2020 MARCH : simplebooklet.com

Newsletter March, 2020Living with GlaucomaMEET LILIAN ROSENBAUMIn her professional life, Lilian Rosenbaum, LCSW-C, BCB, PhD, has been an acclaimed pioneer in the eld of biofeedback. Lilian lived and worked in the Washington, DC area for 60 years until a recent move to the Boston area. A faculty member at Georgetown University Medical School since 1970, she is a Clinical Associate Professor in the Department of Psychiatry. More personally, Lilian has been on a 22-year glaucoma journey. As she explains it, she wore glasses for reading since age 11 and saw an ophthalmologist annually. But until she suered an angle closure attack in 1998, she had not been diagnosed with narrow angles. A narrow angle, which can be detected during a comprehensive eye exam, refers to an angle between the outer edge of the iris and the cornea that is narrower, or more closed, than normal. If not watched, narrow angles can lead to an acute angle attack, which is a medical emergency that can cause permanent damage within hours.“I am one of those who was only diagnosed after an attack, which partially blinded me,” she says. Although Lilian lost much of the vision in her right eye, she praises the glaucoma specialist she began seeing after her attack, who treated her until she moved to Boston in 2016. “That DC doctor is my miracle magician and scientist,” she says.Lilian has made sure that history does not repeat itself within her family, which includes 4 children and 11 grandchildren, ages 11 to 31. “Given my experience, I easily convinced family members to be evaluated by a glaucoma specialist. My younger sister and my youngest daughter both have narrow angles. Both had immediate iridotomies and have avoided the potential nightmares of narrow-angle glaucoma.” (Laser iridotomy is a common treatment for narrow-angle glaucoma. It creates a small hole in the iris, restoring the ow of uid to the front of the eye.) Lilian’s older grandkids are proactive as well.Having narrow angles doesn’t mean that angle-closure glaucoma is inevitable. But the narrower the angle, the greater the risk, especially with increasing age. That’s why it’s important to know if you have narrow angles and to discuss with your clinician how you will be followed. (Read more about angle-closure in this issue)With surgeries and numerous other treatments over the years, Lilian’s DC doctor and her newer specialist in Boston have been able to preserve her remaining vision. Her sight has been under control these last few years, she says, with no medications currently needed.

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Glaucoma is not the main thread of Lilian’s life. In 2017, she was the recipient of a Lifetime Achievement Award from the Mid-Atlantic Biofeedback Society. The award was presented “in appreciation and recognition of her contributions to the eld of biofeedback, specically the establishment of one of the country’s rst biofeedback programs at Georgetown University Medical School…” according to the certicate. A related tribute points out that when she set up her rst biofeedback clinical program as an elective for medical students in the early 1970s, biofeedback was still “bio-WHAT”.More About Narrow Angles and Angle-Closure Glaucoma Open-angle glaucoma, the most common form of the disease, often progresses so slowly and subtly that symptoms, such as reduced peripheral vision, may go unnoticed until the disease has advanced and vision loss is inevitable.By contrast, angle-closure glaucoma can come on suddenly and painfully and cause vision loss or blindness within hours or days. But angle-closure glaucoma is highly preventable. Eyes that develop it have an anatomical feature called “narrow angles,” which can be detected during an eye examination. In angle-closure glaucoma, the trabecular meshwork is obstructed by the iris, because the angle where the iris meets the cornea (sometimes referred to as the drainage angle) is narrower than normal. This slows or blocks the ow of aqueous humor out of the eye. Pressure from the aqueous humor behind the iris forces it against the trabecular meshwork. If you’ve been told you have narrow angles, you should have an eye examination every year. The goal of identifying people with narrow angles is to prevent an acute attack and to catch chronic angle-closure glaucoma -- which develops more slowly -- before damage occurs. Risk for angle-closure glaucoma is greater in farsighted people and in women. Asians and Eskimos are also at increased risk because their eyes tend to have shallow anterior chambers.Not everyone with narrow angles develops angle-closure glaucoma. Using a technique called gonioscopy, a clinician can assess the risk by looking into the eye with a special lens to examine the trabecular meshwork. If more than 50% is obscured, the next step is usually laser iridotomy to prevent an acute angle-closure attack.Laser iridotomy is an in-oce or outpatient procedure that uses an intense beam of light to create a tiny drainage hole at the outer edge of the iris. This ensures that uid behind the iris can ow to the front of the eye and out through the trabecular meshwork. The procedure is quick and has few complications or side eects. An acute attack of angle-closure glaucoma is treated with medications to reduce the production of aqueous humor and increase drainage. After the eye has calmed down, laser iridotomy can be performed. Since it is common for both eyes to suer from narrowed angles, operating on the unaected eye is done as a preventive measure.

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Newsletter March, 2020If you’ve been warned that you have narrow angles, keep in mind that anything that dilates the pupils can trigger an acute angle-closure attack. That’s why clinicians screen for narrow angles before they administer dilating eyedrops. Many of these sudden attacks occur in darkened rooms, such as movie theaters, which cause the pupil to dilate, or increase in size, which further narrows the angle. The pupil also dilates when one is excited or anxious. And certain medications can dilate the pupils, including some antidepressants and over-the-counter cold and allergy remedies. Check drug labels for warnings about glaucoma., and consult your pharmacist or physician.Seasonal Allergies and your Eyes While many parts of the country are still frigid with snow, soon it will be allergy season. For those who live with glaucoma, it’s especially important to manage the symptoms.Seasonal allergies cause a sudden increase in the itchy sensation and increased watering of the eyes as well as swelling. Sometimes these allergy symptoms can cause a temporary rise in intraocular pressure (IOP). In addition to the symptoms of allergies, the residual eect of hardened debris and mucous around the eyes can also hinder drainage and cause complications. Over-the-counter medications, such as antihistamines and decongestants, can be quite eective in relieving allergy symptoms. Note: We’ve all read the labels on over-the-counter cold and allergy medications that say do not take if you have glaucoma. It really depends on which type of glaucoma you have. Antihistamines generally have no eect on open-angle glaucoma -- the most common form of the disease. But people with closed-angle glaucoma, also called narrow-angle glaucoma or angle-closure glaucoma, should avoid or use them with caution. This is because antihistamines in people with narrow angles tend to dilate (enlarge) the pupil, and in rare instances could precipitate an acute glaucoma attack in individuals whose anterior chamber angles are anatomically narrow.

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If you are struggling with seasonal allergies, it is important to speak with your doctor about the treatment of these allergies in an eort to keep your glaucoma risks at a minimum. Dierent types of prescription treatments for eye allergies are available. While oral medications to control allergies can be eective, patients may also require oral steroid medications and allergy shots. Special Free Educational Event Coming Up in NYCDo you want to stay current about cutting edge research relating to glaucoma and vision loss?On Saturday, April 4, 2020, from 8:00am – 11:30am, The Glaucoma Foundation (TGF) will present a morning of talks by experts in their elds. The seminar will take place at the Harvard Club, 35 West 44th Street, in New York City.Four speakers will present on their topics of expertise. Dr. Adriana Di Polo, recently awarded the 2019 Shaer Prize for Innovative Glaucoma Research and the prestigious 2019 Rudin Award for the best scientic paper on glaucoma, will talk about the exciting eld of optic nerve regeneration. Dr. Felipe Medeiros, whose research focuses on the development of pioneering detection and diagnosis methods, will discuss the use of articial intelligence in glaucoma. Dr. Robert Ritch, founder and medical director of The Glaucoma Foundation, will explain the importance of research into exfoliation syndrome, the leading cause of secondary open-angle glaucoma around the globe. And actor, singer, author, producer and motivational speaker Tom Sullivan, blind since birth, will speak on living with blindness.

2020 MARCH

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