New Research Impacts How Surgeons Around The World Approach Glaucoma
Emily Schehlein, M.D., a second-year resident at Kellogg, is one of the driving forces behind new research that may impact how eye surgeons around the world approach glaucoma and cataract care.
She is one of the lead authors of a five-year study comparing rates of newly developed glaucoma, visual outcomes and complications in eyes with and without pseudoexfoliation (PEX) undergoing cataract surgery.
PEX is an age-related eye condition characterized by the deposition of material, most prominently on the lens surface and border of the pupil. It is associated with the development of glaucoma.
The first large-scale, long-term prospective study of its kind, the work was conducted and led by colleagues at India’s Aravind Eye Care System, the world’s largest eye care system. Approximately 1,000 eyes with PEX and 500 without were randomized to different cataract removal procedures and lens implants.
Importantly, the percentage of patients with newly diagnosed glaucoma was four times higher in the PEX group (7.4 percent) than in the control group (1.8 percent). This reinforces the importance of long-term monitoring of these eyes.
“This part of my Kellogg residency was incredibly fulfilling,” Schehlein says. “My Aravind colleagues were so welcoming, and it was a privilege to work side by side with them and see how ophthalmology is practiced in another country. But what made this project so exciting was the potential, as a resident, to be part of changing how we approach cataract surgery in the future.”
In 2019 Dr. Schehlein was honored with the American Glaucoma Society’s Bernard Schwartz Memorial Award, the Michigan Society of Eye Physicians and Surgeons’ Resident Research Award and the U-M Howard Resident Prize for Glaucoma Excellence.
Resident Working With Underserved Populations and Mentoring Medical Students
Philip Garza, M.D., M.Sc., a third-year resident, is making the most of his Kellogg experience, combining his interests in clinical research, working with underserved populations and mentoring medical students.
He’s also playing a central role in two “firsts” for one of Kellogg’s flagship international partnerships.
In 2015, the Kellogg Eye Center for International Ophthalmology began a collaboration with St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. Since then, more and more Kellogg faculty have traveled to the capital city to collaborate with their Ethiopian colleagues.
While the partnership has focused on clinical and educational goals, it is now expanding to include research. Dr. Garza is a contributing author on one of the first research projects, a study of awareness and attitudes about glaucoma. The study is nearing publication.
Garza and a Kellogg/SPHMMC team set out to describe perceptions of glaucoma and its medical and surgical treatments among patients in Addis Ababa. “To our knowledge, this is the first survey of glaucoma attitudes and knowledge to be conducted in Addis,” he explains. “Our study will help inform future public health interventions aimed at increasing awareness of glaucoma in the city,” which is home to more than three million ethnically diverse residents.
Dr. Garza was also the first Kellogg resident to travel to Ethiopia.
“The trip was a tremendous opportunity to broaden my horizons as a researcher, to interact with collaborators in Ethiopia, and to gain hands-on teaching and mentoring experience with the U-M medical student who performed data collection,” he says.
Big Data to Transform Understanding in Patient Care
Annie Wu, M.D., a second-year resident, knows the power of big data to transform understanding.
She chose Kellogg for residency in part to work with and learn from associate professor Joshua Stein, M.D. Drs. Stein and Wu have leveraged large electronic health record (EHR) databases to answer two intriguing questions with implications far beyond ophthalmology.
Does vision impairment influence whether women get mammograms?
Screening mammography has been shown to save lives by detecting breast cancer early. However, it is more challenging for people with physical disabilities to access preventive services such as cancer screenings. Dr. Wu set to find out to what degree vision impairment might be preventing women from undergoing mammography.
Mining thousands of EHRs, Dr. Wu’s analysis demonstrated that women with partial vision loss were significantly less likely to undergo screening mammography.
Do commonly prescribed medications impact glaucoma risk?
Dr. Wu also aggregated and reviewed data from several of Dr. Stein’s previous studies looking for connections—helpful or harmful—between drugs commonly prescribed to regulate blood sugar or lower cholesterol and the risk of glaucoma or glaucoma progression. Her review revealed several associations that warrant more study. Some medications, including systemic corticosteroids, are linked to increased risk, while others, like metformin and statins, appear to have a protective effect.
“Big data helps us see relationships like these that we never considered before,” Dr. Wu says. “As a resident, it’s exciting to be part of eye research that may eventually help primary