Sight for Sore Eyes
By Geoffrey Johnson
Ophthalmology, University of Illinois Medical Center at Chicago
As chief of the University of Illinois Eye and Ear Infirmary, the Lebanon-born Dimitri Azar divides his days between seeing patients and handling administrative duties. "Every evening I'm in the lab," he says—and the results show up in the clinic, where Azar (who is 48) and his colleagues deploy a wide range of seemingly futuristic procedures.
Q. Your chief focus is refractive surgery. What is that?
A. Anybody who needs glasses or contact lenses is having a refractive error; the optics of the eye are not perfectly aligned. Refractive [LASIK] surgery uses lasers to reshape the cornea or add mass to the cornea or operate on the crystalline lens of the eye so that the patient will be able to see better without any contact lenses or glasses.
Q. Who is a good candidate for LASIK surgery?
A. Most patients have the surgery as a convenience. In general, for every ten patients who come wanting refractive surgery, probably we operate on two—at least in my practice. My advice is, don't have the surgery if you're not having a problem. I make it clear to distinguish between reducing the dependence on glasses, which is what we can do with great ease, versus complete elimination of glasses. If you feel your expectations are much higher than what we can offer, you will be advised not to have it done.
Q. Is it a risky procedure?
A. It's relatively safe; the side effects are very minimal. The patients who run a risk of having a problem because of certain particular situations in their cornea, we will tell them: Don't have the surgery. We minimize the problems by reducing the actual complications per procedure and by making sure that patients who are borderline candidates should not have the surgery.
Q. What about artificial corneas?
A. The technology has been improving slowly. Due to some recent research and new testing, we have reduced the likelihood of an infection to practically zero. As a result, this has been a lifesaver for patients who could not have a regular corneal transplant.
Q. What exciting developments are occurring in your research?
A. We have found several molecules that are produced in the cornea that seem to inhibit blood vessel growth. These molecules, which result from the expression of a family of enzymes known as MMPs, have the potential to treat degenerative disease, such as macular degeneration, and even cancer.
Q. Are there any promising treatments in sight for macular degeneration?
A. In the past year, we are starting to see patients with macular degeneration who, after treatment, have improved vision. In the past we used to be content when we could stop the disease; now we can reverse the disease, and that's a major step forward. [Learn more about aging and eye disease in The Eye Digest, published by the Illinois Eye and Ear Infirmary at agingeye.net.]
Q. What other breakthroughs are on the horizon?
A. One of our researchers recently got a very large grant to create a retinal implant in cases where there is a disease in the outer layer of the retina. It employs nanotechnology and gets activated by the light and then the diseased layer of the retina gets bypassed. It's still at the very early stages now, but it has great promise in treating conditions that up to now have been completely untreatable.
Q. What about glaucoma?
A. Glaucoma is a blinding condition where the pressure in the eye goes up and becomes higher than what the nerve can tolerate. It leads to the loss of some of the nerve fibers that transmit the image from the retina to the brain. There are now new approaches of trying to increase the strength of the nerve fibers. Hopefully in the future we will be able to regenerate the nerves.
Photograph: Katrina Wittkamp