Evidence for Brain-Eye Connection Could Spark New Glaucoma Treatment

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A recent study reveals a new feedback pathway from the brain to the eye which regulates eye pressure, and this could promote new glaucoma treatments.

Glaucoma is associated with elevated eye pressure due to a reduced ability of the eye to regulate fluid drainage. Excess fluid in the eye causes increased pressure, which can damage the optic nerve over time. This is known as open-angle glaucoma, the most common form of glaucoma in the United States.

Brain Pressure Affects Eye Pressure

A team of neuroscientists from the University of South Florida conducted a study that proves there is a physiological connection between eye pressure and intracranial pressure (brain pressure). The researchers proved this by “altering intracranial pressure in animal models and noting changes in the fluid drainage properties of the eye that could be blocked by chemicals that eliminate feedback signals from the brain” (Science Daily).

The team found the eye was able to adapt to intracranial pressure changes to restore a healthy pressure differentiation across the optic nerve.

Chris Passaglia, PhD, professor of Medical Engineering at the University of Florida, said, “The drainage control system may service to protect the optic nerve from swings in eye or brain pressure. Its discovery offers a new target for glaucoma treatment. . .” Dr. Passaglia hopes the study can be instrumental in developing new treatments for lowering eye pressure in glaucoma patients and halting glaucoma progression.

Now, the researchers are attempting to verify the exact location of the brain cells that are transmitting messages to the eye, as well as pinpoint the nerve fibers in the eye that the brain mediates.

What Factors Influence Glaucoma Risk?

Glaucoma affects more than three million Americans, but only half are aware they have the disease. Do you know your glaucoma risk? Glaucoma usually does not have symptoms in the early stages, but it can cause permanent vision loss before any warning signs appear.

These are a few risk factors for glaucoma:

  • Age 45 or older
  • Family history of glaucoma
  • History of injury to the eye
  • African American
  • History of steroid use, either in the eye (drops) or systemically (orally or injected)
  • Diabetes
  • Nearsighted (myopic)
  • Farsighted (hyperopic)
  • History of elevated intraocular pressure

What is a Comprehensive Eye Exam?

The best protection against glaucoma is routine comprehensive eye exams. Your ophthalmologist will perform a glaucoma test as well as evaluate your vision for focusing problems, refractive errors and common eye diseases.

Call your ophthalmologist today schedule a comprehensive eye exam for the whole family. Your vision is a precious gift that requires regular care.

Ask Your Doctor About Correct Timing for Knee Replacement

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A new study found most patients who need a knee replacement are waiting too long and are missing out on the benefits of total joint replacement.

Knee replacement is one of the most successful procedures performed today, and it is effective to relieve pain and improve mobility. Doctors perform almost one million knee replacements every year. The average age of a patient scheduling total knee replacement is 70 years of age, and about 60 percent are women. Even though knee replacement is safe and produces good results, a new study from Northwestern Medicine claims patients are not scheduling their knee replacement at the optimum time.

Hassan Ghomrawi, associate professor of surgery at Northwestern University Feinberg School of Medicine, led the study which analyzed more than 8,000 participants who had knee osteoarthritis or were at risk for the condition. Ghomrawi found 90 percent of patients with knee arthritis waited too long to have knee replacement and were not reaping the benefits of surgery. Also, 25 percent of patients who did not even need knee replacement were scheduling surgery too early. Ghomrawi asserted correct timing is essential to maximize effectiveness of total knee replacement.

Problems With Delaying or Rushing Knee Replacement

“People are waiting and waiting to have the procedure and losing the most benefit,” Ghomrawi stated. “When people wait too long, two things happen. The osteoarthritis causes deterioration of their function. Some of them wouldn’t be able to straighten out their legs, affecting their walking and mobility. When you can’t get exercise, you can start to develop other health problems such as cardiovascular problems. You may also become depressed. The overall impact can be huge.”

The study also found race affected patients’ decisions regarding timing of knee replacement. African-American patients were more likely to delay total knee replacement than Caucasian patients.

Scheduling knee surgery too early could mean patients may need to have a second surgery later in life, which could increase risk for less favorable outcomes and longer recovery time. The best timing for total knee replacement is based on a combination of factors such as age, joint function, pain and radiographic assessment.

Ghomrawi said doctors must make sure the timing of total knee replacement is optimal to offer patients the greatest benefit and keep healthcare costs manageable. “Because knee replacement is an elective procedure, the timing of surgery is susceptible to not just clinical factors but also demographic, socioeconomic and sociocultural ones,” Ghomrawi explained. “We need to develop a better understanding of these factors to improve timing of surgery.”

Schedule a Visit to Your Doctor

Are you interested in total knee replacement? Correct timing is essential. Make an appointment with your doctor so you can discuss the best timing for your surgery. Knee replacement surgery can help you regain your independence by alleviating pain and increasing your mobility, but talk to your doctor to make sure you are scheduling it at the optimum time.

Weston Outpatient Surgical Center Brings Total Joint Replacements to the Center

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Each year, more physicians and patients are choosing the ambulatory surgery center setting for total joint replacements. At-home recovery, lower costs and reduced risk of hospital-acquired infections are some of the drivers for this change in setting. In line with the trend, more of our centers are bringing total joint procedures to the facilities. Weston Outpatient Surgical Center in Weston, Florida, is one of the latest to begin performing total joint procedures.

“We made total joints a priority at the center, and with preparation, we were able to perform four procedures in the fourth quarter of 2019,” explained Estella “Stella” Castoreno, Center Leader at Weston. “I am a recent hire at Weston and bring several years of experience in total joints. I made a stretch goal for myself to bring joints to Weston Outpatient Surgical Center as my first quarter initiative.”

Pairing Stella’s own experience with a highly motivated staff, Weston established a special total joints committee to begin the preparations for the new procedures. “We had many comprehensive meetings with the staff, equipment representatives and surgeon. We also created a dictionary with a list of questions and responses so that every person involved in the procedures would be aligned with the overall goals and objectives in joint procedures. The staff, physicians and vendors aligned with one vision.”

Another factor in preparing to bring total joints to the center is ensuring the patients are right for the setting. A pre-telephonic assessment of the patient history and living accommodations were a top concern for the committee. The patients must meet the criteria for an outpatient joint. While there is a significant focus on patient selection, having a high-caliber orthopedic surgeon is even more important. Stella, said, “A successful joint program requires the right patient and right surgeon.”

Preparing for total joints at the center also required the commitment of every member of the 80+ person team. In addition to the special committee that focused on the new procedures, the staff not directly involved in total joints significantly helped by maintaining operations for the center’s regular volume, 600 cases annually.

As a new leader at the center, the preparation for the total joint procedures was also Stella’s time to get better acquainted with her staff and surgeons. “I approached it as taking it back-to-basics. We went through mock procedures with every bit of equipment and supplies needed for the case.  I even included the vendor representative in our mock case,” Stella said. “One of our techs played the role of patient. We had a lot of fun preparing for the procedures.”

“I encouraged the staff to see themselves as travel agents. Our patients expect to get through the joint replacement journey and back home refreshed with even more pep in their step,” explained Stella.

Weston’s first total joint patient had an opportunity to tour the center and meet every person who would interact with the case, from the billing office, registration clerk, nursing staff (pre-admission testing, pre-op, PACU and O.R.), scrub technicians, anesthesia team, physical therapist and administrator. This helped ensure the patient was comfortable when returning on the day of surgery.

Stella encourages centers considering adding total joints to make it relatable to the staff and to consider the three pillars — patient, staff and physician.

  • Patient – Personalize the goal with the patient. A great question is “What did you like to do prior to your knee weakness (walk the mall, plant flowers, etc.)?” Keep in mind, patient(s) don’t measure their quality of life by “ambulating 20 feet.”
  • Staff – To be successful, you must have complete buy-in from everyone at the center. Procedures can become transactional, so we must always take on the opportunity with the goal of creating exceptional experiences for the patients.
  • Physician – A highly skilled, reputable surgeon is just as important. Encourage surgeons to transition to outpatient by using the patient criteria screen tool in an acute care setting.

With four successful total joint replacements completed, Weston plans to continue to expand its total joint procedures. “We thank Dr. Mario Berkowitz, Dr. Alexander Bertot and Dr. Thomas Riley for trusting us to care for your patients. It is a great honor,” Stella concluded.

Touching Hands Project Surgery Day

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OAA’s Hand Surgeons came together to volunteer with the Surgical Center of Allentown, Anesthesiologists from Northeastern Anesthesia Physicians, PC., and Hand Therapists from the Institute for Hand & Upper Extremity Rehabilitation to serve Veterans and uninsured residents of the Lehigh Valley and surrounding community.

Click here to read more.

Rheumatoid Arthritis Associated With Other Chronic Diseases

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A new study says rheumatoid arthritis is associated with other diseases like diabetes and heart disease, irritable bowel disease (IBD), sleep apnea and blood clots.

Rheumatoid arthritis, often known as RA, is a disease of the joints that is characterized by pain and inflammation. About 1.5 million Americans have RA, and women are three times more likely to develop the condition than men.

RA can cause many symptoms unrelated to the joints such as fatigue, weight loss and fever, and it can lead to many complications throughout the body.

A study by the Mayo Clinic found people who already had chronic diseases like Type 1 diabetes, blood clots or inflammatory bowel disease may be more likely to develop RA. The study also found patients with RA are more susceptible to developing blood clots, heart disease and sleep apnea.

Vanessa Kronzer, M.D., a rheumatology clinician investigator fellow at Mayo Clinic, was the corresponding author of the study. She said chronic health issues “accumulate in an accelerated fashion after diagnosis of rheumatoid arthritis.” Autoimmune diseases and epilepsy can make individuals more prone to RA, and RA could be a precursor to heart disease and other systemic disorders.

One of the most significant findings of the study was that there was a strong correlation between patients with Type 1 diabetes developing RA. This could help doctors be vigilant in looking for signs of RA in patients with autoimmune disorders. Blood clots were also common in RA cases before diagnosis. This leads researchers to conclude systemic inflammation might begin before RA symptoms manifest.

“Our findings suggest that people with certain conditions, such as Type 1 diabetes or inflammatory bowel disease, should be carefully monitored for rheumatoid arthritis,” Dr. Kronzer explained. “In addition, people who have rheumatoid arthritis, and their health care providers, should have heightened suspicion and a low threshold to screen for cardiovascular disease, blood clots and sleep apnea.”

Symptoms of Rheumatoid Arthritis

Call your doctor if you develop warning signs of rheumatoid arthritis. These may include:

  • Joint pain, swelling, stiffness or tenderness for six weeks or longer
  • Morning stiffness in the joints for 30 minutes or longer
  • Pain and stiffness in corresponding joints (right and left hands, right and left wrists, etc.)

Undiagnosed RA increases the risk for other chronic diseases, so make an appointment with your doctor if you are experiencing joint problems. Early diagnosis of RA will lead to quick intervention and can prevent other chronic illnesses.

New Study Finds Air Pollution Affects Glaucoma Risk

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A new study from University College London suggests living in more polluted areas increases risk for glaucoma, a common cause of vision loss.

The study, led by Paul Foster, Ph.D., professor of ophthalmic epidemiology and glaucoma studies at UCL Institute of Ophthalmology and Moorfields Eye Hospital, examined data from 111,000 people across Great Britain who had their eyes examined between 2006 to 2010. The researchers found people who lived in the top 25 percent most-polluted areas were at least six percent more likely to say they had glaucoma than people in the least polluted areas.

Particulate Matter and Air Quality

Air quality is measured by amounts of particulate matter, the sum of all solid and liquid particles suspended in air molecules. Particulate matter can include pollen, dust, smoke, soot, and both organic and inorganic particles.

Poor air quality increases risk for lung and heart disease, stroke, Alzheimer’s disease and Parkinson’s disease. In fact, exposure to particulate matter is one of the strongest predictors of mortality due to air pollutants.

Few studies analyze the relationship between pollution and glaucoma. However, ninety percent of the Earth’s population breathes air that is above the World Health Organization’s limits for air pollution.

Air Pollution and Glaucoma

People who lived in more polluted areas were also more likely to have a thinner retina, a typical symptom of glaucoma progression. Pollution did not seem to affect inner eye pressure, the mechanism researchers usually associate with glaucoma progression. The team concluded air pollution must influence glaucoma development through a different route.

The researchers were not sure why particulate matter increased glaucoma incidence. Sharon Chua, Ph.D., a research fellow at the UCL Institute of Ophthalmology and Moorfields Eye Hospital suspected, “Air pollution may be contributing to glaucoma due to the constriction of blood vessels, which ties into air pollution’s links to an increased risk of heart problems. Another possibility is that particulates may have a direct toxic effect damaging the nervous system and contributing to inflammation.”

Glaucoma Risk Factors

According to the Glaucoma Research Foundation, more than three million Americans have glaucoma but only half are aware they have it. Often, there are no warning signs, and patients can suffer permanent vision loss before they notice any glaucoma symptoms. For this reason, glaucoma is nicknamed “the sneak thief of sight.”

Besides air pollution, many glaucoma risk factors can increase the likelihood of developing the disease. These may include:

  • High eye pressure
  • Family history of glaucoma
  • Older age
  • Thin cornea

Take a moment to complete our Glaucoma Risk Assessment. In a matter of seconds, you can find out whether you are at elevated risk for vision loss.

Make a Comprehensive Eye Exam Appointment

At your annual comprehensive eye exam, your ophthalmologist will evaluate your vision health and test your eyes for degenerative conditions like glaucoma, cataracts and macular degeneration. Do not wait for glaucoma symptoms to appear before you make an appointment for an eye exam. Good vision requires regular maintenance, so call your doctor to schedule a full eye examination.

Physicians Play a Key Role in Colon Cancer Screening Rates

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According to a study in Ontario, Canada, you are more likely to get a colonoscopy if your family doctor has undergone screening.

The Centers for Disease Control estimates that one out of three American adults who are due for colorectal cancer screenings are not getting screened. There can be many reasons patients avoid preventive colonoscopy screenings. Patients may neglect colorectal cancer screenings because they:

  • Do not carry health insurance
  • Have limited contact with or do not have a primary care physician
  • Have not been advised by their primary care physician to be screened
  • Lack the proper information on how to be screened

When Physicians Get Screened, Patients Get Screened

Amit X. Garg, M.D., Ph.D., and fellow research colleagues at Western University in Canada administered a population-based study that sought to find a connection between colorectal cancer screening rates among physicians and their patients in Ontario, Canada.

Dr. Garg found that the colonoscopy rate was 67.9 percent among physicians and 66.6 percent among patients. The research team found patients were more likely to comply with colonoscopy when they were aware that their family doctors had undergone colonoscopy screenings themselves.

The study suggests family doctors have a significant influence on their patients’ decision to get screened for colon cancer. If doctors disclose that they have already chosen colon cancer screening, their patients will be more likely to follow their example.

“Conversely, many physicians report difficulty counseling patients about behaviors they do not practice themselves,” the researchers stated in their report. “Given the clear benefits of colorectal cancer screening, programs that promote greater screening in physicians warrant consideration.”

Make Your Colonoscopy Screening Appointment

A colonoscopy is one of the most effective preventive screenings because it stops colon cancer before it starts. During a colonoscopy, the doctor can carefully inspect the entire colon lining for polyps and can remove any suspicious growths so they do not become cancerous. No other colon screening offers the protective benefits of colonoscopy. This screening is also effective in diagnosing digestive disorders like diverticulitis, diverticulosis, Crohn’s disease and ulcerative colitis.

Make an appointment today for a colonoscopy and make your digestive health a priority this year. A few hours can offer up to ten years of protection against colon cancer, so call your gastroenterologist.

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Will Smith, Colonoscopies and Colon Cancer Myths

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You may think you do not need a colonoscopy because you feel healthy. Will Smith made the same assumption, but he was wrong.

Will Smith Makes Colonoscopy Vlog for Fans

Smith, 51, was a little late in scheduling his first colonoscopy. The U.S. Preventative Services Task force recommends adults begin colon cancer screening at age 50, but African Americans should get screened earlier. In fact, the American Cancer Society suggests colon cancer screening for all adults at average risk for colon cancer should begin at age 45 because young onset colon cancer incidence has steadily increased each year.

As a joke, Smith decided to create a colonoscopy vlog for his YouTube channel. He felt perfectly healthy, and he thought his video would amuse his fans. “I’m 50,” he said, “so people need to look up my stuff.”

After the procedure, Smith thought everything was normal. A few days later, he received a phone call from his gastroenterologist, Dr. Ala Stanford, saying he had a “tubular adenoma with precancerous tissue.” The doctor explained to Smith that he had a type of precancerous colon polyp, a small abnormal growth in the colon. She said many people have the faulty assumption that colon disease always has noticeable symptoms.

“Had you not known, it continues to grow and grow and grow,” Dr. Stanford said. “And African American men in particular, the right colon is where cancer is high. … You would’ve had fewer typical symptoms. And by the time you presented, it could be full-blown and spread throughout your body.”

Smith said, “You know, when I decided I wanted to shoot this as a vlog, it was much more, ‘Hey, this will be cool. This will be fun.’ I didn’t realize that there would be a precancerous polyp that would get found out of it.”

Common Colon Cancer Myths

Today, colon cancer is the third-leading cause of cancer death in the United States. However, most cases of colon cancer are preventable with routine screening. Unfortunately, many Americans believe common myths about colon cancer like these:

Colon Cancer Myth Colon Cancer Truth
“Only older people get colon cancer.” No age is too young to develop colon cancer.
“All colon cancer screenings are the same.” Only colonoscopy can inspect the lining of the colon and remove precancerous polyps. It is the only screening that prevents colon cancer.
“Colon screening is too expensive.” Preventing colon cancer is less expensive than treating colon cancer, and most colon screenings are covered by insurance.
“Colonoscopies take too much time.” A colonoscopy appointment only takes a few hours.
“I feel fine. I do not have colon cancer.” Some colon cancer only shows symptoms in late stages.

Avoid falling prey to these colon cancer myths. Follow Will Smith’s example, call your gastroenterologist and get screened today.

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Ideal Blood Pressure Range and Glaucoma

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A 2018 study suggests blood pressure that is not too high or low could help reduce the risk of glaucoma, a common cause of vision loss and blindness.

Researchers have known that blood pressure and glaucoma are connected. Hypotension, or low blood pressure, is a risk factor for open-angle glaucoma. High blood pressure, or hypertension, is another known glaucoma risk factor. A study published in the American Journal of Hypertension suggests maintaining a blood pressure that is somewhere in the middle is best for preventing glaucoma. Scientists refer to this optimum blood pressure range as the “Goldilocks scenario.”

What is the Optimum Blood Pressure Range?

The study included more than 4,000 participants ages 40 or over from the 2005 to 2008 National Health and Nutrition Examination Surveys (NHANES). Standard blood pressure readings are measured in milligrams of mercury (mmHg), with the diastolic blood pressure reading on top and the systolic blood pressure on the bottom.

Glaucoma incidence increased when the systolic blood pressure (the reading on bottom) was greater than or equal to 161 mmHg or less than or equal to 110 mmHg. In other words, having high or low blood pressure increased glaucoma incidence.

Patients with diastolic blood pressure between 81 mmHg and 90 mmHg and systolic blood pressure between 111 mmHg and 120 mmHg were the least likely to develop glaucoma. This blood pressure range is referred to as the “Goldilocks scenario.”

What is Your Glaucoma Risk?

Everyone has an ideal blood pressure, so your optimum blood pressure range may be too high or too low for someone else. The best way to prevent glaucoma is to schedule routine comprehensive eye exams with your eye doctor. Your doctor will perform many tests during your exam to evaluate your eye health, and one of these is a glaucoma test.

In the future, eye doctors may include blood pressure readings as part of glaucoma evaluation. This measure may prove to be a simple, quick method of determining one of many risk factors for glaucoma. Other glaucoma risk factors include:

  • Family history of the disease
  • Diabetes
  • Eye injury or eye surgery
  • Severe myopia (nearsightedness)
  • Steroid use

Most eye conditions do not show symptoms in early stages, so it is imperative to visit your eye doctor regularly for healthy vision. Along with having yearly eye exams, you should also have annual well visits with your primary care physician for routine checks, preventative screenings and lab work.

If it has been more than a year since your last comprehensive eye exam, call your ophthalmologist today to schedule an appointment.