Bone marrow stem cells

LOUISVILLE, Ky. – A team of University of Louisville scientists have discovered that stem cells taken from bone marrow can restore damaged retinal tissue by generating new cells.

This is the first known study where stem cells derived from bone marrow have been used to restore the pigmented cell layer just outside the retina or the retinal pigment epithelium (RPE).

The research moves science a step closer to helping those who suffer from vision loss and blindness due to age-related macular degeneration and hereditary retinal degenerations.

During their experiments, UofL researchers found that bone-marrow derived stem cells (BMSCs) were attracted to damaged RPE, and were able to differentiate or move from less specialized cells into components of RPE. According to researcher Suzanne Ildstad, “More research is needed to optimize the outcome and potential for repair of damaged retinal pigment epithelium. A combination with up-to-date tissue engineering might be critical for ultimate success.”

UofL Department of Ophthalmology and Visual Sciences researcher Henry Kaplan is now expanding this research in conjunction with the Swine Institute at the University of Missouri.

Kaplan says pigs have more optical similarities to humans. “After learning more about how bone-marrow derived stem cells can help regenerate retinal pigment epithelium in swine, we hope to translate our research into the clinical setting,” Kaplan said.

This research has implications for a number of chronic diseases including congestive heart failure, diabetes, osteoporosis, Alzheimer and Parkinson diseases, spinal cord injuries, age-related macular degeneration and hereditary retinal degenerations.

The study, published recently in the Archives of Ophthalmology, is available online at archopht.ama-assn.org/cgi/content/short/127/4/563.

Cataract surgery no effect on AMD

A latest study has showed that cataract surgery has no clear effect on the worsening of Age-Related Macular Degeneration. This is contrary to earlier findings.

AMD and cataract are two of the leading causes of visual impairment in the United States. The relationship between cataract surgery and the development of advanced AMD has generated interest among ophthalmologists. Concerns have been raised regarding the potential of cataract surgery to accelerate progression to advanced, vision-threatening forms of AMD in a number of studies.

In the Age-Related Eye Disease Study Published in the Journal Opththalmology Feb 2009, the population that was followed up carefully at frequent, regular intervals for a long period showed that cataract surgery was not associated with a clinically important increase in the rates of development of advanced AMD.

However, it remains important that individuals with large drusen and pigmentary changes have an understanding of their risk for progression to advanced AMD with or without cataract surgery and that this risk is discussed with the patient before cataract surgery.

Persons with intermediate AMD (bilateral large drusen) or with unilateral advanced AMD should be aware of the fact that the risk of developing advanced AMD is as high as 50% in five years. These results are contrary to the results of some previously published epidemiologic studies, including two reports that each pooled data from different population-based studies.

The five-year results of the Beaver Dam Eye Study and the Blue Mountains Eye Study identified persons with and without a history of cataract extraction at a baseline examination and reexamined them for incident AMD at five and 10 years. They found an association between cataract surgery and the five-year incidence of late AMD.

For the Beaver Dam Eye Study, cataract surgery before baseline was associated with an increased risk of advanced AMD and in the Blue Mountains Eye Study, there was a three-fold increased risk of advanced AMD .

Sudden sight loss drives architect to aid blind

San Francisco Chronicle

Saturday, May 2, 2009

By Sam Whiting
Chronicle Staff Writer

Fifteen months ago Chris Downey was just another green architect, based in Oakland. Now he has an expertise that separates him from every other architect in the Bay Area and all 20,000 attendees at this week's American Institute of Architects' National Convention in San Francisco.


Downey, 46, is a blind architect dedicated to planning buildings for blind people, a niche brought about by his sudden loss of sight after surgery. "It is actually pretty exciting," says Downey, as he sits in a drafting room, like everybody else at SmithGroup Inc. in the Financial District. Then he rises to 6 feet 4, grabs a white cane with one hand and reaches out with the other, grasping for something to shake.

"For someone who likes problem solving, this is quite a challenge," says Downey, who has been working up floor plans in braille to submit to blind clients overseeing the design of a new blind rehab center at the Veterans Affairs center in Palo Alto. "It's a question of how do you design an environment for people that aren't going to see it?"

Right. But there is one question before that. As he puts it, "Blind architect. What a preposterous idea. How does that work?"

The answer starts with a benign tumor that had slowly encircled the intersection of optic nerves. The tumor began to push the nerves out of position, and that's when Downey couldn't follow the flight of a baseball as he played catch with his son, Renzo, now 11, at home in Piedmont. Next Downey was hitting stuff in the road, during the 100 miles he'd do weekly on his bicycle. Still, he could get his work done with the aid of glasses.

His eyeballs looked fine, but an MRI revealed a non-malignant golf-ball-size growth causing the blind spots. "If it weren't for playing baseball with my son and riding my bike, who knows when I would have figured it out," he says.

Because of the tumor's proximity to the optic nerve, radiation treatment to shrink it was not an option. He had surgery on St. Patrick's Day 2008 to try to correct his vision, even though he was aware that it was risky and might not work. Downey's father, a physician, had died of complications from brain surgery at 36, so waking up after the procedure at all made Downey feel "pretty darn lucky."

Luckier still that he had blurry vision, as expected. "It was amazing," he recalls. "It was a 9 1/2-hour procedure, and the next day I was up walking around." When he awoke on the second day, his field of vision had been cut in half horizontally, as if the water were at eye level in a swimming pool.

By the third day he'd lost vision in the top half, too. It varied from dark to light for five days, then it faded to black. "I lost my sight," says Downey, who knew going in that this was a risk. "But I came out pretty darn healthy, with the exception of the sight."

He accepted blindness right away. What he could not accept was the advice of a social worker who came in and immediately started discussing a career change. Every step he had taken since junior high in Raleigh, N.C., had been toward becoming an architect. He had seven years of schooling into it, topped by a master's degree from UC Berkeley in 1992. Since then, he had designed aquariums, libraries, theaters, stores and homes.

He tried returning to the job he'd started a few months before he became ill, but was laid off before Christmas. He searched the Internet, and found one blind architect in Lisbon, Portugal, and a guy who works as a forensic architect, investigating failures in buildings. That was it.

On a whim he called Patrick Bell, a business adviser to architecture firms, and that's when Downey finally got some decent Irish luck. As it happened, Bell was working with a firm called the Design Partnership, which is doing a joint venture with SmithGroup to design a 170,000-square-foot Polytrauma and Blind Rehabilitation Center for the Veterans Administration Palo Alto Health Care System. Bell made the connection, and Downey was hired as a contract architect.

"It's the first time any of us have dealt with even a sight-impaired architect, let alone one who is blind," says Kerri Childress, VA spokeswoman. "It's really been beneficial having an architect who is blind working on a facility to serve the blind."

The design phase runs through July. From there, Downey has been invited to serve as a mentor to blind high school students at a weeklong event this summer in Maryland. (He's also back to cycling on a tandem bike with his buddy steering, and is up to 60 miles in the Oakland hills.)

And he wouldn't mind addressing next year's AIA convention in Miami. "I was always nervous in front of crowds," says Downey, "but now that I can't see them, I think it will make it easier."

Acceptance and adapting

Dr Lee Wei Ling's contributions to The Straits Times in recent months have been garnering attention from the public. In this piece, she spoke about accepting what you cannot change and adapting to capriciousness of life - lessons useful to all macular degeneration sufferers. Hope you find some inspiration and encouragement in her words.

The Sunday Times
May 3, 2009

The day I failed an examination

Failure can be a bitter pill to swallow but it can also bring with it valuable life lessons

By Lee Wei Ling

In February 1982, I took my MRCP part 2 in Edinburgh. The MRCP exam is the postgraduate examination for internal medicine and paediatrics organised by the College of Physicians in Britain. Three universities conduct the examination simultaneously - London, Glasgow and Edinburgh.

I chose to take my examination in Edinburgh because I was not sure I could understand London's Cockney accent or the Glasgow accent. The Edinburgh accent, I figured, would be much easier for me to understand. I was down with flu at the time of the practical examination in which we were supposed to examine patients.

I was told to listen ('auscultate') to the heart of my first patient. I guessed what she had but could not hear the corresponding heart murmur. From then on, my examiners became unfriendly and I became nervous. When the examination was over, I went back to the hospital where I had examined the patient and asked her mother what was wrong with the patient. I had guessed correctly: She had a mitral stenosis, which causes a murmur that is notoriously difficult to hear.

Nowadays, doctors no longer need to have acute hearing in order to diagnose heart conditions. A cheap and simple ultrasound produces clear anatomical pictures, including of heart functions. No more guessing is required. I was sure I had failed the examination though I had sailed through the written paper and the subsequent viva voce.

When the results were announced, I was in the Royal College of Physicians of Edinburgh building. After the crowd had thinned, I went forward to read the list of names. Mine was not on the list. The news spread like wildfire among the Singaporean medical community. 'Lee Wei Ling has finally failed an exam! She is like any one of us.'

I took my failure very badly because I knew I did not deserve to fail. I did not even need the MRCP as I already had my Master of Medicine (in paediatrics), which is on equal footing with the MRCP. I was also hurt by the fact that many Singapore doctors seemed happy I had failed. I swore to myself that I would not take the examination again. But my father told me: 'You have to take that exam until you pass it. You have to prove to Singapore you can do it.'

My parents have never pressured me or my brothers to aim for academic success. If there was any 'pressure', it was no more than an implicit expectation. This was especially so with me, the most highly strung and stubborn of their three children. I was determined to prove I could equal my brothers' academic achievements.

All my previous examination successes - except for the one doctors need to pass to practise in the United States - had occurred in Singapore. For all written medical examinations, local or foreign, one wrote only one's index number on answer sheets. So there was no question of examiners favouring me because I am Mr Lee Kuan Yew's daughter.

But my father nevertheless wanted me to show Singaporeans that I could succeed outside of Singapore, though success in the MRCP examination is to a small but significant extent dependent on luck.

So I returned to Edinburgh to re-take the MRCP in October 1982. This time I took great care not to catch any bug, and I went up to Edinburgh by train wearing a face mask. Everything went smoothly and I knew I had passed. Indeed, I knew more about the patient - a young child with brain damage - than the examiner.

I returned to London after the examination and asked a friend to telephone me the results. After I received confirmation that I had indeed passed, I phoned home. Ming Yang, my late sister- in-law, picked up the phone. I asked her to tell the rest of my family that I had passed. And I asked about her new baby. She told me he was an albino. Hsien Loong was a little disappointed and had told our father the boy would not be able to do national service. I also knew that albinos have poor eyesight. My heart went out to Ming Yang and Loong.

I flew back to Boston, where I was based then. While napping after my arrival, my father phoned me. 'Ming Yang passed away of a heart attack,' he reported. 'Come back now.' I returned to Singapore for Ming Yang's funeral and stayed to mark the new baby's first month.

My father arranged my return flight to Boston. As he believed flying west was less tiring, I flew through London and stopped there for a day. Since then, London has always brought back unhappy memories for me and I avoided going there until 2004, when I needed to meet someone in Edinburgh.

As luck would have it, his house was but a street away from the Royal College of Physicians of Edinburgh building. After our meeting, I walked right up to the front door of the building. The building was locked since it was a Sunday. I stood there for a few minutes, before turning to another friend who had accompanied me and said: 'Red dust.' (A Chinese expression signifying the illusions of life.)

Twenty-seven years later, my examination failure seems inconsequential. But I have no regrets having tried and failed the first time. It made me appear normal to the Singapore medical community. Also, considering how outspoken and aggressive I can be, a failure that lent me a vulnerable image did me no harm. My failure forced me to learn how to roll with the punches and to react to life's capriciousness with equanimity.

As for my albino nephew, he has grown into a kind, considerate and responsible young man who is not ashamed of being different from the average man in the street. He too has learnt to accept what he cannot change and to adapt his life around the constraints. Life is unpredictable for all of us. But if we persevere and adapt, many apparently impossible difficulties can be overcome. That my nephew will graduate soon from the National University of Singapore is proof of that fact.

The writer is director of the National Neuroscience Institute.