changing the course of stroke - New Jersey Medical School ...

elate patterns of colors inside the eye with changes in heartbeat,
allowing the inventors to hone in on a relationship between
heart rhythms and eye pressure, perhaps yielding new insights.
A New Strategy for “Eye Stroke”
Some evidence suggests that “eye stroke” calls for much the
same plan of action as a “brain attack,” and time is as
much of the essence. More sophisticated diagnostic
equipment and a coordinated team approach can frequently
halt the progressive cascade of harmful events, radically changing
the outcome of a stroke from bleak to bright.
Like a brain attack, eye stroke (central retinal artery occlusion)
results from a blocked blood vessel, but its effects are typically
localized at the retina and can result in permanent blindness.
“It cuts off the blood and oxygen supply to the retina and
causes blinding visual loss in the affected eye,” says neuro-ophthalmologist
and orbital surgeon Roger Turbin, MD.
The newest generation of radiological equipment, that
quickly produces clear views of the affected area, and a highly
skilled stroke team that is available around the clock mean that
complex procedures can be performed shortly after the patient
reaches the hospital. In the case of a clot in the ophthalmic
artery, a very thin catheter is threaded through the femoral
DAN KATZ
Learning About Diabetes From
The Eyes of The New Jersey 725
Diabetes is disproportionately prevalent and severe
among African Americans, and can trigger other
complications that are killers. Medical retina specialist
Monique Roy, MD, has been following a group of 725
African Americans with Type 1 diabetes since 1993. The participants—now
numbering 600—ranged in age from 10 through
70, with the majority being in their 30s, when the study began.
Roy has uncovered some information vital to her study population.
Her data shows that African Americans with Type 1 diabetes,
particularly women, have more diabetic retinopathy
(especially vision-threatening retinopathy) than whites with
Type 1 diabetes; and that African American women with Type 1
diabetes are 12 times more likely to die early than African
American women in the general population. African American
men with the disease are at 6.1 times greater risk of dying
early than their peers without the disease, and those with a
small amount of kidney disease when they were first seen were
more likely to die of renal complications than women. “It looks
like many African American men with diabetes start with renal
disease,” she explains. “It’s also what kills them—so protecting
their kidneys early on is very important.”
Roy says that researchers have looked at the environmental
predictors of disease progression, and now need to figure out
the causes. “How can we use genes to predict complications?”
she asks. The retina specialist
says that frequently
those with Type 1 diabetes
have few complications in
the first 10 years of their disease.
Then some will turn a
corner for the worst, and
others will continue to do
fine. “We need to determine who has turned this corner after
10 years and try to find out why.”
Roy says her research is now focusing on genetic factors,
and the interaction between genes and the environment.
Investigators are finding that there are many subtypes within
the large group of those afflicted with diabetes. There is a
small percent of African Americans who have an acute onset of
the disease during adolescence or their 20s, become insulindependent,
and then go into remission 10 to 15 years later, no
longer needing insulin.
The researcher is participating in a world diabetes genetic
consortium. The focus is to gather as many families as possible
who are affected by diabetes to aid in the hunt for the diabetes
gene(s). Roy explains that the researchers would like to
collect blood not only from the person with Type 1 diabetes,
but from his parents, and affected and unaffected siblings. ●
artery in the leg, to the carotid artery, and finally into the very
narrow ophthalmic artery, so that a clot-dissolving enzyme, tissue
plasminogen activator (tPA), can be applied through the
catheter to dissolve the clot. The procedure restores ocular circulation
and can be highly successful at restoring sight if it is
done within four hours of the eye stroke.
Turbin says that the team treated two patients recently who
arrived after the prescribed interval—one within eight hours,
the other within 24 hours—and that both improved, although
vision loss could not be entirely reversed.
New surgical techniques also restore sight in idiopathic intracranial
hypertension (pseudotumor cerebri). If left untreated,
the condition can lead to visual loss or blindness. Medication
generally works to lower cerebrospinal fluid pressure, says Larry
Frohman, MD, director of the division of neuro-ophthalmology,
who treats many patients with the disorder. But continuing
loss of vision may necessitate orbital surgery. According to
Turbin, a new variation of the surgical technique called optic
nerve sheath fenestration creates a “window” in the sheath-like
covering of the optic nerve with better surgical exposure, which
permits less tissue trauma and a chance for improved visual outcomes.
The optic nerve sheath serves as an escape hatch for the
cerebrospinal fluid in the region of the nerve governing vision,
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