January 04, 2013
NIH Podcast Episode #0176
Balintfy: Welcome to episode 176 of the new NIH Research Radio. The new NIH Research Radio is your source for weekly news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode our news summary at the end of the program includes items on bladder cancer, infant oxygen use and coordinated care for disabled adults.
But first, our feature story...
January is Glaucoma Awareness Month
Balintfy: January is Glaucoma Awareness Month. So I’m talking with Dr. James Tsai, Chair of Ophthalmology at the Yale School of Medicine, and Chair of the Glaucoma Subcommittee for the National Eye Health Education Planning Committee at the NIH’s National Eye Institute. First, Dr. Tsai, what is glaucoma?
Tsai: Glaucoma is a group of diseases that is one of the leading causes of blindness and visual impairment for Americans and many people worldwide.
What these diseases have in common is an increase in the eye pressure more than the eye can withstand, which causes damage to the optic nerve and that leads to vision loss.
Balintfy: So are there any particular warning signs or symptoms associated with glaucoma?
Tsai: Sometimes patients will complain of some eye discomfort. But the scary thing about glaucoma is often times the disease is asymptomatic, that is patients do not have any warning signs or symptoms.
Balintfy: You mentioned it is something that can affect Americans, or basically anyone around the world, but are there people who are particularly at higher risk?
Tsai: Yes. African-Americans are particularly at higher risk for developing blindness from glaucoma, also patients who are 40-years or over, everyone over age 60, especially elderly Mexican-Americans. And finally, people with a family history of glaucoma also are at higher risk. Also, if you are either profoundly far-sighted or near-sighted you also may be at risk for developing glaucoma.
Balintfy: And if you have more than one of those risk factors, does it compound your risk?
Tsai: We do believe that the more risk factors that a patient has the more likely they are to either have glaucoma or suffer vision loss from glaucoma.
Balintfy: But it’s both people who have risk factors and maybe even people without risk factors that should have an eye exam, is that right?
Tsai: Yes. We believe that patients and people should visit an eye care professional every one to two years for a dilated eye exam. It’s important just not to focus on the eye pressure. You can have glaucoma with normal eye pressures. So the eye care professional has to do a dilated eye exam and carefully look at the optic nerve for signs of glaucoma as well as asses the side vision or visual field in that patient.
What we’ve learned over the past decade is that a third of patients, at least in the United States, have glaucoma and don not have elevated eye pressure. And in some countries, such as Japan, over 90% of the patients with glaucoma do not have elevated eye pressure.
Balintfy: I’d like to backtrack a little bit and talk about the eye and the part of the eye that’s affected by glaucoma. Can you paint a picture of the parts of the eye and then what parts of the eye are affected by glaucoma?
Tsai: Yes, the fluid in the eye is produced in the front of the eye in an area called the ciliary body. And if flows through the anterior part of the eye and goes through these drainage channels called the trabecular meshwork. Once the pressure builds up, what it does is puts pressure on the back of the eye and there is an optic nerve which is a bundle of nerve fibers which brings vision information to the brain.
Damage to the optic nerve can initially cause blind spots at the outer edges of the field of vision, called the peripheral or side vision. As the damage gets worse, it’s almost like a television cable which is linking a television let’s say to the cable, when that television cable gets frayed, information cannot be transmitted. And even if the rest of the eye is normal if the optic nerve is damaged, there is an inability for patients to see.
Balintfy: So once that damage happens, there’s no turning back so that emphasizes the importance of having the screening and having that found early?
Tsai: Absolutely. I think early detection of glaucoma and early treatment of glaucoma if you have glaucoma is important in helping elderly Americans retain their vision, and their independence. We as eye-care professionals realize that the more vision we’re able to preserve in patients, the more we’re likely to make them comfortable living alone and continue to live independent lives.
Balintfy: Where can people get more information about glaucoma. Say they want to see a diagram about how the disease works in the eye. Are there some good resources for that?
Tsai: Yes, there are excellent resources. One resource is the National Eye Institute website, at www.nei.nih.gov/glaucoma. There is information there and the nice thing about the National Eye Institute website is there’s also information there in Spanish. Also, medical centers and other medical organizations have a lot of information about glaucoma on the internet.
Balintfy: That covered all the questions I had, but is there something that maybe I didn’t cover or perhaps something worth reemphasizing?
Tsai: I think that it’s worth reemphasizing that glaucoma is a challenging disease to manage. And the reason is it often times is quite insidious—it causes very slow vision loss that is very difficult to perceive especially in its early stages. And the therapies that we often times use sometimes have some side effects so its important for the patient to establish a very close relationship with their eye care provider so that they understand what the potential for their vision loss could be and they understand all the therapies that would help them keep their vision.
Balintfy: Dr. James Tsai is Chair of Ophthalmology at the Yale School of Medicine, and Chair of the Glaucoma Subcommittee for the National Eye Health Education Planning Committee at the National Eye Institute. For more information on glaucoma, visit the NEI website at www.nei.nih.gov.
Coming up on NIH Research Radio, our weekly news summary includes items on bladder cancer, infant oxygen use and coordinated care for disabled adults. That’s next.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Balintfy: Now for our NIH Research Radio news headlines, here’s Craig Fritz.
Fritz: Working-age adults with disabilities account for a disproportionately high amount of annual emergency room visits, according to a study by NIH researchers. As emergency department care may not be the best to address non-urgent concerns and is higher in cost, finding a way to decrease these visits is of interest to many. One of the first detailed looks at this population's heightened use of urgent care, the study analyzed pooled data from a national survey. Researchers found access to regular medical care, complexity of the patients health and disability status contributed to people with disabilities' use of the emergency department. To address this disparity, the authors recommend enhanced communication between emergency department and primary care physicians, and tailored prevention and primary care programs.
By the time they reached toddlerhood, very preterm infants originally treated with higher oxygen levels continued to show benefits when compared to a group treated with lower oxygen levels, although they were at higher risk for an eye condition that can lead to blindness. This is according to a follow-up study by a research network at NIH. Additionally, infants treated with a respiratory therapy commonly prescribed for adults with sleep apnea fared as well as those who received the traditional therapy for infant respiratory difficulties, which includes a ventilator and a sticky substance that coats the inside of the lungs
Patients who inherit a specific common genetic variant develop bladder cancer tumors that strongly express a protein known as prostate stem cell antigen, which is also expressed in many pancreatic and prostate tumors, according to researchers at NIH. A therapy targeting the prostate stem cell antigen protein on the tumor cell surface is under evaluation in clinical trials for prostate and pancreatic cancer. The researchers hope that this therapy will be tested in bladder cancer patients with the genetic variant, which could help to reduce potentially harmful side-effects, lower costs, and improve treatment effectiveness.
For this NIH news update – I’m Craig Fritz.
Balintfy: You can get more information on these news items at www.nih.gov/news.
Balintfy: And that’s it for this episode of the new NIH Research Radio. Please join us again next Friday, January 11 when our next edition will be available. Coming up in that episode…
There is some connection between metabolism and obesity, but the direction of that is not what typically people understand.
If you have any questions or comments about this program, or have a story suggestion for a future episode, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next week, I'm your host, Joe Balintfy. Thanks for listening.
Announcer: NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.
About This Podcast
Spokesperson: Dr. James Tsai
Topic:glaucoma, vision, blindness, blind, vision loss, eye, optic nerve, eye health, early detection, screening, dilated eye exam, eye exam, eye pressure, emergency room visit, emergency department, urgent care, disability, primary care, preterm infants, oxygen levels, oxygen, infants, infant respiratory difficulties, ventilator, lung, bladder cancer, tumors, prostate stem cell antigen, pancreatic, prostate, tumors, stem cell
Additional Info: Facts About Glaucoma