Retina Institute of Hawaii - Experts Blog

RIH Hopes to Speed Vision Recovery Time Using Stem Cells.

Tue, 09 May 07:55:10 +0000

Our challenge is to find a way of encouraging adipose-derived stem cells to differentiate into two different kinds of retinal cells and potentially use these to improve outcomes in our retinal transplant surgeries. It is difficult to open a newspaper or magazine these days without seeing an article about stem cell research. There is a great deal of excitement surrounding these amazing cells that seem to have unlimited potential to help treat many different diseases. Most of the excitement centers on scientific research in this field. There is a great deal of hope from both patients and researchers that potential new therapies for restoring vision will be available in the not-so-distant future. Against this scientific and political backdrop, let us explore briefly the different types of stem cells that are currently being investigated and how these might help treat diseases of the retina. Basically, there are two types of stem cells.1 The first, embryonic stem cells, are the cells that have created so much ethical debate. These cells typically come from embryos created by in vitro fertilization, or IVF, which uses human eggs and sperm that are combined outside of the body in a laboratory in order to produce fertilized eggs that can then be put into the mother’s womb. In order to increase the chances of success, these fertilized eggs are typically produced in sufficient numbers to allow an extra supply that can be frozen for later use. As a result of this process, there are leftover embryos like these in just about every location that does IVF. Scientists can use these leftover fertilized eggs to extract an inner core of cells that can multiply indefinitely. These embryonic stem cells can theoretically be induced to develop into any of the 200 different types of human tissue. The second type of stem cell is called the adult stem cell. As the name implies, adult stem cells exist naturally in the adult human body. They can be taken from various tissues that regenerate themselves on a regular basis. This includes such tissues as the blood, bones, skin and lining of the gut. They have also been found in other seemingly unlikely places such as thebrain and fat tissue. There are no ethical considerations involved with the use of adult stem cells because human embryos are not required. They can be removed from and used in the same patient, in which case there is no need for any kind of therapy to prevent the patient from rejecting tissue, as is usually needed with the use of tissue from a different person. Researchers at the University of Washington in Seattle have been able to develop a highly successful method to coax human embryonic stem cells into becoming retina cells. These then further develop into functioning photoreceptor cells after being transplanted into a living mouse model.2 Whether this can be done in humans is yet to be seen. However, progress in this field is certainly very encouraging for patients with degenerative eye conditions leading to severe visual loss, such as macular degeneration and retinitis pigmentosa. Here at RIH, efforts are currently under way to make adipose-derived stem cell therapy available to a select group of macular degeneration patients in Hawaii. This project is being conducted in conjunction with a local stem cell biotech company that has developed its own method for harvesting adult adipose stem cells from patients and using these cells for a variety of stem cell based interventions. Our plan is to use this technology in combination with Retinal Pigment Epithelium (RPE) transplant surgery, a procedure that Dr. Michael Bennett has been performing for the past decade. The basic idea of this surgery is to take functioning RPE from an area of healthy retina and slip it underneath the area of retina that is being affected by macular degeneration. Dr. Bennett has been performing this intricate surgery with growing success as the technology and instrumentation for this procedure continue to evolve. Early RPE transplant surgeries used to take upwards of one and a half to two hours to perform and the collateral damage that occurs for that duration of a retinal surgical case, regardless of the complexity, was simply unacceptable. Our typical transplant surgery is now performed in a fraction of the original time. Now, RIH is poised to take this therapy to an entirely new level. What we envision is a two-step process. First, patients undergo a small, outpatient liposuction procedure during which stem cells from the patient’s own extra fat are harvested and prepared for use in retina surgery. These stem cells can be kept viable for several weeks, which would allow for convenient scheduling of a second outpatient procedure, during which the patient’s own stem cells would be injected underneath the retina along with the patient’s own RPE transplant. Initial results from RPE transplants alone have already indicated that patients are noticing steady improvement in the quality of their central vision following surgery, and our hope is that using adult stem cells in combination will increase the viability of the transplant and lead to additional improvement in vision. RIH is the only research center currently undertaking this kind of research and we expect that a pilot study involving macular degeneration patients will be starting up within the next few months. But this kind of therapy is not limited to treating macular degeneration. Our goal is to further develop this adjuvant cellular therapy for other vision threatening conditions, like macular holes, epiretinal membranes, retinal detachments, vascular occlusions and hereditary conditions like retinitis pigmentosa by: Clifton S. Otto, MD References: 1. http://dels.nas.edu/bls/stemcells/basics.shtml 2. Lamba, D. A. et al. Cell Stem Cell 2009;4(1):73–79.

Systemic Treatments

Wed, 20 April 07:55:10 +0000

Since opening its doors in 2001, Retina Institute of Hawaii has worked hard to become the leader in treating sight-threatening diseases throughout the Pacific region. Being a leader requires passion and commitment, and from day one we’ve served as an enthusiastic incubator for clinical trials and new technology. According to Moore’s law, technology doubles every 12–18 months. As technology expands, so, too, do our treatment options. Today, we offer patients cutting-edge treatments for diseases of the retina and vitreous, including retinal diabetic retinopathy, age-related macular degeneration and detachment, as well as many other complex ocular conditions. Leaders also inspire others. At RIH, we’ve made it a priority to foster the next generation of retina specialists, teaching fellows, residents and medical students in order to disseminate knowledge and give back to the medical community at large. A WORLD LEADER From our office in the middle of the Pacific, RIH is now recognized as one of the world’s foremost retina clinics, seeing patients from around the globe. In just nine years, we have become one of the largest centers in the country and a world leader in research and clinical trials. We design FDA-approved protocols to evaluate new treatments and reach out to the community with education. We also helped create the nationally recognized Pacific Alliance of Retinal Specialists (PARS), a research consortium with retina specialists in Hawaii, Los Angeles, Beverly Hills, Sacramento and Phoenix. NEIGHBOR ISLAND OUTREACH All of us at RIH believe in giving back to our community, not only on Oahu, but throughout Hawaii. We maintain offices in Kailua-Kona and Hilo on the Big Island, and in Kahului on Maui, visiting these offices each week. We also give back through our nonprofit, Project VISION, our mobile vision screening unit, as well as through alliances with community-awareness groups like the Lions Club and American Diabetes Association. The gift of sight is priceless, and we’re working diligently to preserve this gift for patients throughout the islands. THE EYE AND SYSTEMIC DISEASE In many cases, patients will visit their primary care doctor or optometrist, who will then refer their patient to us if they suspect a retinal problem. This network of referring doctors is an invaluable asset. They can sometimes make the difference between a patient losing his or her sight, or saving it, or preventing even more serious health complications. They can even save lives. Educating patients is a top priority for us. Using innovative imaging technology, we’re able to discuss the cause of their vision loss and counsel them and their families about the available treatment options. Often, we’re examining not just the eye but the entire person. That’s because many of the diseases we encounter are the result of a more systemic problem, such as diabetic retinopathy in patients with diabetes. Getting their diabetes under control is critical to their health. We may also discover an eye problem that is a symptom of an undiagnosed illness. When that happens, we may send our patient back to his or her primary care physician for proper diagnosis and treatment. Our referral network works well because it works both ways. While our retinal specialists at RIH treat the problems in the eyes, the referring physician or medical specialist will treat the underlying disease.

Retina Institute of Hawaii Open House 2011

Tue, 19 April 07:55:10 +0000

On April 7, 2011, Retina Institute of Hawaii held their second annual Open House, which focuses on providing continuing education to local optometrists. Some of the latest research and procedures the Retina Institute of Hawaii’s doctors are performing were highlighted in a presentation for the nearly 100 optometrists in attendance. Systemic eye diseases and treatment were the main topic for this year’s presentation. The Retina Institute of Hawaii also debuted the newest edition of their Visionary journal at the open house event. Articles in the journal feature new research and the latest procedures being performed by the clinic’s doctors and testimonials from patients of the clinic.

Age-related Macular Degeneration (AMD)

Thur, 10 March 2011 07:23:10 +0000

What is Age-Related Macular Degeneration? Age-related macular degeneration (AMD) is a degenerative condition of the macula (the central part of the retina), and is the most common cause of vision loss in the United States in those 50 years and older. It is a disease associated with aging that gradually destroys sharp, central vision. In some cases, AMD advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to loss of vision in both eyes. Fortunately, macular degeneration does not cause total blindness, since it does not affect the peripheral retina and peripheral vision. The greatest risk factor for developing AMD is age. Other risk factors include smoking, obesity, race, family history (those with immediate family members who have AMD are at a higher risk of developing the disease), gender (women appear to be at greater risk than men) and low antioxidant levels (read more about the importance of nutrition on the following pages). What is the difference between dry and wet macular degeneration? AMD occurs in two forms: dry (generally, the less severe form) and wet (the more severe form). Dry AMD The majority (90%) of patients with AMD have the dry form of the disease. Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye. The most common sign of dry AMD is drusen. Drusen are yellow deposits under the retina. Some people see a blurred spot in the center of their vision. More light may be needed for reading and other tasks. In addition to drusen, a smaller number of people get advanced dry AMD, in which they have a breakdown of light-sensitive cells and supporting tissue in the central retinal area. This is called geographic atrophy. This breakdown can cause a blurred spot in the center of their vision. Over time, the blurred spot may get bigger and darker, taking more of their central vision. The natural history of dry AMD is that it is a slowly progressive disease. However, a number of factors increase the risk of progression of dry AMD. The dry form also can suddenly turn into the wet form, even during early-stage AMD. There is no way to tell if or when the dry form will turn into the wet form. Wet AMD About 10% of patients who suffer from macular degeneration have wet AMD. Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula occurs rapidly. With wet AMD, loss of central vision can occur quickly. An early symptom of wet AMD is that straight lines appear wavy. This results when fluid from the leaking blood vessels gathers and lifts the macula, distorting vision. A small blind spot may also appear in wet AMD, resulting in loss of one’s central vision. If you notice these conditions or other changes to your vision, contact your eye care professional at once. You need a comprehensive, dilated-eye exam. How is it Treated? Wet AMD can be treated with medications placed inside the eye, and sometimes laser surgery or photodynamic therapy. While these treatments are very effective, none of these treatments offers a complete cure for wet AMD. The disease and loss of vision may progress despite treatment. Wet AMD is currently treated with new drugs that are placed into the eye (anti-VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor, and is the most effective approach, requiring multiple treatments that may be given as often as monthly. Thankfully, new, less-time-intensive drug therapies and drug/radiation combination therapies are now in clinical trials. They show great promise to halt or slow the progression of AMD. Some of these innovative therapies are now being utilized at Retina Institute of Hawaii.

Seeing the Light

Thur, 10 March 2011 07:23:10 +0000

Just over five years ago, Danish artist and musician Aisha (Inger Birgitte) Holm was attacked in her apartment while working on a humanitarian mission in Jakarta, Indonesia. The incident left her blind in one eye and unable to read music or paint. Following this unfortunate incident, Aisha was in and out of surgeries in Denmark until the health system put a halt to her treatments. “It was a really scary time in my life. I had to move back to Denmark and have multiple surgeries on my eye. They helped a little, but I could barely see my artwork,” said Aisha. “I had so many surgeries that they decided they would no longer operate on my eye because of the costs. So I thought that was how I would live the rest of my life.” After her last surgery, the doctors in Denmark told her that there was nothing else they could do. Though physically difficult due to her limited vision, she continued to paint and make music, selling her CDs to make money to cover living expenses. It was a slow process until fate intervened and she met Reynold Feldman, a retired professor from the University of Hawaii and founder of the Aloha Medical Mission. Word spread far and wide, and it was soon thereafter that Feldman received a letter from Dr. Michael D. Bennett of Retina Institute of Hawaii. In his letter, Dr. Bennett volunteered to perform a much-needed surgery for free. After raising enough funds for the flight, Aisha traveled from Denmark and arrived in Hawaii on September 24, 2008. “I did not know what ‘aloha spirit’ meant before I came here, but I felt it before I even arrived,” Aisha said. “So many people helped bring me to Hawaii, and Dr. Bennett achieved something I never thought could happen.” Aisha received her first retinal detachment surgery from Retina Institute of Hawaii soon after her arrival, and immediately following her surgery she noticed a dramatic increase in vision, healing much faster than ever imagined. Ten days later, she had an additional operation to further improve her sight in the other eye, allowing her to regain reading and driving vision before returning to Denmark. Her doctors back in Denmark remarked, “What an amazing change! It was a good thing that you were able to go to Hawaii!” “Restoring Aisha’s vision was a joint effort by many in our community who possess the spirit of aloha,” said Dr. Bennett. Aisha’s restored vision was made possible through the efforts of Reynold Feldman, who raised funds to cover travel expenses; Worldster Lee, M.D., who donated the surgery center and team; and Jorge Camara, M.D., who performed all pre- and postoperative medical ophthalmology, visual calculations and exams. “It has been a truly incredible experience to receive such generosity from people I didn’t know,” added Aisha. “Strangers have literally opened their doors to me, and the spirit of aloha has been inspiring. I am looking forward to giving back to a community that has given so much to me.” A conservatory-trained musician, Aisha travels the world, teaching children about music and art while she composes music for stage productions; plays with various bands; and composes, sings and records her own music. A frequent traveler, she speaks five languages, including Danish, English, German, French and Spanish. On November 2, 2008, Aisha performed at a mahalo concert at Oahu’s Calvary by the Sea to say thank you to all those who helped shed light in her life and to bid aloha to an ‘ohana who helped her see the light.

Technology Inspired by Nature

Thur, 04 November 2010 07:23:10 +0000

The human eye is remarkable. It serves to focus an image of the external world onto the retina and then sends this information on to the brain, where it is interpreted as vision. The individual components of the eye work in a manner similar to a camera. Each plays a vital role in providing clear vision. The cornea behaves much like a lens cover. As the eye’s main focusing element, the cornea takes widely diverging rays of light and bends them through the pupil, the dark, round opening in the center of the colored iris. The iris and pupil act like the aperture of a camera, opening and closing, allowing more or less light into the eye, depending on external lighting conditions. Next in line is the lens, which acts just like the lens in a camera, helping to focus light onto the back of the eye. Note that the lens is the component that becomes cloudy with age. A cloudy lens is known as a cataract, and the lens is the part of the eye that is removed during cataract surgery. The very back of the eye is lined by a layer called the retina, which acts much like the film inside a camera. The retina, which is derived from the brain, is a thin layer of nerve tissue that contains photoreceptors (a type of nerve cell). Photoreceptors convert light rays into electrical impulses, which are then sent through the optic nerve to the brain, where an image is perceived. The central 10% of the retina is called the macula. It is responsible for your sharp vision, your reading vision. The peripheral retina is responsible for your peripheral vision, your side vision. As with a camera, if the “film” is “bad” in the eye (i.e., the retina is damaged or diseased), no matter how well the rest of the eye is functioning, you will not get a good picture. Interesting facts: INVERTED IMAGES: Light rays bend when they enter a camera so that an image ends up upside down on the film, a situation that’s corrected when the picture is processed. The same is true of the light rays that are focused onto the retina, but in this case, the brain actually does the work of correcting the upside down image for us. RODS AND CONES, AND PHOTOGRAPHIC PAPER: There are two types of photoreceptors that make up the retina - rods and cones. Rods cannot distinguish colors, but are responsible for low-light vision. They are more light-sensitive than cones. There are about 125 million rods per eye. Cones are responsible for color vision. They require brighter light to function than rods require. There are about 6 million cones per eye. The retina contains three types of cones, which are sensitive to different wavelengths of color. One type is dedicated to long “red” wavelengths, one type is dedicated to medium “green” wavelengths, and one type is dedicated to short “blue” wavelengths. The three types of cones work together to distinguish all the color variations we see in the world around us. Photography paper works in a way that’s similar to cones. There are three layers incorporated into every piece of photography paper (a red, a green, and a blue layer). Each is sensitive to the three different wavelengths of color. When a picture is developed on photosensitive paper, the different layers combine to create a seamless full-color image, just as the different types of cones in your retina combine to create a seamless full-color image for your brain. DIFFERENCES BETWEEN YOUR EYE AND A CAMERA: The human eye, like a camera, can view tones of gray and the various shades of color (unless a person happens to be color-blind). Both the eye and the camera can see near and far, judge size, register depth, and see movement. However, the human eye can only see in visible light. Specialized cameras, film, and digital photography can go much further by capturing images that are far beyond the eye’s capability. These cameras can show heat and X-ray images, or capture images too fast for the human eye, such as a bullet in mid-flight. Cameras can also be designed to view everything from the smallest particles up close, to the planets at extreme distances. Information cited from: Georgia State University HyperPhysics

IT TAKES MORE THAN JUST A CARROT A DAY

Tues, 04 January 2011 07:23:10 +0000

Though we grew up believing a carrot a day would help keep the ophthalmologist away, the colorful vegetable is not the only food choice for healthy vision. Certain vitamins, minerals and other micronutrients can help prevent or slow down the progression of eye disease. And although it’s important to add certain micronutrients to your diet, it’s also vital to cut some things out. The American Heart Association reports the average American consumes more than 72 pounds of sugar per year. This unhealthy lifestyle is leading many to develop diseases like diabetes, which can have devastating effects on vision, among other problems. “We see many diabetic patients with severe vision problems,” said Michael D. Bennett, M.D., F.A.C.S., “We want to give these and other people the tools to prevent these blinding complications, and a healthy diet is a basic tool that can have a big impact. We also need to remind people that a healthy diet does not always mean forgoing calories or fat, but consuming essential vitamins and other micronutrients that will support our bodies.” The Bottom Line: What you eat can impact your eye health, and future medical research will likely result in a better understanding of which nutrients are most important for preventing common eye diseases. AGE-RELATED MACULAR DEGENERATION Nutrients that may help high-risk patients with age-related macular degeneration (AMD): High-dose antioxidants (vitamins A, C and E) and zinc slow the development of advanced AMD. These micronutrients can most easily be obtained by using one of the over-the-counter AREDS-type “eye vitamin” supplements (the National Eye Institute AREDS [Age-Related Eye Disease Study] trial demonstrated the benefit of antioxidants in AMD), as it is nearly impossible to consume the AREDS level of antioxidant intake by diet alone. These supplements can be purchased at your local drugstore, grocery store and health food store or on the Internet. Note that those who are current smokers or who have smoked within the past 12 months should avoid beta-carotene in their supplements, as this may increase the risk for lung cancer. The normal human retina contains the xanthophyll carotenoids lutein and zeaxanthin, which protect the retina from inflammatory and oxidative damage, as well as from the damaging effects of ultraviolet (blue) light, by acting as scavengers of free radicals. Some studies suggest that decreased levels of these micronutrients increase the risk of AMD, so they are currently being conclusively studied in the ongoing AREDS-2 study. In the meantime, lutein and zeaxanthin can be found in various “next-generation” AREDS-type “eye vitamin” supplements, and using these supplements may make sense for patients at high risk of progression to advanced AMD. Dark green, leafy vegetables (spinach, kale, broccoli, etc.) and yellow fruits and vegetables (corn, peaches, persimmons, mangoes, etc.) are good sources of lutein and zeaxanthin. Omega-3 fatty acids are essential lipid components of photoreceptor membranes. Some recent studies have suggested that high consumption of cold-water fish (salmon, tuna, mackerel and sardines) rich in the omega-3 fatty acids EPA and DHA may lower the risk of AMD. Fish oil supplements may also be helpful in this regard. Finally, smoking has been shown to be a risk factor for development of AMD and its progression, so cessation of this habit is important. DIABETIC RETINOPATHY Nutrients that may help treat diabetic retinopathy: Keeping your blood sugar levels well controlled can help prevent complications of diabetes, such as diabetic retinopathy. If you have diabetes, your eating habits need to be changed in order to control overeating, make better food choices and lose weight. Consulting a dietician may help. Choose a diet that emphasizes vegetables, fruits and whole grains, because they have more vitamins, minerals and fiber. What You Need to Know Macular Degeneration: Age-related macular degeneration (AMD ) is a disease associated with aging that gradually destroys sharp central vision. It is the leading cause of vision loss and blindness in Americans ages 65 and older. AMD occurs when the macula degenerates. There are two forms of AMD : the wet form and the dry form. Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula occurs rapidly. Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye. Diabetic Retinopathy: Nearly 50% of people with diabetes will develop diabetic retinopathy during their lifetime. The longer a person has diabetes, the higher the risk of developing diabetic retinopathy. Diabetic retinopathy is caused by damage to the blood vessels of the retina from high sugar, and it can result in vision loss. The two major forms of diabetic retinopathy are diabetic macular edema and proliferative diabetic retinopathy.

An Innovative Health Care Solution On Wheels | project vision

Thur, 04 November 2010 07:23:10 +0000

Project VISION is a mobile screening unit that provides free vision screenings and advocates for the early detection of eye diseases and disorders. Over a decade ago, Dr. Michael D. Bennett, president of Retina Institute of Hawaii, examined a young University of California graduate who was home from school and was, unexpectedly, experiencing vision loss in both eyes. She had diabetes and, up until that point, had never obtained an eye exam. Knowing her vision could have once been saved through early detection, Dr. Bennett founded Project VISION, a mobile screening unit that provides free vision screenings and advocates for the early detection of eye diseases and disorders. The 35-foot RV is equipped with state-of-the-art digital imaging equipment that takes high-quality photos of the inside of the eye in less than 10 minutes. Using the photos, ophthalmologists who review the images can detect eye conditions like diabetic retinopathy, macular degeneration, glaucoma and cataracts. The free screenings can also detect health conditions like diabetes. Retinal exams can also detect other high-risk conditions in individuals without diabetes. For example, a study published in the American Journal of Epidemiology revealed that moderate retina diseases or eye hemorrhages are associated with an increase in heart-related death. “Project VISION is a unique way to approach community outreach from a health standpoint,” said Dr. Bennett. “This type of program can be expensive, but losing vision is even more costly, both financially and emotionally. I hope what were doing in Hawaii can serve as a national model for vision and health care, and that sponsors and community leaders will lend their support as they realize the importance of this initiative.” Partnerships with the American Diabetes Association Hawaii Chapter, Lions Club and Young Brothers as well as an anonymous grant from a wonderful foundation, have enabled Project VISION to make visits to neighbor islands, including Kauai, Maui, Molokai and the Big Island. The service is especially critical in remote areas like Molokai, where vision care is scarce and diabetes runs rampant. Dr. Bill Thomas, chief of staff and medical director of Molokai General Hospital said, “Hypertension and diabetes are the two most common illnesses on Molokai, both of which a retina test can help detect.” The hospital refers its diabetic patients to retinal experts every year to check sight progression. “Most of the time, people dont go to see a doctor because they dont think anything is wrong,” said Dr. Bennett. Were trying to alter that way of thinking and encourage people to seek education and preventative care. Project Vision Sheds Light on Importance of Screenings in Detection of Disease Over the past two years, approximately 3,000 people have received the important vision screenings through Project VISION. Of those, 40% were found to have abnormalities in at least one eye. If you would like to support Project VISION or just want more information about retinal screenings, please visit retinahawaii.com or call (808) 955-0255. Meet Fr ank Parri no: A Project Vision success story (in his own words) “I was first diagnosed with wet macular degeneration in April of 2001 at the age of 46. A retina doctor on the mainland at that time used a laser a couple of times and said there was little else that could be done for me – to just protect and take care of my unaffected eye. “In September of 2009, Project VISION brought the Vision Van to Molokai, where my wife and I have resided for four years. Doctors with most any specialty are rare on Molokai, so this was an opportunity for us to get screened. The volunteers and staff on the Project VISION were wonderful, and we were in and out in a very short time. I noted on the paperwork that day that I was well aware of my wet AMD in my left eye and was mostly doing this screening to reassure me of my unaffected right eye. “A few weeks later, Retina Institute of Hawaii called me back and spent a great deal of time with me on the phone and told me that huge advances had been made in the treatment of wet AMD in the last 10 years, and they were very optimistic that doctors there at RIH could help me. “My first visit was in early December 2009, where I was put through a battery of diagnostic tests and met Dr. Eugene Ng, who treated me that very same day. Being from Molokai, it can be troublesome making appointments, coordinating airline reservations and returning to our island the same day. Again, Dr. Ng and staff worked with me to make some exceptions to their normal procedures to accommodate me. What an interesting concept…working with the patient to make my life less stressful and less costly. “Ive since had two additional treatments, and I am noticing some improvement! Dr. Ng told me he was nearly positive he could stop the progress of the wet AMD and was very confident he might be able to actually reverse it and restore at least some of my vision. It seems he might be correct! “In closing, I know that if Project VISION had not come to Molokai, I would have never sought help. I would have been satisfied to have one eye. I was ignorant enough to think that just because there was no treatment 10 years ago that nothing had changed. Project VISION offered me the chance to be screened at no cost in a wonderful retrofitted RV. Because of Project Vision and the Vision Van (and the Lions Club here on Molokai), I have a good chance to reverse some of the effects of my wet AMD condition and improve my vision. I am very grateful for this opportunity. Mahalo nui loa.” Diabetes in Hawaii Facts and Statistics • Diabetes is the seventh-leading cause of death in the state. • Approximately 100,000 people in Hawaii have diabetes; 25% of the cases remain undiagnosed. • 7.5% of Hawaii adults have been diagnosed with diabetes (2004), compared to 3.1% in 1994. • Native Hawaiians have the highest diabetes mortality rates when compared with the other major ethnic groups. • Diabetes is the leading cause of new cases of blindness among adults ages 20–74. • Detecting and treating diabetic eye diseases with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.

New Hope is on the horizon for patients with Wet AMD

Thur, 04 November 2010 07:23:10 +0000

Age-related macular degeneration AMD remains one of the leading causes of vision loss in older adults in the Western world. Most patients have the dry form of AMD, but approximately 10% of patients develop the wet, or neovascular, form of AMD. The hallmark of wet AMD is choroidal neovascularization CNV, which is a sprout of abnormal, new blood vessels growing directly underneath the retina, typically right under the center of the macula. These vessels leak fluid and bleed, resulting in dramatic vision loss. The Epi-Rad Radiotherapy System, a Novel and Innovativ e Approach to Treating Wet AMD Retina Institute of Hawaii is the leading recruitment center in the nation for clinical trials of a novel radiotherapy approach for the treatment of wet AMD. Oncologists combine the use of anti-VEGF therapies with radiotherapy in order to improve outcomes in the treatment of various cancers. Retinal researchers are now evaluating the concept of combining radiotherapy with anti-VEGF therapy in order to reduce the frequency of drug treatments or enhance visual outcomes in wet AMD. NeoVista, a pioneering medical device company, has developed the Epi-Rad instrument, which allows targeted, local delivery of radiation to CNV lesions via a simple intraoperative procedure. With NeoVista’s novel wet AMD therapy, the outpatient procedure takes about 30 minutes, and results are noticed within four to eight weeks post-surgery. Just one month after surgery, patients can go from vision acuity of 20/400 to 20/50. RIH was selected as one of a small number of sites for the pivotal CABERNET and MERITAGE clinical trials. The results of these studies and potential application for FDA approval are expected soon.

Dr. Michael Bennett Races for Project Vision

Tue, 27 July 2010 07:23:10 +0000

The Molokai to Oahu Paddleboarding Word Championship drew hundreds of participants, supporters, friends and family to the shores of Hawaii Kai for the dramatic finish of the 14th annual running of a race that crosses the Ka Iwi Channel, separating the Islands of Molokai and Oahu. This 32-mile journey across the 2300-foot deep channel has challenged athletes since the first organized outrigger race in 1952. In support of the race and Dr. Michael Bennett, founder and president of Retina Institute of Hawaii, the Project VISION bus made a pit stop to promote eye health and preventative examinations. Dr. Bennett was one of the visionaries who conceived the mobile screening facility, which has offered vision screening to thousands from Hawaii’s underserved population across the entire chain of islands. Dr. Bennett made a strong showing in the 40+ Men’s Individual Paddleboard Division coming in 9th with a time of 6:46:02. An avid waterman, Dr. Bennett loves nothing more than spending time on the ocean when he is not performing cutting edge retina procedures for his patients. He said this channel crossing was one of the hardest things he has ever done. His super-human feat is quite the opposite from getting your eyes screened in the Project VISION bus…which will probably be one of the easiest things you’ll ever do.

Guarding Against Diabetes

Fri, 16 July 2010 10:15:08 +0000

HOW TO PREVENT DIABETIC EYE DISEASE As we know, diabetes is a major health concern here in the state of Hawaii. It has been estimated that nearly 25% of the population of Hawaii has been diagnosed with diabetes, and that another 10% probably already has diabetes but does not have the regular health examinations necessary to detect this disease. As we know, diabetes is a major health concern here in the state of Hawaii. It has been estimated that nearly 25% of the population of Hawaii has been diagnosed with diabetes, and that another 10% probably already has diabetes but does not have the regular health examinations necessary to detect this disease. THE ROOT OF THE PROBLEM The root cause of the health problems that develop from diabetes are based on the inability of the body to properly metabolize blood sugar, which can result in dangerously high levels of glucose and other sugars inside the blood vessels. These high levels of sugar are toxic to the outer layer of cells that help keep the blood vessels waterproof, and result in blood and fluid being able to leak out of the vessels and accumulate within the surrounding tissues. In terms of the eye, this means that the retina, through which these delicate small blood vessels run, becomes swollen and cannot properly transmit incoming light down to the deeper layers of the retina, where the visual signal is first generated. The amount of swelling and bleeding within the retina is directly proportional to loss of vision, and there are specific treatments available to restore vision based on the severity of the disease. ONE OF OUR MISSIONS One of our missions is to prevent blindness through the early detection and treatment of diabetic eye disease. One way we accomplish this is by being readily available to see all patients who are referred to us by our fellow eye care specialists within the community. Depending on the severity of the condition, we are able to see new referral patients at the earliest possible opportunity, thereby expediting treatment and maximizing the potential for saving and restoring vision. The treatment of diabetic retinopathy is a process that considers a wide range of treatment options that are tailored to the individual patient and the severity of his or her disease. Our extensive experience with this disease allows us to pick the most beneficial treatment plan for each patient. Another way we develop contact with the diabetic population of Hawaii is by means of the Hawaii Vision Project Foundation, which sponsors a free mobile vision screening unit called Project VISION (see story on Project VISION on page 22). This project involves the use of a 35-foot recreational vehicle that has been retrofitted with state-of-the-art digital retinal photographic equipment and that can deliver free retina screening exams to a variety of public venues within the community. Conditions such as diabetic retinopathy, macular degeneration and glaucoma can be detected by review of these photographs, and treatment can be arranged before permanent vision loss results. OUR COMMITMENT Our commitment is to make sure that the latest state-of-the-art equipment is available for our patients. By teaming up with innovative technology development companies, Retina Institute of Hawaii has been able to obtain several new pieces of equipment over the past year that have become essential parts of our diagnostic and therapeutic services. One such device, the Optos ultra-wide-field retinal camera, allows us to take crystal-clear, 360-degree images of the inside of the eye, which has proven very helpful when it comes to looking for areas of vascular leakage and retinal ischemia in our diabetic patients. We have also been able to obtain the PASCAL retinal laser, which allows for precise fine-tuning of the laser energy and spot patterns that are applied to areas of macular edema and proliferative diabetic retinopathy. Lower-energy and more rapid spot applications translate into faster and more comfortable treatments for our patients.

Retina 2010 Event

Fri, 07 May 2010 22:15:08 +0000

All eyes were on the Retina Institute of Hawaii on Thursday, March 25, 2010 when they hosted over 100 guests at Retina 2010, their annual open house and continuing education seminar for Hawaii eye care professionals. The evening’s highlight was a dinner and lecture series by Dr. Michael Bennett and Dr. Eugene Ng on:
Diabetic and Ischemic Vascular Diseases
AMD: Review of Pathophysiology and Current Treatment
Diagnosis and Treatment of Medical and Surgical Retina Conditions
The annual event is one of the many ways Retina Institute of Hawaii maintains and strengthens partnerships with referring doctors in the community and is also a vital conduit of shared knowledge for new breakthroughs and treatments in retinal care. The evening concluded with parting gifts of RIH logo beach towels and a copy of “Visionary,” the new annual journal of the Retina Institute of Hawaii, filled with inspiring patient stories, the latest advances in retina medications and procedures as well as updates on RIH’s involvement in retina research, clinical trials and community outreach. The event was a huge success and guest were raving about the level of professionalism displayed by the entire RIH staff.

Army Medic TJ Laynor Continues to Save Lives in Afghanistan Thanks to Treatment From Retina Institute of Hawaii.

Mon, 21 Apr 2010 22:15:08 +0000

In 2005, while serving as a medic with the Armys 25th Infantry Division, Timothy (TJ) Laynor was involved in a cave-clearing mission in Afghanistan. During this highly hazardous mission, there was an accident and the cave exploded, causing minor injuries to his right ear and right eye.

It wouldn’t be until TJ came back to Hawaii, where he was stationed, that an optometrist began to have concerns about injuries to his eye. She had noticed that his retina was heavily damaged in the periphery and was beginning to tear away from the eye wall. Without specialized procedures, it was a distinct possibility that TJ would not be able to continue living the active lifestyle that he loved. Surfing, mountaineering, snowboarding and also going on deployments with his unit would be things of the past. Immediately after seeing his optometrist, TJ was referred to Dr. Michael D. Bennett and Retina Institute of Hawaii.

TJ said, “When first meeting Dr. Bennett, he wants to know all about you. What kind of person are you? What stuff do you like to do? What is your occupation? I didn’t hold back at all. I didn’t want my lifestyle to end. I wanted to continue to serve my country. I wanted to continue to surf and board. He told me to trust him and things would not change.”

Dr. Bennett explained a procedure he wanted to do for TJ that utilized silicone oil to hold the retina in place against the eye wall until it healed. Once the retina healed, his eye would be back to functioning again and TJ would be out surfing the North Shore of Oahu in no time. TJ went into surgery the next day, and within hours after the procedure was over, Retina Institute of Hawaii called to check on him and ask if there was anything he needed. This highly personal attention would continue to be the standard level of care and cemented a strong relationship from that point on between TJ and Retina Institute of Hawaii.

TJ expressed his experience this way, “Dr. Bennett’s office was one place that radiated comfort. I can’t tell you how much each and every staff member at Dr. Bennett’s office makes you feel as if you are the most important patient there.”

By 2006, TJ was looking to deploy once again, and it was because of Retina Institute of Hawaii and Dr. Bennett’s help that TJ was able to go overseas, run a very successful medical clinic and save more than 700 soldiers’ lives during 2006–2007. During this deployment, TJ was able to successfully treat 35 patients injured in a car bomb attack on the anniversary of 9/11 in 2006. All the patients who came into TJ’s clinic that day were evacuated and survived. To show his gratitude to Dr. Bennett for giving him a chance to help all of these people, TJ saved and carried (for close to a year) the flag that was flown over his clinic on the day of the attack. When he returned to Hawaii, he presented this flag and a plaque to Dr. Bennett, which now are proudly displayed in the RIH office. TJ said, “It was Dr. Bennett and his staff who allowed me to be there and help those people. I owe him and Retina Institute of Hawaii more than they will ever know.”

There was one other thing that TJ was able to do while on deployment, and that was meet a beautiful physician whom he married in 2009. “I would never have met my wife if Dr. Bennett had not fixed my eye,” he said.

Since TJ first walked into Dr. Bennett’s office a few years ago, he has not had any more problems with his retina and is now serving on his third deployment as the medical officer for a Stryker Brigade Combat Team. TJ also continues to be active every day, including surfing in the summer and snowboarding in the winter. Just recently, he summitted Mt. Rainier, at more than 14,000 feet, and now he is looking to travel to Mt. Everest when he gets back from Iraq.

The Development of Retinal Microchips and Artificial Vision Offers New Hope For Those With Failing Vision.

Mon, 19 Apr 2010 21:52:08 +0000

Retinal degenerative diseases affect millions of Americans. For some conditions – such as wet macular degeneration – currently available drug and laser therapies can prevent vision loss or even restore vision before the photoreceptors of the retina are destroyed. For other conditions – such as retinitis pigmentosa or geographic atrophy – the functionality of these photoreceptors is completely lost. What can be done in these settings? The answer may lie in microelectronic prostheses implanted at the retinal surface, the so-called “retinal chips.”

Current Approaches to Retinal Chip Development

In simple terms, the retinal chip can functionally take the place of dying or dead photoreceptor cells. To achieve this, a number of companies around the world are developing varied devices that may restore vision for such patients. The two most advanced approaches are with subretinal and epiretinal implants. These devices are placed in areas of photoreceptor damagein order to stimulate remaining viable retinal cells.

The Subretinal Approach

The subretinal approach (Optobionics) – in which the implant is placed between the RPE and retina – has the advantage of the chip being placed in a “photoreceptor” position such that it has the potential to interact with the natural target neurons of photoreceptors.However, this surgical approach is more complicated than the epiretinal approach. The artificial silicon retina microchip is currently in clinical trials in patients with retinitis pigmentosa.

The Epiretinal Approach

In the epiretinal approach (Second Sight Medical Products, Inc.), the implant is placed on the surface of the retina. This is a less complicated procedure and provides more flexibility in component placement. However, the target neurons are less well defined, and it appears that more complex stimulus algorithms are required. Clinical trials in patients with retinitis pigmentosa are currently being conducted with the Argus II Retinal Stimulation System (second-generation model) in various centers worldwide.

Conclusions

Scientists are harnessing the latest advances in bioengineering to develop exciting new solutions for blinding diseases where more conventional treatments are not applicable. Retinal chips may provide new hope for patients with advanced retinal degenerations.