Seva Canada: A Solution in Sight

For a what is supposed to be a rare eye condition, I’ve heard way too much about retinoblastoma cases lately.

Just the other day an ophthalmologist friend in Vancouver mentioned seeing a case and today we got a story of a little boy in Nepal who suffered from retinoblastoma.

Retinoblastoma is a rapidly developing cancer which develops in the cells of the retina, the light detecting tissue of the eye. Retinoblastoma is rare and affects approximately 1 in 20,000 live births. Untreated retinoblastoma is almost always fatal; therefore, early diagnosis and treatment is critical to saving lives. In the developed world, retinoblastoma has one of the best cure rates of all childhood cancers (95-98%), with more than nine out of every ten sufferers surviving into adulthood.

There are two forms of the disease; a genetic, heritable form and a non-genetic, non-heritable form. Approximately 55% of children with Rb have the non-genetic form. If there is no history of the disease within the family, the disease is labelled “sporadic”, but this does not necessarily indicate that it is the non-genetic form.

In about two thirds of cases, only one eye is affected (unilateral retinoblastoma); in the other third, tumours develop in both eyes (bilateral retinoblastoma). The number and size of tumours on each eye may vary. In certain cases, the pineal gland is also affected (trilateral retinoblastoma). The position, size and quantity of tumours are considered when choosing the type of treatment for the disease.

Himal, age 5, from was brought to Seva’s partner hospital, the Lumbini Eye Institute by his grandmother on February 1st with a history of no vision in his left eye.

The family hadn’t noticed that the boy was blind in one eye until a week earlier when they were watching TV and the little boy’s right eye was itchy so he covered it temporarily.

Himal, age 5, is examined and diagnosed with retinoblastoma in his left eye. Photo courtesy of Seva Canada

The family immediately took Himal to the local health post in a nearby village and the staff there referred him to the Lumbini Eye Institute. After a detailed examination, Himal was diagnosed with retinoblastoma in his left eye.  The pediatric ophthalmologist was unable to restore the sight in the boy’s damaged eye, but was able to save the child’s life by removing the left eye.

It is vital that children receive eye exams. The most common and obvious sign of retinoblastoma is an abnormal appearance of the pupil. Many parents refer to this reflection as “cat’s eye” or “white eye”.  Medically, it is known as leukocoria. Other less common and less specific signs and symptoms are: deterioration of vision, a red and irritated eye, faltering growth or delayed development. Some children with retinoblastoma can develop a squint, commonly referred to as “cross-eyed” or “wall-eyed” (strabismus). However, retinoblastoma presence with advanced disease in developing countries and eye enlargement is a common finding.

Screening for retinoblastoma should be part of a “well baby” screening for newborns during the first three months of life, to include:

• The Red reflex: checking for a normal reddish-orange reflection from the eye’s retina with an ophthalmoscope or retinoscope from approximately 30 cm / 1 foot, usually done in a dimly lit or dark room.
• The Corneal light reflex: checking for symmetrical reflection of beam of light in the same spot on each eye when a light is shined into each cornea, to help determine whether the eyes are crossed.
• Eye examination: checking for any structural abnormalities.

Treatment of retinoblastoma varies from country to country. The first priority is to preserve the life of the child, then to preserve the vision and thirdly to minimize any complications or side effects of the treatment. The exact course of treatment depends on the individual case and will be decided by the ophthalmologist in discussion with the pediatric oncologist.

The process of removing an eye while leaving muscle tissue intact is known as enucleation.  For many cases of retinoblastoma, and particularly unilateral cases, enucleation is considered the primary treatment.  Removal of the eye in unilateral, non-heritable cases is curative.  While the child will suffer some peripheral vision loss as a result of the removal of an eye, the risks associated with attempted treatment, including spread of the tumor beyond the eye, are generally viewed as too great.  Removal of the eye also spares the child invasive chemotherapy and its inherent risks.  Bilateral cases of retinoblastoma, because of the threat of complete vision loss, are often treated more aggressively.  An eye is generally removed only if there is a significant threat of the tumor spreading beyond the eye.

Eye care for children, including school screening, are essential parts of all of Seva’s sight programs. You can support Seva’s work providing eye care for children by making a donation. Himal has lost an eye, but his life has been spared.

From The Globe and Mail, January 27, 2010 by Leslie Beck

Women who took 1,000 mg of vitamin C daily were 25 per cent more likely to develop cataracts

If you want to preserve your vision as you age, you might consider tossing your vitamin C supplement. According to a study published in the February issue of the American Journal of Clinical Nutrition, high-dose vitamin C supplements – 1,000 milligrams daily – can increase the risk of developing cataracts.

Researchers followed 25,593 women, aged 49 to 83, for eight years and found that those who took 1,000 mg of vitamin C daily were 25 per cent more likely to develop cataracts than those who did not use supplements.

Among women 65 and older, vitamin C use increased the risk of cataract by 38 per cent. Taking vitamin C in combination with hormone replacement therapy or corticosteroid medication was associated with an even greater risk.

However, getting too little vitamin C may also contribute to cataracts, since vitamin C is a potent antioxidant, protecting from free radicals. Previous research has linked higher blood levels and dietary intakes of vitamin C with a lower risk of cataracts.

The new study showed that multivitamins containing a small amount of vitamin C (60 mg) did not increase cataract risk.

A cataract is a clouding of the lens of the eye, which focuses light onto the retina at the back of the eye. When the lens is cloudy, the light is obstructed, affecting vision.

It’s thought that free radicals play a role in cataract development by damaging proteins in the lens. Free radicals are produced naturally when we breathe, but ultraviolet light, cigarette smoking and the consumption of alcohol are other sources.

People can develop cataracts in their 40s and 50s, but they’re most common after age 65. Family history, diabetes, exposure to sunlight, smoking and alcohol consumption also increase the risk.

This isn’t the first study to suggest that high-dose vitamin C supplements may harm your eyes. An earlier, 12-year study of 47,000 U.S. women revealed that long-term vitamin C users aged 60 and older were more likely to have surgery to remove cataracts and were twice as likely to develop cataracts.

It may seem paradoxical that vitamin C, a powerful antioxidant, contributes to cataract. Scientists believe that, under certain conditions, vitamin C can also act as a “pro-oxidant.” In other words, the nutrient has antioxidant activity when it reacts with free radicals, but it can also react with other compounds in cells, which leads to the formation of free radicals.

In this study, taking 1,000 mg of vitamin C daily increased the risk of cataract. But the risk was even higher in older women, those using hormone replacement therapy, and those taking corticosteroids (used to treat many conditions including allergy, asthma, arthritis, and inflammatory bowel disease). It’s thought that the combination of these factors may increase inflammation in the body and free radical production.

These findings should not be translated to vitamin C from foods. Eating at least seven daily servings of fruit and vegetables – about 3.5 cups worth – is an important way to meet daily vitamin C requirements. Women and men require 75 and 90 mg respectively; smokers need an additional 35 mg a day because smoking creates free-radical damage.

When it comes to nutrition, evidence suggests the following strategies may shield your eyes from cataracts.

Control your weight

People who are overweight, even moderately, have a higher risk of cataracts. Excess body fat around the abdomen may contribute to cataract formation by increasing inflammation in the body. Carrying excess weight also increases the risk of type 2 diabetes, a condition strongly related to early cataract formation.

Choose low-glycemic carbs

A diet of predominantly high-glycemic carbohydrates (e.g. white bread, white rice, sugary foods) is thought to increase the risk of developing cataracts by elevating blood glucose. Prolonged high blood glucose levels in the lens may increase cataract risk by causing free radical damage to lens proteins.

Choose foods that have a low glycemic index such as whole-grain breads, brown rice, pasta, steel-cut oats, legumes, nuts, citrus fruit, yogurt, milk and soy beverages.

Boost omega-3s

A handful of studies suggest omega-3s from fish oil, called DHA and EPA, protect from cataracts by helping fight inflammation in the body.

To increase your intake of omega-3 fatty acids, eat oily fish such as salmon, trout, sardines and herring at least twice a week. If you don’t like fish, consider taking a fish oil capsule that supplies 500 to 600 mg of DHA and EPA (combined).

Increase fruits and vegetables

These foods contain two natural compounds called lutein and zeaxanthin. Once consumed, they make their way to the eyes where they act as antioxidants and protect the lens from oxidative damage. Studies show that people who consume the most lutein have a 20-per-cent to 50-per-cent lower risk of developing cataracts or having cataract surgery compared to those who consume the least. Scientists speculate that an intake of six to 15 mg of lutein plus zeaxanthin per day is optimal for eye health. The best sources include kale, Swiss chard, collard greens, green peas, broccoli, romaine lettuce, Brussels sprouts, nectarines and oranges.

Reduce sodium

Research suggests that a high-sodium diet can increase the risk of cataracts by as much as twofold. Adults require 1,200 to 1,500 mg of sodium a day, half the amount most of us consume. The daily upper limit is 2,300 mg a day. Read nutrition labels and limit your intake of salty snacks and processed meats. Rely less on convenience foods and cook most of your own meals.

Limit or avoid alcohol

Studies show that compared to non-drinkers, daily drinkers have a significantly higher likelihood of cataracts. Alcohol increases free radicals that damage proteins in the lens and may also affect absorption of nutrients.

Leslie Beck is a Toronto-based dietitian at the Medcan Clinic.  Her website is lesliebeck.com.

On Tuesday February 2, the students of Mme Grunfeld and Mme Lee at Tomekichi Homma Elementary School in Richmond, BC presented Seva Canada with a giant cheque for $2,146.70.

Two of the students at Tomekichi Homma School presenting a cheque to Susan Erdmann

This very generous amount was raised by the students and will be used to restore sight by funding cataract surgeries in remote areas of the developing world. There are 45 million blind people in the world and most of this blindness is caused by cataract, the clouding of the eye’s natural lens, and can be treated with a short operation costing $50 or less.

The cheque was presented to Seva board member, Susan Erdmann, and Seva office manager, Annie Chen, at a special ceremony at the school.

Students of Mme Grunfeld and Mme Lee with cheque for Seva Canada

Susan, who has traveled at her own expense and seen Seva’s work first hand. Susan told the children about the three eye camps in Tibet that she witnessed, at which hundreds of blind people were led in by their family members or caregivers and who, after a short operation lasting 15 minutes or less, they had their sight restored.

Seva Canada is very grateful to the students of Mme Grunfeld and Mme Lee for their hard work and compassion in helping to restore sight to the world’s blind. The money raised will be used to help fund a Seva eye camp in Tibet, an area with the highest rate of blindness in the world.

A donor who once suffered from a blinding corneal ulcer sent me the following video link.

Here’s the news article about it:

Stem cell breakthrough restores sight to sufferers of corneal disease
27  May 2009

In a world-first breakthrough,  medical researchers have used stem cells cultured on a simple contact lens to restore sight to sufferers of blinding corneal disease.

Sight was significantly improved within weeks of the procedure, which is simple, inexpensive and requires a minimal hospital stay.

The research team from UNSW’s School of Medical Sciences harvested stem cells from patients’ own eyes to rehabilitate the damaged cornea. The stem cells were cultured on a common therapeutic contact lens which was then placed onto the damaged cornea for 10 days, during which the cells were able to re-colonise the damaged eye surface.

While the novel procedure was used to rehabilitate damaged corneas, the researchers say it offers hope to people with a range of blinding eye conditions and could have applications in other organs.

A paper detailing the breakthrough appears in the high-impact journal Transplantation this week.

The trial was conducted on three patients; two with extensive corneal damage resulting from multiple surgeries to remove ocular melanomas, and one with the genetic eye condition aniridia. Other causes of cornea damage can include chemical or thermal burns, bacterial infection and chemotherapy.

“The procedure is totally simple and cheap,” said lead author of the study, UNSW’s Dr Nick Di Girolamo. “Unlike other techniques, it requires no foreign human or animal products, only the patient’s own serum, and is completely non-invasive.

“There’s no suturing, there is no major operation: all that’s involved is harvesting a minute amount – less than a millimeter – of tissue from the ocular surface,” Dr Di Girolamo said.

“If you’re going to be treating these sorts of diseases in third world countries all you need is the surgeon and a lab for cell culture. You don’t need any fancy equipment.”

Because the procedure uses the patient’s own stem cells harvested from their eye, it is ideal for sufferers of unilateral eye disease. However, it also works in patients who have had both eyes damaged, Dr Di Girolamo said.

“One of our patients had aniridia, a congenital condition affecting both eyes. In that case, instead of taking the stem cells from the other cornea, we took them from another part of the eye altogether – the conjunctiva – which also harbours stem cells.

“The stem cells were able to change from the conjunctival phenotype to a corneal phenotype after we put them onto the cornea. That’s the beauty of stem cells,” Dr Di Girolamo said.

The therapeutic contact lens used in the trial was of a type commonly used worldwide after ocular surface surgery. However, of the several brands on the market, only one was suitable for growing the stem cells.

“We don’t know why. It’s probably to do with the components the manufacturers have used in that particular lens,” Dr Di Girolamo said.

The researchers are hopeful the technique can be adapted for use in other parts of the eye, such as the retina, and even in other organs. “If we can do this procedure in the eye, I don’t see why it wouldn’t work in other major organs such as the skin, which behaves in a very similar way to the cornea,” Dr Di Girolamo said.

Source: The Medical News

Researchers from the University College London (UCL) Institute of Ophthalmology have developed an apparently simple and inexpensive eye test that is able to detect neurodegenerative diseases, such as Alzheimer’s, many years before symptoms appear.

Led by Francesca Cordeiro and Stephen Moss, the research team discovered that brain cell death could be observed through patients’ eyes, given the direct link between the retina and the brain.

The technique involves introducing fluorescent markers in the form of drops that attach themselves to the relevant cells and indicate the stage of cell death. Using a laser ophthalmoscope, they measured the cell death in real time.

Until now, tests have only been conducted on rats and mice but human testing should begin by the end of the year. With this new technique, not only will neurodegenerative disorders, such as Alzheimer’s, be detected many years before symptoms appear—scientists are even saying 20 years!—but it could help in the development of new treatments to slow down or stop disease progression.

The first patient trials to assess the technique for the eye disease will begin later this year.

Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, said:  “These findings have the potential to transform the way we diagnose Alzheimer’s, greatly enhancing efforts to develop new treatments and cures.

“If we spot Alzheimer’s in its earliest stages, we may be able to treat and reverse the progression of the disease as new treatments are developed.

“Dementia scientists currently lack a way of assessing the brain’s responses to new treatments in real time; this technique may help overcome that obstacle.”

Sources:
The Times of India
Le Matin
BBC