Melanie Cole (Host): Various eye diseases can affect the structure and or the functioning of the eye. The end-stage of many eye diseases may be vision loss or blindness. However, many eye diseases are treatable, and this requires early diagnosis and management before too much damage is done. Today, we are talking about building a foundation for the treatment of complex ophthalmic conditions and my guest is Dr. Nicholas Volpe. He’s the Chairman of Ophthalmology at Northwestern Medicine. Dr. Volpe, tell us about some of the biggest needs and challenges in ophthalmology today.

Nicholas J. Volpe, MD (Guest): The way that I like to think about the challenges as the Chair of the department here is twofold. The first is actual clinical care and delivery of ophthalmic care to our patients, because in this setting, we are dealing with a huge volume of patients. If you think about it, our diseases are almost unique to the aging population and our population is indeed aging at the highest rate ever. There are about 10,000 new 65-year olds every day for the next 15 or 20 years. And these are the patients that we have to design strategies to be able to have them access our care and to be able to get to our specialists. At the same time, there are a number of patients who have easily treatable conditions that don’t have easy access to ophthalmic care that we definitely try to work towards treating them.

On the other end of the spectrum, particularly as an academic department, I recognize that we are at an incredible precipice of scientific discovery in our ability to offer treatments to deliver drugs. We are now delivering genes, perhaps stem cells in the future to reverse some of our most blinding conditions. So, being able to understand degenerative diseases, how to identify them early, potentially how to prevent them and how to treat them is very important to any academic department of ophthalmology that’s trying to innovate and change the way we treat patients.

Host: Doctor, what are some of the most complex and common conditions that you treat and since it’s an aging population; are there comorbidities that contribute to these complex conditions and are they suffering from other diseases that are also exacerbating the eye condition?

Dr. Volpe: There are any number of conditions that affect the various parts of the eye. Some of them are straightforward and everybody deals with them on a routine basis, at least in this – there are actually many different conditions that affect the aging population that are easily treatable and are familiar to the lay population. For example, cataracts, which are treated on a fairly routine basis, at least throughout this country with state-of-the-art procedures using very advanced technology. And while nobody wishes they have to go through cataract surgery; it is a very predictable and safe procedure that here, we continue to innovate about making it better and trying to get patients free of their glasses and have them have the best possible vision for this completely reversable condition.

On the other hand, we have other conditions, most notably macular degeneration, glaucoma, conditions that affect the optic nerve, and conditions that potentially affect the brain with other degenerations that can affect vision. Most of our aging population bring with them some lifetime risks for these various conditions; much of it determined by family history for instance, for macular degeneration and glaucoma. It’s very important if you have a family history to access specialists to make sure you don’t have those conditions. Perhaps some of the usual suspects also contribute to the development of eye disease such as exposure to smoking, not enough antioxidants, green leafy vegetables, sunlight, all of those things may contribute to development of cataract and macular degeneration.

But the actual pathogenesis of these conditions is not well understood in terms of is it mostly an aging phenomena that simply occurs like some of the other degenerative diseases of aging whether it be Alzheimer’s disease or Parkinson’s disease or are there specific genetic and environmental triggers that allow some patients or are the setting in which some patients develop these important and blinding degenerative conditions.

On the flip side, probably one of our greatest public health and treatable group of conditions relate to the complications of diabetes. There, the comorbidities of obesity and the increasing prevalence of diabetes mellitus certainly in this country; which actually now is affecting younger and younger populations, are capable of causing some of our most blinding eye conditions which while they are on one end of the spectrum quite severe, are completely treatable and identifiable early if patients get themselves to ophthalmologists to identify the complications of diabetes and its treatment.

Host: Dr. Volpe, tell us how you are building your program to address these needs you have discussed. What are some of the key elements for building a world-class ophthalmology department?

Dr. Volpe: Well as in most situations, the most important part of the delivery of any type of healthcare whether it be the most primary care or the most complicated; it’s about the people, the caretakers, the physician extenders and the physicians themselves who all share our vision here for creating a highly specialized, easily accessed academic department that at the same time provides access to Northwestern and all of its expertise.

We have unique initiatives, for instance, in Teleophthalmology; where we are having – making efforts to access patients who don’t otherwise have access to ophthalmologists by screening them with photography in remote locations and identifying pathology in those remote locations so that patients can be identified who need specific treatment. We have a state-of-the-art brand-new facility with particular expertise in ophthalmic imaging; so most of our diseases, we can take living pictures at the cellular level for instance, of macular degeneration or glaucoma or diabetic retinopathy. And our facilities are equipped to take these images, identify these problems and how to best treat them and at the same time, to potentially shed light on our understanding of these conditions as we try to develop new treatments.

We very actively participate in a number of clinical trials to develop new treatments that we have initiated here ourselves and which we participate on a national level through the National Eye Institute and or through pharmaceutical companies that are trying to introduce new treatments.

I think one of the really exciting parts of developing a world-class ophthalmology department of course, are both its education and training component as well as its research component. Northwestern and Northwestern University have unique expertise in nanotechnology, biomedical engineering, genetics, health services research, vascular biology, neurodegenerative disease; all of those other conditions that are potentially related to eye disease are collaborators with us as we both treat and try to research some of the most difficult problems that we face in ophthalmology.

The other unique day to day aspect of our practice is that we work in a singular facility in which the entire spectrum of ophthalmic specialists are practicing together. It might be hard to believe but, even though it’s only the size of a golf ball, we have divided the eye into eight different specialties where people have unique expertise either in glaucoma, neuroophthalmology, retinal diseases, vitreoretinal surgery, orbit and eyelid disease to name a few; ocular inflammation and we actually all practice together in the same facility just a few rooms apart. So, patients with the most complex conditions can really have access to specialists all working together to identify their condition and its best treatments and at the same time; make the novel observations that we need to potentially stimulate new treatments and research.

Side by side, we are working very closely with residents, and fellows. Residents and fellows only add to the intellectual environment and help us to provide the most state-of-the-art care and at the same time; ensures that the doctors working here are at the very cutting edge and are the best teachers and are the ones who are creating the new knowledge that other ophthalmologists want to learn from. So, this whole composite of a large hospital-based multispecialty academic practice in a single facility is really what we have focused on over the last few years in building Northwestern Ophthalmology.

In addition, world-class ophthalmology departments obviously, focus intensely on research and creating new knowledge. At Northwestern, we have particular interest in understanding how the retina works and how the retina makes connections. If we are ever going to have an artificial chip or stem cells that are successfully inserted into the retina; we are going to need to have to understand how the retina makes connections to itself and to the brain. And that’s something of great interest to us here at Northwestern. We are particularly interested in imaging. I mentioned that earlier and developing state-of-the-art imaging that helps us understand how the retina works and how it functions.

We have a new initiative trying to use artificial intelligence to understand how to interpret diseases and the images we take of them in their pathogenesis. And we are also very interested in understanding the pathogenesis of macular degeneration and potentially its treatment and through our collaborations with the neurobiologists and nanotechnology experts; we are hoping to be able to create new treatments and new opportunities for our patients.

Host: Dr. Volpe, as a summary, what do referring physicians need to know about your very comprehensive and multidisciplinary program? What sets it apart?

Dr. Volpe: Well, to summarize again, I think we pride ourselves on providing same day access to any patient to our most outstanding ophthalmic specialists that co-practice together in a state-of-the-art facility with the opportunity to collaborate across Northwestern and Northwestern Memorial Hospital and its expertise to make sure that the most difficult patients are receiving the best possible care. If you don’t mind, I’ll end with a pun. Note that I think the future really is bright for ophthalmology and for opportunities that exist that are better than ever to treat some of our most blinding and difficult conditions, for instance macular degeneration, glaucoma, complicated retinal detachments, difficult glaucoma surgeries. These are all conditions that are routinely being treated here at Northwestern in a very innovative and collaborative environment and as we do this, at the same time, our researchers and our learners are working to create new knowledge in a way that makes our care state-of-the-art.

Host: Thank you so much for joining us and for explaining your program so very well for us and sharing your expertise about some of these complex conditions. Thank you again. This is Better Edge, a Northwestern Medicine Podcast for physicians. For more information on the latest advances in medicine, please visit www.nm.org, that’s www.nm.org. This is Melanie Cole. Thanks so much for listening.