A bright vision for the future

Wilmer : The past 75 years brought stunning medical advances -- and the next century promises even more.

April 30, 2000|By Morton F. Goldberg, M.D.

IMAGINE YOURSELF as a young eye doctor in Baltimore, early in the last century. You treat various types of eye problems with some slight success, including lid infections and eye trauma suffered by the city's mill laborers, dock workers, and barroom brawlers.

But many of the cases you see present mysteries for which little explanation -- and no medication -- is available. When you perform surgeries, you use large surgical tools and perhaps a magnifying glass. Afterwards your patients stay in the hospital for two to three weeks, with sandbags placed around their heads to ensure that they remain still. They will face more weeks of bed rest when they return home. Many lose their vision, despite receiving the best care available.

Now, imagine that you have been given the use of the "Time Machine" described by a leading fantasy novelist of that period, H. G. Wells. You venture into the future, to the year 2000. There you find that eye surgery has advanced to the point that patients rarely stay in the hospital even one night for major operations (and never require sandbags as part of their recovery). Cataract extraction and corneal transplantation are amazingly successful. New diagnostic tools enable doctors to see inside the eye as never before. Highly specialized eye surgery devices and microscopes make possible delicate procedures previously unimaginable. In fact, doctors use light itself -- laser beams -- to improve their patients' vision, and have begun to identify the genetic mutations involved in blinding diseases.

At the same time, there seem to be many more severe eye diseases: because people live so much longer, doctors must deal with the degenerative vision problems of the elderly, including glaucoma, and those who suffer vision loss as part of other conditions, such as diabetes and sickle-cell anemia. An entirely new group of caregivers has emerged, to help those with severe vision loss to continue to function. Others study the effects on vision caused by sunlight, diet, smoking, and general hygiene, and travel around the world to help those in less fortunate countries. New information, including televised, live eye surgery, is rapidly shared by transmission over communication systems, such as the Internet, that immediately link doctors and scientists everywhere. The result? Eye doctors can actually help most of their patients most of the time.

In all probability, the shock of this experience would be staggering. But as a young person of a questioning nature, you would have to ask yourself, "How will all this come to pass? How will we get from my world to this one?"

And part of the answer would be standing like a beacon before you in that future Baltimore: the Wilmer Eye Institute at Johns Hopkins.

ka10 The Wilmer Eye Institute, founded by charitable gifts in 1925, has, like the other academic eye centers that have been established in its wake, advanced the knowledge and skills of eye doctors to a level inconceivable in the past. Bringing together researchers, clinicians, and educators, Wilmer has created a model for vision care that has brought better eyesight and health to millions of people here and around the world. And so many more advances lie ahead that, like our time-traveling adventurer, the men and women who work with such dedication at Wilmer must certainly experience a dizzying sense of expectation as they enthusiastically imagine what will happen in the coming decades.

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ka10 We're all familiar today with laser correction of common vision problems such as nearsightedness and farsightedness. But lasers are also used to treat corneal scars and to slow or stop the most common blinding diseases such as age-related macular degeneration (AMD) and diabetic retinopathy in some patients. In fact, a new laser technique, called photodynamic therapy, has just been approved for AMD, increasing the number of patients eligible for treatment. Wilmer doctors pioneered laser treatments back in the 1960s, and led the recent clinical trials for the new technique. Further enhancements of laser therapies are underway at Wilmer right now. Future uses may include laser activation of powerful drugs injected into the blood stream through a vein in the arm. When they reach the eye, the drugs will be stimulated by the laser to work only in pinpoint, super-safe areas inside the eye.

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