Cure A Publication of the Johns Hopkins Wilmer Eye Institute 2017

Ian Pitha, M.D., Ph.D., works in his lab, located in Wilmer’s Robert H. and Clarice Smith Building. A Microsolution for a Major Challenge or Ian Pitha M.D., Ph.D., a physician-scientist in both have an implant placed on the eye or the Glaucoma Center of Excellence and the Center for under the surface of the eye, and then Nanomedicine (CNM), becoming a researcher was joining the let the medicine do its trick for the family business. “I always knew I wanted to do research and next four to six months. Fmedicine from a very early age. My parents were scientists,” he says. To make a microparticle, the One reason he chose ophthalmology in particular is because the eye scientists take glaucoma drugs that is “a really interesting little machine.” already exist and combine them with polymers, which are long strings Unfortunately for doctors, patients fewer than 50 percent of the patients of compounds. Pitha works with themselves do not behave nearly were what we would consider well- polymer chemist Jie Fu, Ph.D., a as reliably as mechanical objects. adherent with their eye drops,” says research associate at the CNM, to This is certainly the case for Pitha. And if a patient had to use create the microparticles. “There’s a patients prescribed eye drops—for a multiple drops a day, then he or she considerable amount of science in just multitude of reasons, from the simple did even worse. combining those two in a way where inconvenience of application to an But hope is on the horizon. Pitha you’re going to get enough drug in inability to squeeze the eye drops and other researchers at the CNM there and it’s going to release over a because of arthritis. have created microparticles as a nice duration of time,” Pitha says. In a pivotal study done at Wilmer, different “delivery mechanism” for The key development for patients will researchers learned that, “less than 50 the medication to treat glaucoma. If be the extended release of the drug, percent of patients used their drops the microparticles work as desired, which will eliminate daily drops. more than 75 percent of the time, so, then a patient would visit the doctor, (Continued on back page)

Honoring the Special Relationship A New Tool in the Fight for Seeing the Future inside: 2 Between Patients and Their Vision 3 Sight: Exercise 5 From the Desk of Harry Quigley, M.D., Honoring the Special Relationship Director of the Glaucoma Between Patients and Their Vision Center of Excellence manda Bicket, M.D., of the he 10 physician- Glaucoma Center of Excellence, surgeons and our admires her patients immensely. wonderful team are “People want to fight for their happy to present Avision. They’ll do anything,” she says. This Tthis selection of some of the motivation drew her to ophthalmology many research programs that because the field offers “a unique are ongoing in the Glaucoma opportunity to partner with patients in Center of Excellence. Our a fight that is unbelievably important to patients, from infants to them in a really visceral way,” she says. centenarians, are our first “You get to guide and shepherd them and bring whatever tools priority. During regular care that you’ve acquired along the way to bear on their goal of visits, we strive to preserve maintaining their sight.” and improve the quality of life and vision of each person who Bicket brought a host of new tools a Johns Hopkins division called trusts us with their care. with her when she joined the Wilmer CERSI, which is the Center for faculty last year—namely, surgical Excellence in Regulatory Science Each physician additionally seeks techniques used in minimally and Innovation,” says Bicket. “We to develop new diagnosis and invasive glaucoma surgery, or MIGS are looking at what patients prefer treatment methods for glaucoma for short, which actually comprises a in their eye care.” through investigations that family of surgeries. Bicket and collaborators from the involve a plethora of tools and “MIGS, by definition, are ab Bloomberg School of Public Health strategies, from new nerve cells in interno, conducted from inside are interviewing patients from culture dishes and new imaging the eye using mirrored prisms and Wilmer’s glaucoma division to elicit instrument approaches to new other things that let you see where from them what they value in their surgery methods and projects you’re going,” says Bicket. “They eye care and how they weigh risks throughout the world for those are done through incisions that are and benefits. “This information will suffering from glaucoma. no larger than a surgery be used to build patient-reported Many of our patients graciously incision.” outcomes instruments”—basically, donate their time to help with this These surgeries are a boon to a set of criteria—“that the FDA work during regular visits or on patients. “Recovery from MIGS will ultimately use to accelerate extra days by allowing us to learn is more like the recovery from approval for things that patients about glaucoma from the people cataract surgery, which is a week, need or want that aren’t available,” who have it. whereas the recovery period from she says. Others support our work with traditional glaucoma surgery can be Bicket’s research and patient care donations. We use this assistance, four to six weeks,” says Bicket. work in concert to honor what she whether large or small, to start new This is important to Bicket, sees as the defining characteristic of research projects that are grown whose research efforts focus on ophthalmology. “People value their into major, nationally funded understanding what exactly patients vision. Obviously, people value research, which totaled over value about their ophthalmic care. their health in general, but people’s $1 million in 2016. “I work with an interdisciplinary relationship with their vision is From each member of our team that represents the American really special and unique.” n group, thank you. n Glaucoma Society, the Food and Drug Administration (FDA), and

2 A New Tool in the Fight for Sight: Exercise

ne patient can make all the or other reasons,” says Ramulu. “The difference. Just ask Pradeep data suggested maybe the opposite Ramulu, M.D., Ph.D., who is was happening—that the reason we launching the Visual Improvement found this association was that the Owith Physical Activity Study (VIPS), largely people who were more physically based on the experience of one patient whose active just weren’t getting the disease vision improved after she started running. as much.” “Her findings are very striking,” says Ramulu. So, one day, when a patient “And with VIPS, we’re trying to actually see came to see him desperate to do whether people’s vision can get a little bit something, a suggestion bubbled up. better if they start exercising.” “She said, ‘What can I do?’ and I said, ‘Well, we have this theory that Interested in understanding how more complicated ways, we could maybe running helps.’ So she started people were affected by their actually see that it didn’t seem like running, and her vision got a little glaucoma, Ramulu began to study if, they were restricting their activity bit better. Then she stopped, and her and in which ways, people changed because they were fearful of falling vision got a little worse. And then their behaviors as their she started up again, disease progressed. He and it improved,” and his researchers says Ramulu. “When put GPS trackers and I saw these results, accelerometers on patients I said, ‘Oh, this is with various levels of real.’ At least in this glaucoma to try to answer one person, exercise these questions. made a difference.” “We found those Ramulu describes with greater disease were VIPS as a small less physically active,” study of 35 to 40 Ramulu says. This people. “We’re really could seem like a simple trying to see whether conclusion to reach, “but we can get people when we started looking (Continued on at that association in back page)

Ramulu wins Lighthouse 2016 Pisart Award

Lighthouse Guild, a leading nonprofit vision and health care organiza- tion, named Pradeep Ramulu, M.D., Ph.D., the Pisart Honoree in March 2016. Established in 1981, the Pisart Award recognizes an early-career vi- sion clinician or scientist whose contributions in vision science have the potential to substantially aid the understanding of vision loss, treatment of or rehabilitation of people with vision loss. “There are some amazing people who have won this award. When you see who’s won this award and you see your name, it’s very humbling,” says Ramulu.

3 SToP in the Name of Sight

avid Friedman, M.D., Ph.D., to determine who needs to be seen M.P.H., chose glaucoma as his by an eye doctor,” says Friedman. specialty because “you have a “And we have arranged for a free eye long-term, close relationship with exam here at Wilmer for everybody Dyour patients. And that really appealed to who screens positive for an eye me,” he says. And there was another reason condition. If they need glasses, we too. “It’s an area where we’re on the edge also give them a pair for free.” The of tremendous research change. There glasses are funded through charitable are basic science research programs that donations by grateful patients to will fundamentally alter how we manage Johns Hopkins. glaucoma, and there are a lot of newer technologies that will allow To recruit people for the eye for better care processes.” screenings, the team works with organizations like Chase Brexton, a Because glaucoma is a silent disease or diabetic federally qualified health center, and with almost no symptoms before a retinopathy.” nonprofits such as Sisters Together person has lost a substantial amount The SToP Glaucoma team just and Reaching. And it sets up its of vision, the challenge is to find finished the second year of its five- mobile clinic in churches and senior people before it is too late. year grant and has so far screened housing facilities as well. Enter Screening to Prevent more than 3,000 people. To ensure Reaching people where they live (SToP) Glaucoma, a Centers for its efforts have the widest reach at is a priority for Friedman. “I’ve Disease Control and Prevention- a low cost, the team has instituted always wanted to have a larger funded, multiyear effort led by several innovative practices. impact on communities and people, Friedman to screen people, free “Our screeners are all laypeople,” particularly people who are the most of charge, for glaucoma and other says Friedman. The screeners vulnerable. And a lot of those people eye diseases. “I’ve hired a team evaluate people using a series of don’t make it to my clinics,” says of people, and we’ve created a procedures, including testing vision, Friedman. “This is why we have to traveling clinic, where we go and measuring to see if glasses can go to them to help them preserve screen for eye diseases and vision improve vision (autorefraction), their sight.” n loss,” says Friedman. “While we are taking photos of the back of the determined to find undiagnosed eye, measuring eye pressure and, if To learn more about SToP Glaucoma, glaucoma, we also find people who indicated, testing side vision. visit stopglaucomahopkins.org. need glasses, or who have , “I review all the electronic data

The SToP Glaucoma team, composed of Johns Hopkins University students and staff members from the Dana Center for Preventive Ophthalmology, hosted a screening event at Chase Brexton Health Services in Baltimore.

4 Seeing the Future

ourtney Kraus, M.D., knows well the stress a child can feel on the road. For the third year in at the doctor’s office. Luckily for children who come to a row, she spent a week in Belize Wilmer, Kraus has dedicated herself to building a practice working with an organization called where “kids come into my office and do not leave crying.” the World Pediatric Project, which C coordinates volunteer surgical A pediatric ophthal­ “For better or for worse, missions to South and Central mologist whose practice I have a personality America in a range of specialties, includes the medical and and a mindset that help including ophthalmology. surgical management of me jump into a child’s “You’re often operating long into glaucoma, Kraus knew brain,” she says. “Shiny, the night and working with a group she wanted to work with sparkly things appeal of people sharing this common, children before she knew to me too. I can often single-minded vision to take care of which specialty to pursue. come up with another this large group of children,” says She chose ophthalmology thing within my arm’s Kraus. “There’s a lot to love about because “a child’s sight reach that will distract it.” is something that is so a child for a split second This passion extends to the entire critical to their interaction with the longer and allow me to get that field of ophthalmology. “I love that world, with their education, with critical piece of information that is I can focus on this one little thing, what they go on to be, and I want going to enable me to better treat the eye,” says Kraus, “but because to maximize whatever potential they them.” so much of our general health is have.” Kraus also takes her skills and reflected in that one little thing, I’m While children are her favorite passion for working with children also caring for a whole person.” n part of her chosen field, they are also a “unique challenge. Unlike adults, where coming in to check eye pressure can be a very simple thing to do, with children, this can be the absolute hardest aspect of the appointment.” There is a “true art” to figuring out a way to check a child’s eye The World pressure so the process doesn’t result Pediatric Project partners with the in screaming or crying and provides Belize Council for the Visually accurate information, says Kraus. Impaired, which For this, Kraus has a secret weapon. informs people about Kraus’ arrival and the availability of appointments for patients, such as Kahleel Wade, left, There is a “true art” in Kraus’ arms. to figuring out a way to check a child’s eye pressure so the process doesn’t result in screaming or crying.

5 Cure Glaucoma

For information on how to support the Johns Hopkins Wilmer Eye Institute, contact: Libby Bryce Bell Wilmer Development Office Email: [email protected] Phone: 410-955-2020 Editor, writer: Jessica Wilson Designer: Max Boam Cure Glaucoma is published once a year by the Johns Hopkins Wilmer Eye Institute. If you prefer not to receive communications from the Fund for Johns Hopkins Medicine, please contact 1-877-600-7783 or [email protected]. Include your name and address so that we may honor your request.

A Microsolution continued from page 1 Wilmer faculty “If the medication in the drops already lowers the pressure, the member Randy microparticles are going to be more effective. If, on average, people Craven, M.D., is are getting drops in 50 percent of the time, microparticles are a returning to Mary- guarantee that medicine is always getting delivered,” says Pitha. And land from his post as chief of glaucoma this reliability will help Pitha’s “interesting little machine” get what at King Khaled Eye it needs to combat glaucoma as effectively as possible. n Specialist Hospital in Saudi Arabia. He A New Tool continued from page 3 will now practice at to safely exercise and get some understanding of whether it seems to the Johns Hopkins actually help their vision in some meaningful way.” Wilmer Eye Institute’s East Baltimore In the meantime, Ramulu has found that glaucoma patients location and in the national capital region at Wilmer, Bethesda. We are excited that who walked more experienced less damage to their visual field over his addition to the Glaucoma Center of time, independent of other factors, such as intraocular pressure and Excellence increases our ability to serve age. These results inspire hope that any physical activity—even more patients. n nonvigorous exercise—can provide vision protection for patients. n

WE’RE IN YOUR NEIGHBORHOOD Glaucoma Center of hopkinsmedicine.org/wilmer Excellence Faculty Wilmer Eye Institute at Columbia Amanda Bicket, M.D. The Johns Hopkins Hospital Medical Pavilion at Howard County 1800 Orleans St. 10710 Charter Drive, Ste. 310 Michael Boland, M.D., Ph.D. Baltimore, MD 21287 Columbia, MD 21044 Randy Craven, M.D. Johns Hopkins Bayview Frederick David Friedman, M.D., Ph.D., M.P.H. Medical Center 87 Thomas Johnson Drive, Ste. 102 Henry Jampel, M.D., M.H.S. 4940 Eastern Ave. Frederick, MD 21702 Courtney Kraus, M.D. Baltimore, MD 21224 Green Spring Station Ian Pitha, M.D., Ph.D. Bel Air 10753 Falls Road, Pavilion 2, Ste. 455 Harry Quigley, M.D. 620 Boulton St. Lutherville, MD 21093 Pradeep Ramulu, M.D., Ph.D. Bel Air, MD 21014 Odenton Donald Zack, M.D., Ph.D. Bethesda 1106 Annapolis Road, Ste. 290 Air Rights Center, West Tower Odenton, MD 21133 7315 Wisconsin Ave., Ste. 610 White Marsh Bethesda, MD 20814 4924 Campbell Blvd., Ste. 100 White Marsh, MD 21236