since he was young.

And this fall, his boyhood ambition became a reality. Kahnke is now immersed in his first year of medical school at Albany Medical College in Albany, New York.

But before deciding to pursue that dream, Kahnke wanted to discuss how his vision might affect his success in medicine with his longtime ophthalmologist, C. Gail Summers, M.D., a professor in the Department of Ophthalmology at the University of Minnesota.

Summers, who first examined Kahnke when he was 7 months old, put him in contact with a visually impaired doctor in Minnesota whom he shadowed in the clinic for a day, observing how she practices medicine while overcoming visual challenges.

“There weren’t a lot of surprises for me when I shadowed her,” explains Kahnke. “I’ve spent my entire life accommodating my vision, whether it’s enlarging an image on a computer screen or holding my head close to the subject at hand. I’ve learned not to be afraid to do whatever it takes to help me function best. And that’s what I did in the clinic that day. I had to hold my head a little closer to the patient during a retinal exam, for instance.”

Kahnke says his vision is comparable to that of many older adults. He wears a special type of contact lens made to fit the eyes of people with astigmatism, which gives him better vision than he would have with glasses alone. For reading and other close work, he wears reading glasses in addition to his contact lenses.

With his diagnosis, Kahnke’s visual acuity is expected to remain stable throughout his life, until he faces the eye conditions and diseases that are typical in old age.

Kahnke hasn’t yet settled on which area of medicine he’d like to pursue, but he has ruled out a surgical specialty, given his visual limitations. He thinks it’s possible that he will end up in a specialty that allows him to do minor procedures and hands-on work, perhaps in urology, dermatology, or neurology.

“Neurology is the most interesting to me at this time,” he says. “I’m very interested in studying human consciousness. What makes every one of us so different is a question that’s both biological and somewhat philosophical.”

It’s clear that Kahnke’s innate curiosity, intelligence, and hard work have contributed to his character today. He also credits his parents for giving him opportunities to be successful.

“They’ve always done absolutely everything they could for me, whether it was giving me encouragement or opportunities like taking high school science and math classes when I was in the eighth grade, or purchasing a close-circuit television or these contact lenses that were recently made available. I’m extremely grateful for the love and support I’ve received from them.”

Besides understanding what patients go through when faced with physical challenges on a personal level, Kahnke thinks, as a doctor, he will be able to bring patients hope.

“In many cases, diseases can be treated but can’t be cured,” he says. “I’m one example of that. And in spite of that, with the right approach, the best technology, and good coping skills, people like me can live very enjoyable, functional, successful, completely normal lives.”

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New Center for Thyroid Eye Disease aims to simplify patients' lives and improve care

2008-10-01T17:55:11Z

People with thyroid eye disease can experience many troubling complications, including protruding eyes, eye pressure or pain, and eyelids that are swollen or don’t close completely. Left untreated, a person with this disease could suffer permanent vision loss.

To prevent that from happening, some people with thyroid eye disease have orbital decompression surgery to improve their vision and allow their eyes to return to a more normal position, followed by surgery to treat double vision due to strabismus (misaligned eyes) and then eyelid surgery.

It takes a team of doctors who specialize in these procedures to manage and treat people with thyroid eye disease, also known as Graves’ ophthalmopathy. To help simplify these patients’ lives, the University of Minnesota recently opened its Center for Thyroid Eye Disease, housed in the Department of Ophthalmology. This center makes it possible for people with thyroid eye disease to be seen by an entire team of specialists in one visit: a neuro-ophthalmologist, an adult strabismus specialist, an orbital and oculoplastic surgeon, and an orthoptist.

The team provides innovative multidisciplinary care and offers the latest diagnostic and treatment options for people with thyroid eye disease. These specialists are also researchers working to advance medical understanding of thyroid eye disease and develop new ways to treat it.

The center’s codirectors are Erick Bothun, M.D., assistant professor of pediatric ophthalmology and adult strabismus; Andrew Harrison, M.D., assistant professor of ophthalmic plastic and reconstructive surgery; and Michael Lee, M.D., associate professor of neuro-ophthalmology.

“The idea behind the center is to streamline care for the patient,” Lee explains. “Instead of the patient being seen by each of us separately, which requires at least three visits, we examine the patient as a team. This approach enables us to give thyroid eye disease patients the best possible care and, in the long run, it will also save both time and money.”

The team approach “is a real change from a care perspective,” Bothun says. “With better communication and collaboration comes better care. Because we are together while examining a patient, we can hear what our colleagues are thinking and make treatment decisions collectively.”

The majority of thyroid eye disease patients need to see more than one specialist. “Especially in complex cases, it’s nice to see these patients together from the start,” Harrison says. “It can take a long time for thyroid eye disease to run its course. It’s a complex disease and complicated to treat, but I enjoy the challenge of taking care of these patients, doing both orbital decompression and eyelid surgery. It can be a disturbing disease socially, from a cosmetic standpoint. That’s just one of the things we’re able to fix with surgery.”

Erika Shane was fatigued and felt sensitive to cold when she was diagnosed with Graves’ disease in her late teens, when she lived in Texas. After she moved to Minnesota, her thyroid eye disease started to emerge, and over time her eyes began to bulge. Then she sought help from the team of ophthalmologists at the University.

“At first I said I never wanted to have eye surgery,” says Shane, who is now a 25-year-old animal sciences graduate student at the University. “But as I got older and noticed the bulging more, I reconsidered.”

When Shane first met with Harrison, he explained the risks and benefits of orbital decompression surgery. “I felt really comfortable with him,” she says. “He explained that he has done tons of these surgeries. The surgery went well, although I developed double vision afterward, which is one of the risks.”

To fix that problem, Bothun performed another surgery to correct the double vision. Now Shane is awaiting eyelid surgery to make both eyelids symmetrical, as the previous procedures she has had left one eyelid wider than the other.

Shane says she appreciates the team approach to her care at the new Center for Thyroid Eye Disease.

“I can see all three doctors in one visit,” she says. “I don’t need to go anywhere else for help because all three of them are top in their field. I know I’m getting the very best care.”

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Part of the big picture: Team takes part in large-scale studies aimed at improving treatments for eye disorders in children around the world

2008-10-01T17:54:36Z

Treating children with eye diseases is a rewarding experience for pediatric ophthalmologists. But depending on the disease, it can be difficult to know exactly which treatment will be most successful.

At times like this, it helps to know which treatments have worked best for other children with the same condition.

This is why the pediatric team in the University of Minnesota’s Department of Ophthalmology— which regularly collaborates with colleagues within the department, in the University’s Medical School, and at other University centers and schools—also collaborates with pediatric ophthalmologists across North America by contributing to a multi-institution database called PEDIG, or the Pediatric Eye Disease Investigator Group, so that answers to common clinical questions can be found faster.

The PEDIG database contains critical information about which treatments have resulted in the best outcomes for various eye diseases in children at more than 60 sites in the United States and Canada.

“PEDIG has a huge patient base, and study sites are added all the time, so these studies give us a great deal of information and help answer important treatment questions in a relatively short period of time,” says Ann Holleschau, the department’s pediatric study coordinator.

For the past 10 years, large-scale clinical research studies have been conducted through PEDIG using patient data from a network of more than 120 pediatric ophthalmologists and optometrists in North America. This network has helped to answer important research questions related to treating strabismus (misalignment of the eyes), amblyopia (sometimes called “lazy eye” ), and other eye disorders that affect children.

“We are fortunate to be actively involved in a well-recognized group that has found meaningful results that we can use in the clinic every day to treat patients,” says professor of ophthalmology C. Gail Summers, M.D.

PEDIG studies of amblyopia, for example, “have given us confidence that treatment options such as patching the good eye or using eye drops to blur the vision in the good eye will strengthen the weak, amblyopic eye,” Summers continues. Research studies have examined the frequency of treatment for amblyopia, as well as treatment for older children and options for discontinuing treatment.

Also collaborating on the University’s PEDIG related studies are pediatric ophthalmologists Jill Anderson, M.D.; Erick Bothun, M.D.; Stephen Christiansen, M.D.; and department orthoptists.

Christiansen served as protocol chair for the Esotropia Treatment Study coordinated by PEDIG. (Esotropia is a form of strabismus in which one or both of the eyes turn inward.) The results of that study showed that doctors did not have to wait for alignment to become stable before considering surgery, Christiansen says.

Other clinical research studies currently being conducted by the pediatric team are focused on finding new ways to treat amblyopia that hasn’t responded to conventional treatments and on measuring the thickness of the cornea and pressure inside the eye.

Although getting these studies going requires a good deal of time and effort, it’s well worth the investment, Summers says, for one simple reason: “What we learn makes a huge difference in the care we can provide for our patients.”

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Research examines cellular mechanisms involved in macular degeneration

2008-10-01T17:53:49Z

Are we on the verge of an epidemic of vision loss?

Considering the large number of baby boomers and the prevalence of macular degeneration among older adults‚ it’s possible. As a result‚ a sense of urgency propels research in the lab headed by Deborah Ferrington, Ph.D., an associate professor in the University of Minnesota Departments of Ophthalmology and Biochemistry, Molecular Biology, and Biophysics.

Ferrington studies the cellular mechanisms involved in the retinal degeneration that accompanies aging and age-related macular degeneration.

The retina is the part of the eye that captures light rays and turns them into electrical impulses‚ which are then converted into the images we see. “My lab looks at how proteins in the retina change with aging and with age-related macular degeneration‚” Ferrington explains. “We focus on the proteins because they are the components of the cell that do the cell’s work.”

Many studies have looked only at end-stage macular degeneration‚ where there is total degeneration and the person is legally blind. Ferrington is more interested in learning about the very early stages of the disease and concentrating on understanding how retinal proteins change.

Sophisticated research techniques allow scientists in her lab to look at thousands of proteins at once and compare the number of retinal proteins in a healthy younger person with the number found in a healthy older person.

Another aspect of the study will compare the retinal proteins in a healthy aging person with those in a person with age-related macular degeneration.

Ferrington’s group collaborates with colleagues at Emory University to evaluate the tissue samples. Scientists at the University of Minnesota‚ using donor eyes from the Minnesota Lions Eye Bank‚ dissect and photograph retinas and then send the photographs to Timothy Olsen‚ M.D.‚ a macular degeneration expert at Emory‚ who evaluates the stage of macular degeneration present in the donor’s eyes.

“This is a very important aspect of our research because the system we have in place is based on the same grading system used for patients‚” Ferrington says. “That means what we find in the lab has direct application to the patient in the clinic.”

Not many labs use donated human eyes for this type of research. The cultured cells or animal models used in some labs make it almost impossible to replicate macular degeneration because the macula—the center part of the retina that is responsible for high-detail vision—is unique to humans and nonhuman primates‚ Ferrington says.

“Using human donor eyes is more expensive‚ but it puts us ahead of many labs in the country in terms of the quality of the research‚” she says.

While scientists have yet to define exactly what causes agerelated macular degeneration‚ they are getting closer to finding the answer. Recent scientific papers describe alterations in the immune system‚ but finding the pathway by which vision may be repaired remains elusive.

“This is ultimately what we hope to do‚ of course‚” says Ferrington. “If we can interrupt macular degeneration in its early stages‚ we hope to slow down the process with drugs that show promise or‚ better yet‚ even stop the progression of the disease.”

The Minnesota Lions Eye Bank accepts donations of healthy eyes for corneal transplantation and also eyes with disease for research like Ferrington’s. For more information about becoming an eye donor‚ visit www.mnlionseyebank.org/about-donation/becoming-a-donor.html.

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Center helps people with glaucoma and other eye conditions adapt to visual changes

2008-04-01T17:53:07Z

Limited peripheral vision, which often occurs in people with glaucoma, makes it difficult to see someone approaching from the side or objects such as keys on a table. But often before noticing a difference in their eyesight, people with reduced peripheral vision may begin to feel anxious in unfamiliar places, seem to be misplacing things more frequently, and feel more forgetful in general.

Experts at the Visual Rehabilitation Center at the University of Minnesota can help people understand why these changes may be happening and offer devices and strategies for coping with them. “Through understanding comes insight and the ability to compensate,” says Mary Ruff, an occupational therapist at the center.

Strategies for coping with limited peripheral vision might include stopping in a doorway and scanning the room before entering it, looking for obstacles as well as targets. If glaucoma progresses and affects the central vision, making it difficult for the person to read or see detail, staff at the Visual Rehabilitation Center will assess lighting and magnification to address these challenges as well.

The center, directed by Mary Lawrence, M.D., M.P.H., is equipped with numerous lighting and magnification devices for patients to use. A book of resources—listing everything from transportation options to sources for large-print sheet music and prayer books—is also in the works.

“People pay attention to what they see,” says Ruff. “If what people see is limited by visual field loss, it’s our job to provide instructions on how to effectively attend to the missing part. People aren’t programmed to do this, and it doesn’t come naturally. But we can help people learn how to live safely and successfully with changes in their vision.”

For more information on the Visual Rehabilitation Center, call 612-625-4474 or visit www.med.umn.edu/ophthalmology and click on “Centers and Special Programs.”

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Department's physicians work toward a brighter future for people with glaucoma: Department's physicians work toward a brighter future for people with glaucoma

2008-04-01T17:52:09Z

Researchers at the University of Minnesota are working to improve that statistic.

The University’s Department of Ophthalmology has a large team of specialists who treat people with glaucoma and conduct research involving the many types of glaucoma. Associate professor Martha Wright, M.D., is director of the department’s glaucoma service.Wright works with professor Alana Grajewski, M.D., and associate professor Mary Lawrence, M.D., M.P.H., to diagnose and manage glaucoma in adults. Many of the people they treat need advanced subspecialty care because their previous treatments have failed.

Although glaucoma is largely considered a disorder that affects older adults, it can occur in people of any age. Grajewski, along with assistant professor and pediatric ophthalmologist Erick Bothun, M.D., specialize in treating infants and children with glaucoma.

“It’s unusual and quite remarkable that there are four of us right here at the University with so much background and interest in glaucoma,” Wright says. “To help people with glaucoma maintain good vision, we know that early diagnosis and early, aggressive treatment are important. We use a preventive approach to help people with glaucoma maintain their vision throughout their lives.”

A new surgical solution

What the University’s specialists learn through their research and clinical work could someday influence the way glaucoma is treated, contributing to a brighter future for people with the condition.

Wright believes the future of glaucoma treatment lies in new surgical techniques, her primary area of research interest.While medication is helpful to many people with glaucoma—and is the most common glaucoma treatment—Wright notes that medications sometimes put a burden on patients, both in terms of costs and adherence. Even the most well-intentioned people don’t always remember to take their medicine, she says.

Surgical treatment options for glaucoma include laser surgery and incisional surgery. The Department of Ophthalmology has an innovative new tool used for laser glaucoma surgery called the selective laser trabeculoplasty (SLT).

Unlike older laser equipment, the SLT precisely targets only the affected cells, preserving the surrounding eye tissue. This allows the surgeon to perform repeat procedures, if necessary, until the desired results are achieved or until incisional surgery is needed.

Lawrence, whose work is based at the Minneapolis Veterans Affairs Medical Center, has similar research interests.Working with colleagues in the University’s Department of Biomedical Engineering, Lawrence is developing a study to examine configuration of the eye’s iris, the colored part of the eye. She is especially interested in learning about how the anatomy of the eye may predispose certain people to glaucoma.

“We want to perform predictive modeling to determine who might get hereditary open-angle or other types of glaucoma to see if there are structural aberrations that lead to the condition,” says Lawrence, who also directs the University’s low vision service.

Tracking treatments

To help younger people who have glaucoma, Grajewski, Bothun, and other members of the department’s pediatric ophthalmology faculty are teaming up with the Bascom Palmer Eye Institute at the University of Miami to create a pediatric glaucoma registry. The registry will allow researchers to track a large number of children over time and then make meaningful observations about which treatment methods are the most effective.

“Every time we get results from these multicenter studies involving large groups of patients, we can direct treatment not based on our biases or preferences, but on evidence,” Grajewski says. “With an uncommon condition such as pediatric glaucoma, combining efforts like this makes it more likely that we will find better ways to diagnose and treat patients.”

The Department of Ophthalmology’s pediatric team—which includes Jill Anderson, M.D.; Bothun; Stephen Christiansen, M.D.; Grajewski; and C. Gail Summers, M.D.—has been able to apply the findings of its groundbreaking research on glaucoma and congenital cataracts directly to patient care. Bothun believes the work they are doing today will have another big impact on the way pediatric glaucoma is treated—and not just locally.

“Through our research and this pediatric glaucoma registry,” Bothun says, “we have the opportunity to help not only the patients we see here at the University, but to influence glaucoma treatment for people around the world.”

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