 |
 |
As the caretaker of her husband and her mother, Gloria Hanson Cohen understands what it means to be dependent and incapacitated. A youthful 72, she is an agile tennis player and golfer who was losing her vision to age-related macular degeneration (AMD). Strolling along the beach in front of her home, she is eager to share her story about how her vision improved after her recent treatment with Lucentis, a new drug used to treat certain forms of AMD.
AMD causes the macula, which consists of light sensitive photoreceptor cells that provide central vision, to progressively deteriorate. AMD interferes with one’s ability to recognize faces or drive or to perform detailed work such as reading and sewing. AMD is the leading cause of vision blindness in individuals over 55. It can manifest itself as either dry AMD or wet AMD. Dry AMD is the less serious of the two and visual loss progresses slowly. Wet AMD is less common but more serious, often causing a sudden and severe loss of vision. Lucentis, the drug that helped Gloria, treats wet AMD.
Gloria was diagnosed with AMD when she was 49 years old. An avid reader, she noticed one evening that the words on the page were blurred. Gloria made an appointment with an optometrist to get reading glasses. The optometrist referred Gloria to the Massachusetts Eye and Ear Infirmary (MEEI) for further examination.
After two days of screening and testing, Gloria was diagnosed with dry AMD and learned that nothing was available at that time to help her. “I was told that I might eventually go blind from this disease. I was afraid of being alone and blind,” she recalls.
Thankfully, Gloria’s vision did not change for many years. Then, in 2004 while playing golf she noticed that another person on the tee appeared to have “squiggly” legs. Soon afterwards she realized that she was not seeing objects that were in her direct vision. Gloria tried to ignore her vision loss until one day while driving she almost had a collision with another car.
This incident motivated her to seek help as her family members rely on her for daily care. “When I met with a retina specialist, I learned my condition had changed from dry to wet AMD,” Gloria said. “This progression occurs only in 15 percent of all AMD cases.”
Wet AMD occurs when abnormal blood vessels grow into the retina. As the vessels are unstable, they leak fluid and bleed, causing a sudden and severe loss of vision. The growth of these blood vessels is triggered by an abundance of vascular endothelial growth factor (VEGF).
The retina specialist suggested that the next time Gloria had any bleeding in her eye she should come immediately to him to undergo laser treatment to destroy the blood vessels and stop the leakage. Uncomfortable with this suggestion, Gloria decided to do research into other options. She read an article in AARP Magazine about Dr. Joan W. Miller, a retina specialist at MEEI who was working with a new drug called Lucentis. Today Dr. Miller is the Chief of Ophthalmology at MEEI and Chair of Ophthalmology at Harvard Medical School.
In late November 2004, Dr. Miller examined Gloria and found that she had evidence of leakage and her visual acuity had decreased to 20/200 on the eye chart. What the average person can see from 200 feet, Gloria could only see from 20 feet.
Dr. Miller recalls, “When I met Gloria, I was conducting a clinical trial investigating Lucentis here at MEEI. Gloria was a good candidate for the treatment.”
Drs. Miller, Evangelos Gragoudas, Ivana Kim and Tony Adamis from the MEEI and Judah Folkman from Children’s Hospital, Boston, were the first to identify VEGF’s key role in wet AMD. They found that ranibizumab, an anti-VEGF antibody fragment that makes up the drug Lucentis, inhibits the growth of the destructive new blood vessels.
“The studies found that Lucentis slowed or helped prevent vision loss in patients,” Dr. Miller recalls, “Some patients showed improved vision. In fact, 30 percent of the patients who were given Lucentis were able to read smaller font size – three or more lines lower on an eye chart. Forty percent of patients given Lucentis ended up with driving vision (20/40) or better.”
The Food and Drug Administration approved the new drug on June 30, 2006.
Lucentis is administered in small dose injections directly into the sclera or white coating of the eye. Prior to injection, the sclera is swabbed with a topical anesthetic. Remembering the procedure, Gloria laughs and says, “The treatment was quick and I didn’t feel a thing.”
Patients are given antibiotic drops for use after the procedure to reduce the risk of infection from the needle’s penetration. “We haven’t seen any side effects with Lucentis,” Dr. Miller says
Gloria was given three injections of Lucentis over a three-month period. “When I saw Dr. Miller after the third injection, I had a wonderful surprise. My vision had been restored to 20/25 with correction,” she says. Two months later, she had a fourth injection and her vision improved to 20/20.
“Lucentis,” Dr. Miller notes, “is the first treatment that, when taken monthly, can maintain the vision of more than ninety percent of patients with wet AMD.” This is heartening for the 155,000 Americans who are diagnosed each year with wet AMD.
However, Lucentis is expensive and some people are not covered by insurance. Those individuals have to consider other treatments. For others the logistics of getting to a doctor’s office for treatment each month creates a burden. “To make treatment easier,” Dr. Miller says, “we are looking at ways to slowly release Lucentis into a patient’s eye without injections as well as combination therapies with other drugs that might lead to good results with fewer treatments.”
Lucentis and her care at MEEI have transformed Gloria’s life. “I no longer feel handicapped,” she says. That’s a very good feeling.”
Whether she’s singing at Fenway Park, teaching children’s theater or coaching Miss America contestants, Lorna Brunelle’s voice is as beautiful as ever. She doesn’t take it for granted. After a thyroid cancer diagnosis in 2004, a surgeon bluntly told her that the required neck surgery would be routine –- but that it could permanently alter her voice. Terrified by the possibility that her career could be over, Lorna took matters into her own hands.
After researching major Boston hospitals, Lorna found Gregory Randolph, M.D., at the Massachusetts Eye and Ear Infirmary (MEEI), one of the world’s top endocrine surgeons. “Dr. Randolph meticulously detailed the procedure with an extraordinary kindness and understanding that I had not received elsewhere,” she added. “He discussed how nerve monitoring would protect my voice. Dr. Randolph gave me hope. I knew that I was in good hands.”
One month after surgery, Lorna’s voice was exactly as it had been before. “Dr. Randolph handed me a second chance to make a difference by saving my voice,” said Lorna. “My experience catapulted me into humanitarian work for efforts like the Chernobyl Children Project USA. I now use my voice to raise cancer awareness and to help people.”
Lorna is just one example of why Dr. Randolph and MEEI are moving aggressively to change the thyroid and parathyroid surgical landscape globally. “Patients are currently receiving variable treatment when it comes to thyroid surgery,” said Dr. Randolph, Director of the General Otolaryngology Service and Director of the Thyroid and Parathyroid Surgical Service at MEEI. He added, “We need better surgical care with fewer complications for more patients.”
To that end, Dr. Randolph and MEEI are now raising funds for a new Thyroid and Parathyroid Surgical Center of Excellence at MEEI, which will provide international leadership in advancing endocrine surgery of the head and neck. Under the direction of Dr. Randolph, the Center will serve as an integrated hub for surgical care, research and education in diseases affecting the thyroid and parathyroid glands. A key objective will be to improve survival rates of patients with thyroid cancers while preserving their speech, breathing and swallowing. The Center will also work with affiliates worldwide to provide patient information, train specialized surgeons, and conduct research.
“The Center is an opportunity to create standards and improve thyroid and parathyroid surgery to the point where there are minimal complications,” said Dr. Randolph.
To understand the importance of the MEEI Center, it is necessary to know about thyroid and parathyroid conditions that require surgery, along with the risks of that surgery. Thyroid surgery is one of the most common operations in the United States, with more than 140,000 thyroidectomies (removal of the thyroid gland) performed each year. These procedures treat thyroid cancer and thyroid “nodular” disease, a common affliction characterized by large, suspicious nodules on the gland. Thyroid cancer is becoming increasingly prevalent in the U.S. — doubling since 1973, and continuing to increase by two percent a year. Women, people with hereditary risk, and those with radiation exposure are among the groups most affected. “I have seen a 2,000 percent increase in thyroid and parathyroid surgeries since joining the hospital in 1986,” said Dr. Randolph.
The risks can be significant as the thyroid and parathyroid glands are located in the base of the neck, which serves as the crossroads of voice, swallowing and breathing. “The anatomy of this region is complex. Thyroid procedures require highly specialized surgical expertise,” stated Dr. Randolph. He added, “Unfortunately, we have a long way to go educationally to improve surgical skills in the performance of thyroidectomy.”
Damage to the recurrent laryngeal nerve, located near the thyroid, is a major procedural risk. This nerve controls speech, swallowing and breathing, and even slight surgical trauma can lead to vocal cord paralysis — a potentially life-threatening condition. A simple monitoring technique called Recurrent Laryngeal Nerve (RLN) Monitoring, developed by Dr. Randolph, significantly improves patient safety. While the technique is easy to implement, limited awareness and over-confidence lead many surgeons to skip nerve monitoring. The outcome can be catastrophic.
While no centralized statistics are kept, Dr. Randolph believes that up to six percent of thryoidectomies result in paralysis of at least one cord. The Center will create standardized surgical outcome measures and treatment guidelines, building on Dr. Randolph’s current work with the American Academy of Otolaryngology (AAO) to establish an outcome registry for thyroid and parathyroid surgery.
Importantly, the Center’s initial research focus will be on RLN monitoring. “I’ve seen what’s possible with nerve monitoring. We need to teach the techniques and make it available to all surgeons,” said Dr. Randolph.
With one of the top records in the world for surgical outcomes, Dr. Randolph’s expertise will be central to the new Center. “A priority will be to substantially increase the number of trained thyroid oncology surgical specialists,” he said. “While it’s gratifying to work on one patient at a time, you can’t operate on everyone. You can have a greater impact and reach thousands of patients, many of whom you will never see, by training other surgeons.”
Dr. Randolph has devoted much of his life to endocrine head and neck research and teaching. He travels to Russia, China, the Ukraine and Italy to teach thyroid surgery worldwide. In the Ukraine, he assists the Children’s Chernobyl Project International, an organization that provides surgery and treatment to children with thyroid cancer due to radiation exposure.
Dr. Randolph also established the first otolaryngology thyroid and parathyroid fellowship in the country to educate future surgeons and specialists. The Center will establish a permanent endowment to train future generations of thyroid surgical oncologists.
In terms of research, the Center will pursue safer and more effective ways to treat thyroid cancer. MEEI is seeking seed funding for projects including a study of genes found in thyroid lesions in conjunction with Massachusetts General Hospital’s Pathology Department.
The MEEI Center will also serve as a coordinating center for international multi-center clinical trials. “The possibilities are tremendous if we can pool research from the world’s top thyroid and parathyroid organizations,” he said.
“No one can be perfect, but I was taught early on that you assume responsibility and work toward your goals with extreme energy,” Dr. Randolph said. “When it comes to taking care of patients, we should all be perfectionists. It’s not a matter of patient volume. It’s a matter of patient outcome.”
Kathryn Colby, M.D., Ph.D., has served the Massachusetts Eye and Ear Infirmary (MEEI) in many different capacities since she first arrived for an ophthalmology residency 14 years ago. A committed believer in the three-pronged mission of the MEEI, Dr. Colby is now a busy cornea surgeon who sees patients, teaches medical students, residents and fellows, and is actively involved in research into blinding diseases of the cornea.
Dr. Colby’s main research interest is Fuchs’ Corneal Dystrophy, which is an enigmatic condition in which the inner layer of the cornea (the transparent dome that covers the pupil) stops pumping fluid from the normally clear tissue, causing the cornea to become water-logged, thickened and cloudy, eventually resulting in painful blindness. Besides spearheading laboratory studies of this condition, she has been actively involved in advancing new surgical techniques, such as DSEK or selective endothelial transplantation, to treat Fuchs’ Dystrophy.
Dr. Colby’s real love, however, is caring for patients with complicated corneal diseases and passing that knowledge on to those in training. “It’s gratifying to be able show talented young people why you love your specialty,” she says.
Dr. Colby also directs the Joint Clinical Research Center, a collaborative venture between MEEI and the Schepens Eye Research Institute. In this role, Dr. Colby, who earned her doctorate in neurobiology at Brown University, works to foster scientific collaboration between laboratory and clinical researchers.
“Bringing scientists and clinicians together creates the potential for the most rapid development of treatments and preventive therapies that can help with a variety of ophthalmic conditions,” says Dr. Colby. “Helping patients, after all, is the real reason we are all here.”
Age-Related Macular Degeneration (AMD) is a degenerative eye disease that causes vision loss. The disease damages a part of the eye called the macula, the middle part of the retina, which is responsible for central vision.
“Dry” AMD happens when the light-sensitive cells in the macula degenerate. It has three stages: early, intermediate and advanced. “Wet” AMD develops when abnormal blood vessels grow under the macula. These vessels leak blood and fluid, and cause rapid damage to the macula. Both the advanced dry form and the wet form are considered advanced AMD; it is advanced AMD that causes vision loss in most cases. Two thirds of people with advanced AMD have the wet form.
Common signs of early AMD include blurred vision and straight lines that appear crooked. A small blind spot may appear in a person’s central vision. Loss of central vision makes it difficult to read, drive or recognize faces.
It is estimated that there are more than 1.7 million people in the United States with AMD. It is the leading cause of blindness in people over the age of 60 in the United States.
Risk factors that can increase your risk of developing AMD are smoking, obesity and family history. Caucasians are more likely to lose vision from AMD than African-Americans. Women appear to be at a greater risk than men.
There is no cure for AMD. However, several new treatments have been approved in recent years. These treatments can help to slow or prevent the progression of the disease and in some cases even improve vision.
Don’t Smoke. Eat a healthy diet, including plenty of green, leafy vegetables and fish. Watch your weight and exercise.
Research continues to learn more about the causes of AMD and to find better treatments. The Ocular Molecular Genetics Institute at MEEI is currently studying the genes that cause AMD and other hereditary retinal diseases. If you have been diagnosed with AMD and believe you might be a candidate for this research, please contact Meg DeAngelis, Ph.D., at 617-573-4345. To make a donation to support AMD research at MEEI, please contact Melissa Paul at 617-573-4168.
*Information compiled from www.meei.harvard.edu and the NIH National Eye Institute at www.nei.nih.gov.
MEEI Audiologist Chris Halpin discussed the details of choosing a hearing aid in The Aug. 28 the Wall Street Journal article entitled “The Sleek, Chic, High-Tech Hearing
Aid.”
Read the Wall Street Journal article.
Dr. Halpin also discussed hearing aids during a segment which ran on WCVB-Channel 5, Boston’s ABC affiliate.
Read the transcript.
The 2008 Guys for Eyes calendar was noted on WCVB-Channel 5, Boston’s ABC affiliate. The 2008 calendar features a number of Boston-area men, including Channel 5 meteorologist Mike Wankum, as well as MEEI ophthalmologists Douglas
Rhee and George Papaliodis. Proceeds from the Guys for Eyes calendar benefit research into age-related macular degeneration and other retinal diseases at the hospital’s
Retina Research Institute.
View the story transcript.
Formerly blind, MEEI patient James Elleyby described the experience of regaining his
vision in the Nov. 5 issue of the Boston Globe. In the column “No Time for Tears,” Elleyby discusses how MEEI cornea surgeon Dr. Claes Dohlman performed surgery to
implant the Boston Keratoprostesis (an artificial cornea) that restored his sight.
Read the Boston Globe article here.
The November issue of Boston Magazine recognized more than 350 elite doctors in the most
sought after specialties. “Top Docs 2007: The Specialists” included several MEEI physicians in addition to a profile of ophthalmologist Lucy Young.
Read the Boston Magazine Article.
To see more news visit the MEEI Public Affairs webpage.
The Massachusetts Eye and Ear Infirmary continues the fight to preserve and restore sight, hearing, voice and balance. Help the Massachusetts Eye and Ear Infirmary help people throughout the world by making your tax-deductible gift. There are many ways that you can contribute. Every gift, no matter the size, is important and is deeply appreciated.
If you have questions or would like to discuss specific plans to designate your bequest to a physician or research area of your choice, please contact the Development Office at 617-573-3345. Thank you for your thoughtful consideration.
To learn more, contact the MEEI Development Office.
 | We comply with the HONcode standard for
health trustworthy information: Verify here. |
|
|
|
