TAG: "Eye care"

Building an objective, lower-cost, portable glaucoma screening tool

UC San Diego developing a new diagnostic tool.

Felipe Medeiros, UC San Diego

Glaucoma is the leading cause of irreversible blindness in the world, affecting more than 80 million people. However, because the disease remains largely asymptomatic as it progresses, researchers estimate that more than 50 percent of individuals are unaware that they’re afflicted until it’s too late.

To make matters worse, there are is no effective way to screen for the disease. The current diagnostic process — which requires patients to have the forethought to make an appointment — is subjective, cumbersome and expensive, says Felipe Medeiros, professor of ophthalmology and the Ben and Wanda Hildyard Chair for Diseases of the Eye at the University of California, San Diego.

Medeiros is hoping the new diagnostic tool he’s developing in collaboration with the Qualcomm Institute will provide an objective, low-cost and even portable means for screening patients for visual field loss and glaucoma.

“The way we currently assess visual function in these patients is with Standard Automated Perimetry (SAP), which evaluates loss of vision by requiring the patient to press a button to indicate whether or not he or she has seen a series of very dim visual stimuli,” he explains. “This test has a number of limitations – not only must patients come into a physician’s office to be tested, but the testing process is fatiguing, difficult and tedious. It’s also subject to a lot of variability and learning effects.”

“It’s not an easy test for patients to do,” he continues, “but it’s pretty much all we have, not only for glaucoma but for other diseases that can affect the visual field.”

Medeiros’ proposed replacement combines head-mounted virtual reality goggles typically used for video games with a wireless dry Electroencephalogram (EEG) system to measure the electrical field changes associated with processing visual field stimuli. The testing platform is based on objective analysis of the EEG signals and therefore does not require subjective responses from the patient. The data can be transmitted to a smartphone or tablet device, making for easy retrieval and analysis by clinicians.

Medeiros received a $50,000 Calit2 Strategic Research Opportunities (CSRO) grant earlier this year to build a proof-of-concept of the device, which he and his team will use to conduct preliminary investigations of its worth as a diagnostic tool.

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Seeing is believing

UC Santa Barbara’s Dennis Clegg is taking stem cell-based therapy for AMD to clinical trials.

Dennis Clegg, UC Santa Barbara

Age-related macular degeneration (AMD) is the leading cause of vision loss in the United States among people age 50 and older. It is estimated that 11 million people in the United States have some form of age-related macular degeneration, and the number is expected to double by 2050.

Pioneering research using stem cells to regenerate eye tissue conducted by UC Santa Barbara’s Dennis Clegg and co-workers may one day help people with AMD. As the first person to hold the newly endowed Wilcox Family Chair in BioMedicine, Clegg, a professor in UCSB’s Department of Molecular, Cellular and Developmental Biology, is poised to bring stem-cell-based therapy for AMD to phase one clinical trials.

Supported by a generous gift from UCSB alumni Sue and Gary Wilcox, the chair is designed to further pre-translational work on human biological systems that may lead to clinical studies.

“I am so grateful to Gary and Sue Wilcox for their generosity in creating the Wilcox Family Chair in BioMedicine,” said Clegg, who is also a co-founder of campus’s Center for Stem Cell Biology and Engineering. “It will help fund innovative, high-risk, high-gain research as well as provide seed money to support students and postdoctoral scholars.”

Clegg is also co-director of the California Project to Cure Blindness, a collaborative effort aimed at developing a stem-cell-based therapy for AMD. The project is funded by the California Institute for Regenerative Medicine (CIRM), the state’s stem cell agency. Partners in the project include the California Institute of Technology (Caltech), the University of Southern California (USC), the City of Hope and University College London.

AMD takes two forms: wet and dry. In the wet form, for which treatment is currently available, growth of abnormal blood vessels causes blood and fluid to leak into the retina, resulting in vision distortion, blind spots and, ultimately, loss of central vision.

The dry form of the disease, which has no treatment and is the focus of Clegg’s research, is caused by the presence of yellow deposits in the eye’s macula. As these deposits grow in size and increase in number, vision is dimmed and distorted. A concomitant thinning of the light-sensitive layer of cells in the macula eventually leads to the death of a cell type called retinal pigmented epithelium (RPE). These are the support cells for the rods and cones — the eyes’ photoreceptors, which allow light to be translated into recognizable images.

“It’s especially devastating because the visual defect occurs in the macula, which is the center of the retina,” Clegg explained. “That part is used for high acuity vision, so people with the disease end up with a big blank spot in the middle of their field of vision. Some reports estimate that more than 30 million people worldwide have this disease, so there is a real unmet medical need for a therapy.”

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Seeing the future: Whole eye transplant under development

Could be ‘holy grail’ for vision restoration.

Jeffrey Goldberg, UC San Diego

The concept of a whole eye transplant seems futuristic, if not impossible. But with a $1 million grant from the U.S. Department of Defense, researchers at UC San Diego School of Medicine hope to someday make implantation of an entire, functional eye a reality.

“A whole eye transplant could be a holy grail for vision restoration,” said Jeffrey Goldberg, M.D., Ph.D., professor of ophthalmology and grant co-recipient with colleagues at University of Pittsburgh Medical Center and Boston Children’s Hospital/Harvard University. “It is in the realm of scientific plausibility.”

The basic idea is straightforward: Doctors would implant a donor eye in the recipient’s eye socket. The vascular system to the eye would be re-established, as would the eye’s musculature to enable normal movement. The greater challenge – and focus of the two-year project – would be devising effective methods to reconnect the eye’s neuronal wiring to the brain through the optic nerve, which contains more than 1 million nerve cells and transmits visual information from the retina.

Past experiments at University of Pittsburgh Medical Center have demonstrated the ability to perform whole eye transplants in genetically inbred rats (selected to minimize issues of tissue rejection). But while retinal tissue in the transplanted eyes appeared healthy, the optic nerves did not recover and regenerate connections, eliminating the possibility of restored sight.

“We know from previous experiments that the biggest scientific hurdle is not hooking up all the eye’s tiny blood vessels or its musculature,” said Goldberg, who is also director of research at UC San Diego Shiley Eye Center. “It’s that when you cut the optic nerve, the nerve cells do not regrow.”

“Our goal for this project is to be able to transplant a whole eye in an animal model and successfully demonstrate neuronal regrowth from the donor’s eye to the recipient’s optic nerve,” he said.

Researchers at UC San Diego and Harvard University have developed a variety of molecular techniques for enhancing optic nerve regeneration. One of the primary objectives is to assess whether these different techniques can be combined for greater therapeutic effect.

Among the most promising is restoring the embryonic ability of adult nerve cells to grow and blocking production of molecules that squelch nerve cells’ initial intrinsic regenerative properties. This loss of regenerative capacity is similar to what happens in spinal cord injuries that result in permanent paralysis.

Scientists have also identified proteins in the optic nerve known as neurotrophic factors that are involved in growth, survival and maintenance of developing neurons and have developed techniques for enhancing their signaling to nerve cells. Other “molecular tricks” will be used to try to overcome the inhibitory environment for re-growth normally found in the optic nerve.

If successful, researchers suggest whole eye transplants might restore sight in a wide range of patients who are blind due to structural or functional problems in the eye. For example, an estimated 120,000 Americans are blind due to damage to their optic nerves caused by glaucoma.  An estimated 186,855 eye injuries were incurred by deployed U.S. military personnel from 2000 to 2010, usually related to traumatic brain injury. Some of these cases might be remedied through eye transplants in the future.

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Professor receives Champalimaud Award for role in eye disease therapy

Research led to drug for wet macular degeneration and diabetic retinopathy.

Napoleone Ferrara, UC San Diego

Napoleone Ferrara, M.D., Distinguished Professor of Pathology and Distinguished Adjunct Professor of Ophthalmology at the UC San Diego School of Medicine and senior deputy director for basic sciences at UC San Diego Moores Cancer Center, was named today as one of seven recipients of the António Champalimaud Vision Award in Lisbon, Portugal.

The 2014 António Champalimaud Vision Award was bestowed for the development of anti-angiogenic therapy for retinal disease. Anti-angiogenic therapy is used to treat age-related macular degeneration and diabetic retinopathy, which are the leading causes of blindness in high- and middle-income countries. Both are rising in prevalence due to an aging population and increased obesity rates.

Ferrara was recognized for the discovery of vascular endothelial growth factor (VEGF), for exposing the role of this molecule in promoting angiogenesis (the formation of new blood vessels), his co-discovery of the role of VEGF in retinal disease and the development of the monoclonal antibody drug ranibizumab (marketed as Lucentis), which treats wet age-related macular degeneration, diabetic eye disease and other related disorders.

Ferrara shared the award with six researchers from Harvard Medical School: Joan W. Miller, MD, and Evangelos S. Gragoudas, M.D., both of Massachusetts Eye and Ear Infirmary and Harvard Medical School; Patricia A. D’Amore, Ph.D., of the Schepens Eye Research Institute of Mass. Eye and Ear; Anthony P. Adamis, M.D., of Genentech; and George L. King, M.D., and Lloyd Paul Aiello, M.D., Ph.D., both of Joslin Diabetes Center.

The work of this year’s awardees begins with the identification of VEGF by Ferrara, to the collaborative revelation of its role in retinal-vascular disease, to the experimental evaluation of VEGF inhibition in animal models and its final application with a pharmacologic intervention that significantly improves the vision of patients affected by these often devastating retinal conditions.

The award, presented by the Champalimaud Foundation, is given alternately between contributions to overall vision research (even numbered years) and contributions to the alleviation of visual problems, primarily in developing countries (odd numbered years). The honor comes with a $1.3 million prize, the largest such award given in vision and ophthalmology research. It will be shared among the seven recipients.

Earlier this year, Ferrara was one of eight recipients of the Canada Gairdner Awards, among the most esteemed honors in medical research, for his work identifying the role of VEGF. In 2013, Ferrara was named one of 11 recipients of the inaugural Breakthrough Prize in Life Sciences. He has also won numerous other awards, including the General Motors Cancer Research Award (2006), the ASCO Science of Oncology Award (2007), the Pezcoller Foundation/AACR International Award (2009), the Lasker-DeBakey Clinical Medical Research Award (2010), the Dr. Paul Janssen Award for Biomedical Research (2011), and The Economist’s Innovation Award for bioscience in 2012.

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A clearer picture: Vision-correcting display could replace reading glasses

The technology has potential to help hundreds of millions of people.

What if computer screens had glasses instead of the people staring at the monitors? That concept is not too far afield from technology being developed by UC Berkeley computer and vision scientists.

The researchers are developing computer algorithms to compensate for an individual’s visual impairment, and creating vision-correcting displays that enable users to see text and images clearly without wearing eyeglasses or contact lenses. The technology could potentially help hundreds of millions of people who currently need corrective lenses to use their smartphones, tablets and computers. One common problem, for example, is presbyopia, a type of farsightedness in which the ability to focus on nearby objects is gradually diminished as the aging eyes’ lenses lose elasticity.

More importantly, the displays could one day aid people with more complex visual problems, known as high order aberrations, which cannot be corrected by eyeglasses, said Brian Barsky, UC Berkeley professor of computer science and vision science, and affiliate professor of optometry.

“We now live in a world where displays are ubiquitous, and being able to interact with displays is taken for granted,” said Barsky, who is leading this project. “People with higher order aberrations often have irregularities in the shape of the cornea, and this irregular shape makes it very difficult to have a contact lens that will fit. In some cases, this can be a barrier to holding certain jobs because many workers need to look at a screen as part of their work. This research could transform their lives, and I am passionate about that potential.”

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New compound treats both blindness and diabetes in animal studies

UCSF-led study offers fresh insights into role of cellular stress in degenerative illnesses.

In a new study led by UC San Francisco scientists, a chemical compound designed to precisely target part of a crucial cellular quality-control network provided significant protection, in rats and mice, against degenerative forms of blindness and diabetes.

In addition to opening a promising drug-development path for the wide range of diseases caused by cell loss, the new research offers a new view of the workings of the unfolded protein response (UPR), a cellular “life-or-death” signaling network: When cells are under stress, the UPR works to ensure that they produce properly configured proteins, but those cells not up to this task are quickly prompted by the UPR to self-destruct.

A component of the UPR known as the IRE1 pathway has generally been thought to handle the protective aspects of this response, promoting cell survival by providing cells with the biological resources they need to cope with stress, while a complementary pathway, called PERK, has been associated with cell death.

But in the new research, published in today’s (July 10) edition of Cell, when researchers used KIRA6, a small-molecule kinase inhibitor they designed to inhibit the actions of IRE1α — the molecular sensor that triggers the IRE1 pathway — they blocked cell death and preserved function in experimental models of two human diseases.

In two rat models of retinitis pigmentosa, a disease in which light-sensing cells in the eye progressively die off, causing blindness, KIRA6 preserved both the number of these cells and visual function. And in mice from a strain known as Akita, which carry a genetic mutation that causes diabetes in early life as stressed insulin-producing beta cells of the pancreas degenerate, KIRA6 protected beta cells from cell death, leading to a twofold increase in insulin production and improving blood glucose control.

“This is a huge advance in our field,” said co-senior author Scott A. Oakes, M.D., associate professor of pathology at UCSF. “On the surface these would seem to be two very different diseases, but IRE1-induced cell death is at the root of both of them.”

The results are the culmination of “a gigantic project,” first to establish that the IRE1 pathway could drive degenerative disease, and then to design and test compounds to head off the damage, said UCSF’s Feroz Papa, M.D., Ph.D., associate professor of medicine and co-senior author, and a member of the California Institute for Quantitative Biosciences. “It took four years, over a hundred separate experiments in various contexts — not counting replications — and involved 24 researchers working in seven labs across four cities.”

KIRA6 is the latest in a series of compounds (the acronym stands for “Kinase-Inhibiting RNase Attenuators”) that were originally designed and synthesized in the labs of study co-authors Dustin J. Maly, Ph.D., associate professor of chemistry at The University of Washington, Seattle, and Bradley J. Backes, Ph.D., associate professor of medicine at UCSF.

“While KIRA6 showed efficacy in animals,” said Papa, “it is important to stress that more optimization through medicinal chemistry efforts is needed to develop this class of compounds to the stage where they could be tested for efficacy in humans through clinical trials.”

Oakes and Papa said that support from the Cleveland, Ohio-based Harrington Discovery Institute was crucial to sustaining this complex collaboration. Both scientists were 2013 winners of Scholar-Innovator Awards from the institute, which is part of The Harrington Project for Development and Discovery a $250 million national model to accelerate the development of medical breakthroughs by physician-scientists into medicines that benefit patients. Other critical support for the work came from the National Institutes of Health, the Juvenile Diabetes Research Foundation, the Burroughs Wellcome Fund, the American Cancer Society and the Howard Hughes Medical Institute.

Other UCSF researchers on the project included Douglas B. Gould, Ph.D., associate professor of ophthalmology; Michael German, M.D., professor of medicine; postdoctoral fellows Rajarshi Ghosh, Ph.D., and Likun Wang, Ph.D., and graduate student Eric S. Wang, all co-first authors; postdoctoral fellows Aeid Igbaria, Ph.D., Shuhei Morita, M.D., Ph.D., Kris Prado, M.D., Maike Thamsen, Ph.D., Hector Macias, Ph.D., and Marcel V. Alavi, Ph.D.; former research associate Deborah Caswell; graduate student Kurt F. Weiberth; and research associate Micah J. Gliedt. The team was also joined by other colleagues from The University of Washington, Seattle; The Miller School of Medicine at The University of Miami, Florida; and the Albert Einstein College of Medicine, in Bronx, New York.

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Miniature eye telescope used to treat macular degeneration patients

Successful treatment highlights UC Irvine Health’s partnership with community.

Ophthalmologists at the new UC Irvine Health Gavin Herbert Eye Institute, a state-of-the-art eye center that opened last fall, recently implanted the first CentraSight miniature telescope at the new facility to treat advanced macular degeneration. It was the sixth such procedure performed by UC Irvine Health specialists since the FDA approved the implant in 2010.

In September 2013, Gavin Herbert Eye Institute opened its new home on the UC Irvine campus. The 70,000-square-foot building has 34 comfortable patient exam rooms, including an area specifically designed for pediatric care, the latest optical equipment, fully equipped outpatient surgical rooms and modern research labs.

“Macular degeneration damages the retina and causes a blind spot in the center of a person’s field of vision,” said Dr. Sumit “Sam” Garg, the institute’s medical director. “The telescope projects an image onto an undamaged portion of the retina, making it possible for patients to recognize faces, read and perform daily activities.”

Fullerton resident Stewart Roberts underwent the 45-minute procedure, in which the pea-sized CentraSight telescope implant is inserted through an incision made in the cornea.

Several weeks after the surgery, Roberts feels great and will soon start low-vision occupational therapy to retrain his brain to process the images seen through the device.

“I’m just so excited,” Roberts said. “This is going to make all the difference in the world.”

The 80-year old was referred to Gavin Herbert Eye Institute by Dr. Timothy You, a retina specialists at Orange County Retina.  Specialists at Orange County Retina, as well as UC Irvine Health retina experts Dr. Baruch Kuppermann and Dr. Stephanie Lu, can refer patients to cornea surgeons Garg and colleague Dr. Marjan Farid for the procedure.  Kuppermann conducted trials of the telescope at UC Irvine prior to its FDA approval. A similar partnership exists with eye care specialists in the Inland Empire counties of Riverside and San Bernardino.

Garg said the Gavin Herbert Eye Institute is a resource for community-based eye specialists who want to offer their patients access to treatment, expertise and technology that may only be found at a university medical center.

“We want to make this treatment available to as many people living with end-stage age-related macular degeneration as possible,” Garg said. “Working with retina and low-vision specialists across the region is a great way to reach more people who may be helped.”

Clinical trials demonstrated that the implant, in addition to improved vision, increases patients’ independence. It also aids social interaction by making visible the facial expressions of family and friends.

“Until now, there has been no mechanism, surgical or medical, to restore that central sight,” said Farid, the institute’s director of cornea, cataract and refractive surgery. “These patients are now experiencing a quality of life that they’ve not enjoyed in many years. My patient is seeing her son’s face for the first time in more than a decade.”

The U.S. Food & Drug Administration approved the miniature telescope in July 2010 for use in patients with irreversible end-stage macular degeneration. At least 15 million Americans are affected by some form of the disease. The cost for the telescope implant and visits associated with the associated treatment program are Medicare eligible.

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UC San Diego names Hildyard Chair for Diseases of the Eye

Glaucoma specialist Felipe Medeiros appointed inaugural holder of chair.

Felipe Medeiros, UC San Diego

Glaucoma specialist Felipe Medeiros, M.D., Ph.D., professor of clinical ophthalmology and medical director of the Hamilton Glaucoma Center at the UC San Diego Shiley Eye Center, has been named the inaugural holder of the Ben and Wanda Hildyard Chair for Diseases of the Eye. The chair is one of three established by a bequest from Ben and Wanda Hildyard to help UC San Diego School of Medicine recruit and retain top faculty members. The bequest provided endowment funds of more than $6 million to establish the three chairs.

“I am honored to be the first faculty member to hold the Hildyard Chair for Diseases of the Eye and am appreciative for the resources it provides to advance my work,” said Medeiros, whose research is focused on glaucoma, the second leading cause of blindness in the United States. “I have been very fortunate to be able to collaborate with an outstanding group of people and be part of a wonderfully supportive environment.”

Although there is no cure for glaucoma, early diagnosis and treatment of the disease can help preserve vision. The Hamilton Glaucoma Center at UC San Diego Shiley Eye Center, where Medeiros serves as medical director and director of visual function research, is a comprehensive clinical and research center that offers management programs for glaucoma through clinical trials and innovative medical and surgical therapies, including genetic testing and regenerative ophthalmology.

Medeiros’ interests encompass many different areas in glaucoma research, including identification of risk factors and development of new methods for diagnosis and management of the disease. He is the principal investigator on a National Institutes of Health (NIH) grant to evaluate functional impairment in glaucoma. His laboratory is currently evaluating the impact of the disease on activities of daily living in patients with glaucoma, using techniques such as driving simulation and virtual reality. The results of his research have provided major contributions to the understanding of how glaucoma affects quality of life, how physicians can better determine risk and how to prevent patients from developing impairment from the disease.

“This endowed chair recognizes Dr. Medeiros for his transformative clinical and research contributions to ophthalmology,” said Robert N. Weinreb, M.D., chair of the department of ophthalmology and director of the Shiley Eye Center. “We are grateful to the Hildyards for their legacy of support, and for investing in the future of ophthalmology at Shiley Eye Center.”

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Simulator evaluates how eye diseases affect driving

Driving skills can be tested on conditions that would be too dangerous to test in reality.

The UC San Diego School of Medicine is the first ophthalmology department in the nation to feature a fully dedicated high-fidelity, highly realistic driving simulator for evaluating the effects of visual impairment on a person’s driving performance.

Located in the UC San Diego Shiley Eye Center’s new Visual Performance Laboratory, the simulator occupies an entire room. Drivers sit in an actual Ford Fusion cabin mounted on a motion platform and look out onto a realistic cityscape with road and traffic projected on large-screen panels covering a 180-degree field of view. The scenes interactively respond to the driver’s changes in direction and speed.

The car pitches, rolls and rumbles in response to acceleration, braking and road conditions. The three adjustable rear-view mirrors display images of what would be visible behind the vehicle.

Felipe A. Medeiros, M.D., Ph.D., professor of ophthalmology and the Ben and Wanda Hildyard Chair for Diseases of the Eye, and colleagues plan to use the simulator to investigate how eye diseases, such as glaucoma and age-related macular degeneration, alter a person’s visual performance and ability to drive well and safely.

Glaucoma is the leading cause of irreversible blindness and visual impairment in the world, and it is believed that people with glaucoma are more likely to be involved in motor vehicle accidents.

“We know that standard visual acuity or visual field tests may not provide enough information to evaluate whether a person is capable of driving safely,” Medeiros said. “The driving simulator will allow us to assess visual performance in a realistic and demanding scenario, providing a much better evaluation of the impact of eye diseases on driving fitness.”

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Retired physician creates a legacy with endowed faculty chair

UC San Diego Shiley Eye Center establishes Hollander chair.

Dr. Trude Hollander with Dr. Don O. Kikkawa

The Department of Ophthalmology at the UC San Diego School of Medicine will establish a new endowed chair thanks to a legacy gift from Trude Kahn Hollander, M.D. A longtime friend of the UC San Diego Shiley Eye Center, which houses the department, Hollander has made arrangements in her estate plan to fund the Dr. Trude K. Hollander Endowed Chair. The endowment will support a faculty member in the Division of Ophthalmic Plastic and Reconstructive Surgery.

“We appreciate Dr. Hollander’s generosity for choosing the UC San Diego Shiley Eye Center to leave her lasting legacy toward our future growth, innovation and success,” said Robert N. Weinreb, M.D., director of the Shiley Eye Center.

Recognized internationally as a leader in patient care, teaching and research, the UC San Diego Division of Ophthalmic Plastic and Reconstructive Surgery has pioneered operations and techniques that have become the standard in the field of oculofacial plastic surgery — a specialty that focuses on disorders of the eyelids, orbits, face and lacrimal system. The establishment of the Dr. Trude K. Hollander Endowed Chair will help the division to attract and retain a leading faculty member in this specialty. At UC San Diego, endowed chairs created by philanthropic gifts provide chair holders with funding support for teaching and research. As endowments, these funds live on in perpetuity.

Hollander first became aware of the division’s work when she came to the Shiley Eye Center as a patient in the late 1990s. She got to know Don O. Kikkawa, M.D., chief of the Division of Ophthalmic Plastic and Reconstructive Surgery, and they remained close friends.

“Dr. Don Kikkawa is and always has been the perfect example of a true physician who makes a difference,” said Hollander. “He has an extraordinary pair of hands and eyes which bring healing for the most complicated and rare eye conditions. He has been my idol from the moment I met him.”

Hollander completed her medical degree in Bonn, Germany, in 1936; she was one of four women to graduate in a class of 120. She left Germany before World War II to complete her internship at Mount Zion Hospital in San Francisco, then moved to Massachusetts and became board certified in gynecology. She met her late husband, Alfred, a prominent dermatologist, while practicing in Springfield. Hollander enjoyed a 45-year career in medicine before the couple retired to San Diego in 1979. This year, she celebrated her 104th birthday.

“Trude is an extraordinary person,” said Kikkawa. “Her grace, beauty and generosity are unparalleled. I have been extremely blessed to be her friend and am so touched and grateful for her kindness.”

At UC San Diego, the Office of Gift Planning offers a variety of ways to make an impact and create a legacy on campus. From including a bequest in a will or living trust, to designating UC San Diego as a beneficiary of a retirement account, to making a gift of an appreciated security that will provide income for life, planned gifts can help individuals achieve financial as well as philanthropic goals. To learn more, visit giftplanning.ucsd.edu. For more information about the UC San Diego Shiley Eye Center, visit shileyeye.ucsd.edu.

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UC Davis, Orbis partner in telemedicine initiative

Alliance will work to treat, prevent blindness in the developing world.

Today, UC Davis Health System and Orbis International, a leading global non-governmental organization (NGO) that works to eliminate avoidable blindness, signed an agreement of cooperation that will expand the use of telemedicine technology to help treat and prevent blindness in the developing world.

The new alliance, which features the expertise of the UC Davis Center for Health and Technology and the UC Davis Eye Center, paves the way for developing new research, education and telehealth collaborations to advance vision science and eye care on a global scale.

The World Health Organization estimates that 285 million people are visually impaired worldwide. This includes 39 million individuals who are blind and 246 million who have low vision. About 90 percent of the world’s visually impaired live in developing countries, and 80 percent of all cases of visual impairment can be avoided or cured. These include refractive errors, cataracts and glaucoma, the leading causes of visual impairment worldwide.

Through the agreement, UC Davis specialists in telemedicine, information technology, ophthalmology, anesthesiology and nursing will work with Orbis on initiatives such as  staff development, fellowships and programs on the Orbis Flying Eye Hospital — a fully equipped mobile teaching hospital on board a DC-10 jet. Trainees will have opportunities for hands-on training in the UC Davis Center for Health and Technology simulation center and Orbis’s telehealth program for real-time surgical demonstrations.

“Orbis is honored to join in this agreement with the UC Davis Eye Center,” said Jenny Hourihan, president and chief executive officer of Orbis. “UC Davis is such an impressive partner and dedicated in helping to make quality eye health accessible while advancing programs and technology used in eye health worldwide. We are excited to collaborate and share tools and resources to expand the reach and influence that telehealth has in preventing and treating avoidable blindness.”

The project includes establishing telehealth links that will transmit live broadcasts of eye surgeries at UC Davis to virtual classrooms in remote regions in the developing world with the opportunity for trainees thousands of miles away to ask questions of surgeons in real time. It also will explore live e-consultations with partners around the world and further Orbis’s ongoing efforts to establish an open-source ophthalmic electronic medical record system, which will help develop a more robust e-health infrastructure, provide access to increased decision-making support and offer researchers a wealth of global data.

“Advances in telecommunications technologies and broadband capacity in developing countries has created new opportunities to improve training for physicians, nurses and other members of the health care team and expanded access to health care services among the world’s most vulnerable populations,” said Thomas Nesbitt, associate vice chancellor for strategic technologies and alliances at UC Davis. “By partnering with Orbis, a recognized pioneer in establishing sustainable, quality eye health care worldwide, we are leveraging UC Davis’ expertise in telehealth and distance learning to have a profound impact on global health.”

Orbis works to bring quality eye care to communities by building capacity with local partners to develop infrastructure, trained staff and, ultimately, sustainable eye care services. Since 1982, Orbis has carried out programs in 92 countries, enhanced the skills of more than 325,000 eye care professionals, and provided medical and optical treatments to more than 23.3 million adults and children. Since 2006, nearly 20 UC Davis faculty and staff have participated in 14 medical missions, traveling to China, Vietnam, Peru, Indonesia, India, El Salvador, Ethiopia, Zambia and Panama.

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Saving diabetics from blindness in Libya

UC Berkeley grad student, professor, alum join forces in international public service project.

UC Berkeley optometry student Fatima Elkabti and professor Jorge Cuadros discuss a magnified digital image of a healthy retina.

A UC Berkeley graduate student in optometry, one of her professors and a Berkeley alumnus have joined forces to build a long-distance diagnostic project that has the potential to keep a large number of people in crisis-torn Libya from going blind.

The public service project involves training Libyan doctors to take detailed digital photographs inside patients’ eyes, of their retinas, as part of routine health care and put the images online for remote diagnosis of damage caused by diabetes before it’s too late. Too often, diabetes-related retinopathy isn’t caught until it causes symptoms, when treatment can no longer save vision.

The first 11 Libyan doctors underwent training for three days in February in Istanbul, in a seminar organized by the Avicenna Group and taught by Berkeley optometry professor Jorge Cuadros. Turkey was chosen as the training site for security reasons and because it is easily accessible from Libya.

If all goes according to plan, many more doctors will be trained over the next year, both in Libya and out — all because of a project that developed rapidly from a seed planted in a Diabetic Health Clinic class in Berkeley’s School of Optometry.

In the class, Cuadros taught students how to analyze photos of diabetic retinopathy as part of EyePACS, the California-based online initiative he co-founded to train people working in diabetes care to screen patients’ vision for remote diagnosis by certified eye doctors.

In his class was third-year optometry student Fatima Elkabti, who knows firsthand the toll that diabetes is taking in Libya, where the disease is rampant but greatly underdiagnosed. Elkabti’s father, a Libyan, has diabetes, as do about half of her many aunts and uncles.

“I walked out of the class and asked Dr. Cuadros, ‘Can we do this in Libya?’ “ Elkabti relates. Do some research, the professor told her.

Elkabti got to work and within an hour found Ethan Chorin, who earned his Ph.D. at Berkeley in 2000, served in the U.S. diplomatic corps in Libya from 2004 to 2006 and has published a book about the recent Libyan revolution. He founded the not-for-profit Avicenna Group in 2011 with a Libyan-American colleague to catalyze health-related partnerships between Libyan organizations and U.S. universities. Traveling back and forth between Benghazi and Berkeley, he looked for ways to involve Berkeley in Libya’s reconstruction efforts.

“I shot Ethan an email, and within hours we were talking about how to make this happen,” Elkabti says. The Berkeley-Libya retinopathy project was off and running.

Diabetes-related retinopathy is one of the leading causes of blindness in Libya — as well as in the United States and in much of the world. EyePACS has brought retinal screenings to poor and medically underserved areas from California’s Central Valley to Peru, and the Libyan retinopathy project extends the concept to politically unstable and dangerous regions.

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