The Visionary - Fall 1998 Winter 1999

For the past two years, the Illinois Society for the Prevention of Blindness (ISPB) has been involved in a joint partnership with Cook County Department of Public Health (CCDPH) and the Illinois Department of Public Health (IDPH) to sponsor vision clinics and co-payment of glasses for children with financial need. This program has been a successful coalition of private/public resources.

Each year, the CCDPH performs vision screening on thousands of children in school and daycare programs. Children who fail two screenings are then referred to a follow-up vision exam by an eye care professional. Many families do not have insurance coverage and the financial means to obtain eye exams and eyeglasses if prescribed. The IDPH provides the funding for the exam fee; a local clinic provides the site and professional staff as well as reduced fees for the exam and glasses; and the CCDPH coordinates the clinic, schedules appointment and oversees records and statistics. Funding for the provision of glasses comes from a copayment arrangement between ISPB and the parent. This is a key contribution since the provision of an eye exam is only half of the equation. "ISPB recognizes that without the means to obtain glasses, successful follow-up is not complete," states James A. McKechnie, ISPB executive director.

During the past year this partnership provided forty-two children with eye exams and thirty-two children with glasses as prescribed. The copayment arrangement for the glasses preserves the parents' pride, promotes ownership and responsibility for their child's vision care and maximizes available funds to serve more children.

Following one of the clinics this year, Pat Cormery, coordinator of the Vision and Hearing Screening Program at CCDPH, received a very touching hand-made thank-you card from Roberto Robles, a first grade student in Maria Femandez's bilingual class at Longfellow School in Buffalo Grove (see p. 2). He had been seen at a local CCDPH clinic and had been provided with his first pair of glasses.

In a follow-up conversation with his teacher, she stated that before he had glasses Roberto would literally press his face to the board to do any close work, and he had trouble keeping up in his journal writing. Distance work was also very hard for him. "The glasses opened up new horizons for Roberto. It was like watching a movie in black and white and now being able to see the world in color," stated Ms. Fernandez. She mentioned that without glasses, he could only see a white border around the classroom because he couldn't see the numbers or letters surrounding the boards. Being bilingual, Roberto also faces the challenge of leaming to read in a new language. This challenge was greatly increased by his vision difficulties. Now Roberto can read words in charts, and he is able to keep up every day with his journal writing. His school work has improved and he wants to read more.

Ms. Fernandez also stated that both his outlook and disposition have changed-that Roberto is a much happier child. The whole class was amazed at the difference the glasses made. It gave them some insight into the importance of good vision. "What a gift this has been; we knew something was wrong with his eyes!"

"Intellectually we all know the importance of good vision, but this story translates program efforts into a real human story and reinforces how the efforts of all of these agencies and professionals working together do touch and change peoples' lives in far-reaching ways," states Pat Connery, CCDPH.

Research and Medication Updates

This has been an exciting year for eye research and treatment. The ISPB is pleased to report on the following; and, as always, please check with your eye care professional for further information.

Age-Related Macular Degeneration (ARMD): A new technique to help save sight, called macular translocation, aims at moving the most light-sensitive part of the retina away from the eye's underlying diseased area. This procedure-for the "Wet" form of ARMD-must be done early in the disease. Research and procedures are being conducted at Wilmer Eye Institute at Johns Hopkins by Eugene de Juan, Jr., M.D., et al. (Source: Johns Hopkins Medical Institutions, Press Release, May 20,1998). A more invasive translocation procedure is being researched and tried at Duke University Eye Center by Cynthia Toth, M.D. (Source: Associated Press Release, Web posted, May 27, 1998).

Glaucoma: There are two newly FDA-approved topical medications in the treatment of glaucoma. (1) Dorzolamide Hydrochloride-Timolol Maleate Ophthalmic Solution, the first combination drop treatment for ocular hypertension or open-angle glaucoma. It combines a carbonic anhydrase inhibitor (CAI) and a beta-blocker, both designed to decrease the aqueous (fluid) flow into the eye. Studies indicate that additional reduction of intraocular pressure (IOP) is possible, compared to using either drug alone.

(2) Brinzolamide Ophthalmic Suspension, 1%, a new carbonic anhydrase inhibitor (CAI), which also reduces the production of aqueous (fluid) flow through the eye. Please consult your eye doctor for more information (Source: Eye to Eye, Sununer 1998, The Glaucoma Foundation 800-452-8266 and Gleams, Sunimer 1998, Glaucoma Research Foundation-800-826-6693).

Hyperopia (Farsightedness): The holmium YAG laser, which uses laser light to heat the corneal of the eye, is the first device of its kind designed to correct farsightedness. It was used for the first time at Alkek Eye Center at Baylor College of Medicine and is currently being studied to evaluate effectiveness and safety. "The technique involves gentle heating the peripheral cornea to steepen the curvature of the center of the comea," says Douglas Koch, M.D., at Baylor. He expects the FDA to approve the holmium laser for widespread use in 1999 (Source: Texas Medical Center NEWS, Sep.

Dry Eyes: Women suffer more from dry-eye syndromes, marked by a sandy or gritty and usually painful feeling in the eye. Treatment usually calls for artificial tear ointments or solutions, goggles or punctal plugs (prevents tears from draining). Recent research by David Sullivan, Ph.D. at Schepens Eye Research Institute and Harvard Medical School and others show that many syndromes are related to a lack of male hormones, called androgens, produced in smaller quantities in women - even less after menopause. A new topical androgen preparation, when applied directly to the eye, may be safe and effective. Clinical trials of the preparation are scheduled to begin in 1999 (Source: Consumers Digest, Skokie, Ill., January/February 1998).

ISPB Funds 10 Illinois Eye Research Grants for 1998

The board of directors of the Illinois Society for Tthe Prevention of Blindness has awarded nearly $25,000 in ten research grants to five Illinois institutions in 1998-Edward Hines, Jr. VA Hospital, Hines; Illinois College of Optometry, Chicago; Loyola University Medical Center, Maywood; RUSH University, College of Medicine, Chicago; University of Illinois at Chicago. The ISPB research program was first established in 1916 to help fund exploratory research studies in vision, especially as they relate to the prevention of blindness. These research grants have provided important initial funding for key vision research at Illinois institutions As funds permit, ISPB continues this program on an annual basis.

1998 ISPB Research Grant Recipients:

Edward Hines, Jr. VA Hospital Jay I. Perlman, M.D.: The Effect of Cardiopulmonary Bypass Surgery on Intraocular Pressure;

Joan Stelmack, O.D. and Michelle Marciniak, O.D.: Assessing Outcomes of Low Vision Rehabilitation Using the NEI VFQ-25.

Illinois College of Optometry Daniel K. Roberts, O.D.: The Anterior Chamber Angle Characteristics in the Family Members of Blacks with the Pigment Dispersion Syndrome.

Loyola University Medical Center Charles S. Bouchard, M.D.: Effect of Dexamethasone on Cytokine Stimulated Expression of ICAM-1, VEGF and HLA-DR in Cultured Human Corneas;

Thomas John, M.D.: Adherence of Staphylococcus Epiderrnidis to Collapsible and Non-Collapsible, Rigid Punctal Plugs.

RUSH University, College of Medicine Mathrew W. MacCumber, M.D., Ph.D.: Influence of Non-Steroidal Anti-Iniflammatory Agents on Ameliorating Retinal Degeneration in Dystrophic Mice.

University of Illinois at Chicago Debra A. Goldstein, M.D. and Howard H. Tessler, M.D.: Corticosteroid Sparing Effect of Hydroxychloroquine in Treatment of Ocular Sarcoidosis: Double-Masked, Placebo Controlled Comparison;

Enrique Garcia-Valenzuela, M.D., Ph.D.: Effect of Brain-Derived Neurotrophic Factor on Photoreceptor Survival in a Rat Model of Retinal Detachment;

Gerard C. Carandang, Graduate Student: Mechanism of Visual Loss in an Animal Modelfor Juvenile Congenital Stationary Night Blindness Due to G90D Mutation in Opsin Gene;

Chibo Li, M.D.: Animal Model for Juvenile Macular Degeneration Due to a Mutation in Peripherin/RDS Gene.

Sports Eye Injuries on the Rise

The number of Americans participating in sports continues to grow. Unfortunately one result has been a startling increase in the number of eye injuries. According to the American Academy of Ophthalmology (AAO) sports-related eye injuries have increased 100 percent in the last 3 years: from 41,000 to 100,000. The reported injuries range from bruises to the loss of an eye.

The International Federation of Sports Medicine says the eyes are at considerable risk in any sport that involves the use of a high speed ball or puck, a bat, racquet, or stick or aggressive play with body contact.

Children face the greatest risk when playing sports. Eye injuries are the leading cause of blindness in children and sports are the major cause of eye injuries in school age children. Baseball causes the largest number of eye injuries for children aged 5-14 while basketball is responsible for the greatest number of the eye injuries in people aged 15-24.

Of the 100,000 eye injuries last year, 90 percent could have been prevented had the athlete been wearing protective eyewear. The AAO recommends athletes wear shatterproof goggles, constructed of 3 millimeter polycarbonate, that are fitted by an eye care professional. -Mike Weigus, ISPB Health Education Coordinator

Recall ... J.C. Higgins bolt action 12 guage Model 10 shotguns - first sold by Sears, Roebuck and Co. in the early 1950's and discontinued in the early 1980's - pose a poetential hazard. Model 583.13 through 583.22 may require corrective action. The model number is engraved on the barrel of the shotgun.

The bolt latch assembly may fail allowing it to dislodge and strike the operator in the face. This could result in injury such as broken facial bones or eye damage. Immediately stop using this shotgun!

Call 1+800+817-9165 for identification verification, instructions on the return procedure of the bolt of the shotgun and refund of $160.00 (Source: Sears, Roebuck and Co.).

November 1998 Diabetes Awareness Month

Of the estimated 16 million Americans who have diabetes, all are at risk of developing diabetic eye disease, a leading cause of blindness among individuals ages 20 to 74. Diabetic eye disease refers to a group of sightthreatening eye problems that people with diabetes may face as a complication of the disease. They include:

DIABETIC RETINOPATHY (the most serious eye condition associated with diabetes). This disease damages blood vessels in the retina, the light-sensitive tissue at the back of the eye that translates light into electrical impulses that the brain interprets as vision. Annually, as many as 25,000 people go blind from this disorder.

CATARACT. A cataract is an opacity of the eye's crystalline lens that results in blurring of normal vision. Cataracts tend to develop at around late middle-age in people with diabetes.

GLAUCOMA. This disease occurs when increased fluid pressure in the eye leads to progressive optic nerve damage. People with diabetes are nearly twice as likely to develop glaucoma as other adults.

During the last twenty-five years, scientists have made great progress in managing and treating diabetic eye disease. Laser surgery, cataract surgery, and glaucoma medications and surgery have all been either developed or improved considerably during this period. But if this research progress is to continue, additional understanding is needed of the cellular and biochemical basis of each disease. Improved treatment and ongoing research, coupled with heightened public awareness, should go far toward reducing diabetic eye disease as a future national health problem.

The ISPB has, once again, joined the National Eye Health Education Program (NEHEP) of 40 Partnership organizations to increase awareness of diabetic eye disease and the importance of early detection and timely treatment.

ISPB Lectureship - Chicago Ophthalmological Society

The Illinois Society for the Prevention of Blindness was pleased to present the 11th ISPB Lecturer Award to Gregory L. Skuta, M.D. at the Chicago Ophthalmological Society's 50th Annual Clinical Conference, Chicago, May 29, 1998. Dr. Skuta's presentation was entitled "Clinical Perspectives on the Use of Antiproliferative Agents in Glaucoma Filtering Surgery." He is the James P. Luton Clinical Professor of the Department of Ophthalmology at the University of Oklahoma at Oklahoma City.

The Award is made possible by an ISPB grant to the Chicago Ophthalmological Society.

Computer use and "Sore'' Eyes

Lewis and Clark, the explorers, stated in their journal, dated May 11, 1805, that "sore eyes continue... to be common to all of us in a greater or lesser degree." Sore eyes are still bothersome today, but the external factors causing the discomforts are ever changing. The computer is the latest external factor playing havoc with our eyes and our health. It is estimated by the National Institute for Occupational Safety and Health (NIOSH) that nearly 60 million Americans suffer from eyestrain, a statistic probably boosted by the fact that there are more than 75 million computer users in the U.S. Computers do not cause eye problems, but they do bring on symptoms, collectively refeffed to as Computer Vision Syndrome (CVS).

Common symptoms of CVS may include any or all of the following: tired or sore eyes; red, watery or dry eyes; periodic blurred near vision or occasional blurred distance vision; difficulty focusing; heaviness of eyelids or forehead; changes in color perception; contact lens discomfort; as well as headaches; back and neck aches, and other musculoskeletal discomforts.

Industries have been designing more products to detect and/or relieve CVS symptoms, such as antiglare/antiradiation screens; video display terminal (VDT) prescription systems for checking levels of strain placed on the eye muscle for proper fit of computer glasses; software packages that preprogram vision break reminders and the selection of background colors for the computer; more artificial-tear preparations; and, recently, computer eye drops (containing one percent glycerin).

Alert: Contact lens wearers will need to remove their lens before using the computer eye drops or find a specialized, formulated product just for them.

According to a Japanese study, a person blinks 22 times a minute in conversation, 10 times a minute in reading, while only 7 times a minute working at a computer. Blinking is the eye's way of relubricating and relaxing itself. No wonder we have "sore" eyes!

Based on available scientific evidence, the American Academy of Ophthalmology (AAO) considers "VDTs to be safe for normal use and to present no hazard to the eye." The AAO goes on to say that "there is no convincing experimental or epidemiologic evidence that exposure to VDTs results in cataracts or any other organic damage to the eye." However, some people still fear the long-term effects of computer usage. Hopefully, time and continued studies will alleviate these eye and health concerns.

Since computers are a necessary part of our workplace and our homes, please consider the following tips on the elimination of CVS:

Some Tips for Eliminating Computer Vision Syndrome (CVS)

Don't take a vision problem to work. You may have a vision problem that can be aggravated by using the computer. You may need a mild lens prescription to wear only on the job to reduce vision stress. Computer users should have a thorough eye exam each year.

Be sure your glasses meet the demands of your job. If you wear glasses for distance vision, reading or both, they may not give the most efficient vision for viewing your computer screen which is about 20-30 inches from your eyes. Measure on-the-job seeing distance of job tasks and computer screen. You may benefit from new lens designed specially for computer work.

Take alternative task breaks throughout the day. Make phone calls or photocopies. Consult with co-workers. Do anything that doesn't require your eyes to focus on something up close. Reduce room lighting to half normal office levels. Remove half the bulbs ceiling fixtures. Use desk lamps for tasks that require more light.

Minimize glare on your computer screen with a glare-reduction filter; by repositioning your screen; and by using drapes, shades or blinds. Also eyeglasses can be tinted or coated to reduce glare.

Use an adjustable copy holder to place reference material at the same distance from your eyes as your computer screen and as close to the screen as possible.

Adjust your work area and your computer for your comfort. Most people prefer a work surface height of 26 inches for computer use. Desks and tables are usually 29 inches high. Place your computer screen 16 to 30 inches from your eyes. The top of the screen should be slightly below horizontal eye level. Tilt the top of the screen away from you at a 10 to 20 degree angle.

Clean your computer screen frequently. Dust and fingerprints can reduce clarity.

(Source: American Optometric Association)

The Illinois Society for the Prevention of Blindness would like to emphasize the importance of an annual eye exam for computer users. You can improve and safeguard your eyes and health in this high-tech society! Prevention is the name of the game.

JANUARY 1999 Glaucoma Awareness Month

More than 60 million Americans are at risk of losing their eyesight to glaucoma, a leading cause of blindness in the United States. But health offlcials report that many people at risk for the disease are not having their eyes examined regularly.

Glaucoma is a chronic eye disease that affects an estimated three million Americans-half of whom do not know they have the disease. It can lead to reduced side, or peripheral vision. As the disease worsens, the field of vision gradually narrows, and blindness may result.

Although anyone can get glaucoma, some people are at higher risk. They are: Blacks over age 40 everyone over age 60 people with family history of glaucoma.

"If people at high risk want to protect their vision, they must get an eye examination through dilated pupils at least every two years," states Dr. Carl Kupfer, director of the National Eye Institute (NF-1).

ISPB is one of forty members of the National Eye Health Education Program (NEHEP) Partnership, coordinated by the National Eye Institute, to spread the word on the importance of eye exams and timely treatment.

Laser Pointers Can Damage Eyes

Hand-held laser pointers were originally developed for use in presentations in business and lectures at educational institutions. But now they are popping up in the hands of children and teenagers, who are aiming the concentrated red dot on movie screens, people in shopping malls and amateur/pro athletes in action Why? The speculation is that the lipstick-sized device has now become readily accessible and affordable under $25. Pranksters consider it the "hot new toy."

Recently, the Food and Drug Administration (FDA) warned parents and school officials that "the light energy that laser pointers can aim into the eye can be more damaging than staring directly into the sun." And the American Academy of Ophthalmologists (AAO) has also stated that "it is possible to damage the retina by looking directly into a laser beam."

Communities are cracking down on the sale of laser pointers, including Chicago Ridge, Ill., Virginia Beach, Va., Ocean City, Md., just to name a few. Also, some school boards have banned lasers in schools.

In September, the Chicago Ridge trustees adopted an ordinance prohibiting people under the age of 18 from buying, selling or owning a laser pointer (helium neon laser or diode laser). Parents or legal guardian of a minor living with them at the time of the violation will also be subject to liabilities.

Hopefully, these types of measures will be a warning to parents on the importance of educating their children on the dangers involved in owning, in using or being a subject of one of these pointers.

"Laser pointers are not toys. They are useful tools for adults that should be used by children only with adequate supervision," states Michael A. Friedman, M.D., FDA Lead Deputy Commissioner.

Toy Guides and the 1998 List of Harmful Toys

The holidays are close at hand. Two questions come to mind: What should we buy our special people? and/or What toys on the market are harmful? The ISPB hopes that the following guides and list will be of assistance to you during this joyous time.

Guide to Toys for Children Who are Blind or Visually Impaired, 1997-1998 by The American Federation for the Blind and The American Toy Institute, Inc - Call AFB at 1+800+232-5463 for free copy.

Toy Guide for Differently-Abled Kids, by The National Parent Network on Disabilities in conjunction with Toys "R" Us - Call 1+800+732-3298.

Dr. Phillip Kaufman's 1998 List of Toys That Will Cause Eye Damage. To obtain a copy, send a stamped, self-addressed envelope to TOY LIST, Dr. Phillip L. Kaufman, 1395 Main Street, Crete, IL 60417.

Remembrances

Gifts to the Illinois Society for the Prevention of Blindness are a wonderful way to acknowledge people we love, cherish and respect. An attractive card is sent to person(s) specified by the contributor for special occasions (anniversary, birthday, special event or achievement, recovery) while a memorial card is sent to the family of the deceased. Donors receive an acknowledgment of their gift.

Thank You
A special thank you to the Clark-Halladay Memorial Foundation for its continued and generous support of the work of the Illinois Society for the Prevention of Blindness. The Clark-Halladay Memorial Foundation perpetuates the memory of Emma Clark Halladay; her husband, John Burlingame-Halladay; her father, Warren Thomas Clark; and her mother, Sophia Symington Clark, all pioneer residents of the City of Chicago.

In Memory of:

Quick Tips

Photograph Alert. If in viewing developed photographs-especially in children-one eye shows up red and the other shows up white, contact an eye care professional to schedule a dilated eye exam to rule out any serious eye condition (Source: Dean E. Dell, M.D., NewsTalk Radio 89).

Speaking of dilated eye exams. If you plan to have a dilated eye exam, make sure to take sunglasses with you to wear after the exam; or, if possible, arrange for someone to drive you home. Your eyes will be extra-sensitive to light and sometimes blurry for a short time after the exam.

NEI new clincial trials database on Web site. The National Eye Institute (NTEI) has a new Web site for information on clinical trials for various eye diseases (http://www.nei.nih.gov). You can search for a clinical trial by keyword, eye disease or location (Source: NEI News Release, April 1998). Remember: always consult with your eye doctor regarding any information found on the Internet.

Joint Partnership to Help Children