Eyes Wide Open: Stem Cell Therapy Patients Confront Promise, and Peril
March 24, 2017
I want to share a few thoughts regarding the recent stories about three elderly patients in Florida who hoped to slow the decline of their vision due to macular degeneration by opting for stem cell injections to the eye. Instead of enjoying restored vision, they wound up blind. The doctors offering the treatment believed that because the stem cells were harvested from the patients’ own bodies, (using liposuction) the treatments were exempt from FDA approval or other regulations regarding the use of stem cell therapies. Unfortunately, the results were devastating.
If you are considering stem cell therapy, the short answer is: at this time, in the U.S., the only legitimate retinal stem cell therapy protocols are trials being conducted with oversight from the FDA and after careful review by an independent Institutional Review Board (IRB). You can go to the National Institutes of Health clinicaltrials.gov website to read about the trial. But this listing is not evidence that the trial has been endorsed by the government or by the FDA. You need to confirm with your doctor that the trial has been approved by an experienced IRB. You should also carefully review all of the risks and benefits described in the written informed consent form. Legitimate clinical trials rarely charge patients to participate in the study. If you are being charged, be wary. In addition, I personally would never participate in a study where both eyes are being treated by an experimental therapy at the same time. Any of these should be warning signs to you that the experimental procedures have not been vetted carefully.
I’ve written here before about Doheny’s work in the area of adult stem cell research. We are encouraged by the early findings, and we continue to collaborate with our colleagues around the globe to find the best approaches and applications. We are committed to ensuring that we proceed in a careful and meticulous fashion, making sure that all risks and safety concerns are addressed.
We are engaged in this research because we are always searching for the treatments that will work. Yet, even when we have proven approaches, it is impossible to predict the precise outcome of any medical procedure, because every case is different, as every individual is unique.
What we do know is that the best Rx for vision loss is always some combination of what Doheny has to offer every patient—excellent doctors + top notch technology + superior science + hope. I understand how important hope is. We at Doheny hope along with our patients. And, rigorous science and continuous institutional review is the foundation of all that we do. When considering any experimental therapies, don’t be shy about exercising due diligence to make sure the procedure you are considering has been carefully reviewed by the FDA and by an IRB.
SriniVas Sadda, MD
Health Care: Seeing Both Continuity and Change in New Trump Administration
February 6, 2017
There is significant news about shifts in health care under the new Trump administration, so it is important to clarify that part of former President Obama’s health care legacy remains intact; and that remaining part affects our patients at Doheny.
The law known as MACRA, which re- defines how Medicare reimburses doctors, was written to strengthen Medicare access. MACRA went into effect January 1 and is fully expected to stay in place. That’s because the law ties physician reimbursement to quality, not to volume of patients served.
The quality care reimbursement model has generally appealed to lawmakers from both major parties: MACRA was drafted by a Republican Congress and signed by a Democratic president.
Also, while the shift in payment model under MACRA is new, the bill is largely a re-authorization of existing law, and many of its provisions are familiar to health care professionals and legislators.
It is true that Dr. Tom Price, the new U.S. Secretary for Health and Human Services, will review and implement the system with his own approach. Some aspects of delivery of services and reimbursements may be slowed. But I feel confident that cost containment of rising health care costs in this country will remain a priority, and MACRA will remain.
In this time of change, please know you have my assurance that Doheny doctors are committed to quality care, cutting-edge research and best practices every day. Our core mission never wavers; we are here to ensure eye health care.
SriniVas Sadda, MD
Out in Front on Zika
January 24, 2017
One of the hot topics among my colleagues in this new year is how to combat and treat the Zika virus, because there is now significant data now indicating that the virus affects the eyes of newborns, causing retinal lesions, and leaving large retinal scars that can damage vision.
The Doheny Eye Institute is fortunate to have a handful of the most accomplished pediatric retinal specialists in the world on faculty, including Dr. Irena Tsui, so Zika is prompting new questions and approaches in their research and practice.
As of this week, the CDC has recorded slightly more than 4500 travel- related cases of Zika virus in the US, plus some mosquito-borne cases locally acquired, including in Los Angeles County.
How to identify molecules that can kill Zika- carrying mosquitoes is part of the research already underway, and time is of the essence. As we begin to see more cases of Zika, here, understanding and fighting the disease is increasingly urgent. Together with doctors at the UCLA’s Jules Stein Eye Institute, and in cooperation with their peers at the UCLA’s David Geffen School of Medicine, we at Doheny are part of an excellent team engaged in this pioneering work to protect infants’ eyesight from the Zika virus. As the work unfolds, I promise to keep you apprised.
SriniVas Sadda, MD
Ryan Legacy Strong in China
January 17, 2017
It was my honor to participate in the International Retina Conferece at the distinguished Zhongshan Ophthalmic Center in southeast China. The Zhongshan Ophthalmic Center (ZOC) is a one of the best eye institutes in all of China and is a key partner and collaborator for the Doheny Eye Institute.
We have recently collaborated to establish the Zhongshan Image Reading Center, which is already actively conducting research studies. The ZOC is also on the cusp of opening a new state of the art facility that will increase its capacity to serve patients and advance research in important ways. We will continue to partner with the Center, and we look forward to deepening these relationships around retina advances.
A few days later, many colleagues gathered in Beijing to honor the legacy of Dr. Steve Ryan. Through an extensive network of former Doheny fellows, collaborators and colleagues, Dr. Ryan’s vision and work drives much of the current endeavor in the field today in China. His impact and far-reaching accomplishments in cultivating and supporting international collaboration to advance our work cannot be overstated.
I was reminded of Dr. Ryan’s influence and leadership as I listened to tributes and connected with friends and peers, all inspired to make improvements for patients and research in China by Doheny’s towering leader of many years. I was happy to be present as my predecessor, Dr. Steve Ryan, was remembered eloquently with words; but moreover, I know he is remembered in the good work that is done to improve vision that happens around the world every day.
All of these connections, in China and beyond, strengthen the foundations of our mission at Doheny Eye Institute, our global networks, and our ability to move the work forward in the year to come.
SriniVas Sadda, MD
Your Vision for Doheny
December 28, 2016
When I share information in this space, I realize that I am dominating the conversation about advances and innovations at Doheny Eye Institute.
The truth is, your vision for Doheny makes it all possible. In honor of our friends, this post is about you, all of you who care about our work and support our efforts generously throughout the year.
Doheny Eye Institute pioneers in research and treatment that has a profound impact on thousands of lives around the world every year. The work that we do makes it possible for people to see, to live independently, and to enjoy life. Our work spans from infant care to working towards solutions and cures for elderly patients, as well as making sure those in the prime of their lives can reach their potential.
In 2017, the Doheny Eye Institute celebrates 70 years at the forefront of ophtalmologic advances and care. Our story is beautifully told in A Clear Vision: The History of the Doheny Eye Institute 1947 – 2017
This illustrated coffee table book traces the origins of the Doheny Eye Institute with an intriguing collection of vintage photographs, documents, and our evolving story through the present day.
I hope you will consider an end of year gift to Doheny. Your vision drives our work here. We look forward to sending you a copy of this keepsake book as thanks for your kind support
SriniVas Sadda, MD
US-China Cornea Forum Launched
December 16, 2016
The US-China Cornea Forum that took place during the American Academy of Ophthalmology fall conference in Chicago was a first. I’m happy to say the gathering was a direct result of Doheny’s enduring emphasis on international collaboration.
Former Doheny technician, resident and fellow, Dr. Mingwu Wang, an MD, PhD graduate of China Medical University in Shenyang, and now based in Tucson, Arizona, organized this inaugural exchange of ideas, with the intention of helping doctors identify peers and establish relationships in person that can move forward virtually.
The forum expands on our targeted efforts in East Asia. Earlier this year, Doheny doctors Olivia Lee and Laura Vickers made a trip to Mongolia to work directly with colleagues on corneal transplant techniques and training. These in-person working groups are critical to sharing the latest know how and even bringing transplantable corneas to patients.
We are fortunate to have ample evidence at Doheny by now that connections made among doctors in person continue successfully online and can have transformative effects on the state of research and patient treatment. My hope is that Doheny’s sponsorship of this new US-China Cornea Forum will incubate many collaborations in the years ahead.
SriniVas Sadda, MD
Imaging Update: Kudos to Dr. Vik Chopra for Innovative Applications
December 2, 2016
Throughout the year, I have the pleasure of using this space to call out the successes of my colleagues as they work to advance research and treatment in important and innovative ways.
Doheny’s Dr. Vikas Chopra is an exceptional doctor, as well as a gifted and talented speaker. At this fall’s annual American Academy of Ophthalmology meeting in Chicago, his paper on using OCT angiography in glaucoma prevention and care was cited by our colleagues as the best paper presentation.
Dr. Chopra’s work illuminates new approaches for early detection of glaucoma using state-of-the-art OCT angiography technology to analyze the density of the fine capillaries in and around the optic nerve to look for evidence of possible damage. Once a glaucoma patient loses nerve fibers, irreversible damage has been done. This work is in the early stages. This new approach deserves continued study because of the very real potential to save sight with advanced imaging diagnostics.
The discovery that OCT angiography may be a powerful tool in early detection of glaucoma and in patient care is the result of Dr. Chopra’s inquiry and original approach, part of what makes Doheny a leader in the international quest for cures of eye disease.
SriniVas Sadda, MD
November 3, 2016
Doheny fosters research at the frontiers of medical science, and, I am happy to say, we also foster expertise that can literally write the book on advances in treatment.
Next month, a brand new textbook will be published. Written by Doheny faculty members Dr. Brian Francis and Dr. James Tan, along with their colleague Dr. Steven Sarkasian of the Dean McGee Eye Institute, Minimally Invasive Glaucoma Surgery: A Practical Guide is a comprehensive volume detailing state of the art techniques and discussion of cases.
The revolutionary procedures illuminated in the book matter, because they result in far fewer complications for patients, which means better outcomes overall.
This publication also includes video, a teaching element that can significantly enhance understanding among medical students and practicing doctors alike. I like the confluence of technologies making an impact for patients fighting eye disease.
I was there when Dr. Francis and Dr. Tan introduced their book at the American Academy of Ophthalmology annual meeting in mid-October to great interest. That’s because doctors around the world treat millions of people who live with glaucoma, and our foundational and innovative work at Doheny is vital to improving their patients’ vision.
SriniVas Sadda, MD
Doheny Research Reaches Quingdao Colleagues in Mandarin
October 18, 2016
In September, when Doheny’s Dr. Irena Tsui delivered a lecture in Mandarin to our colleagues at Quingdao Hospital at Nanjing University on the latest advances in fighting retinopathy of prematurity, I felt the legacy of our immediate past leader, Dr. Steven Ryan.
My colleague, Irena Tsui, grew up in the U.S., speaking mostly Mandarin at home with her parents. When she connects with past Doheny fellows who live and work in China, the communication takes on an added efficiency and meaning.
At Doheny, over many decades, Dr. Ryan cultivated and cared about sustaining strong international relationships in the quest to conquer eye disease. That tradition continues to define the culture at Doheny. So it was with great pleasure that I attended this talk and witnessed the engagement of our Chinese colleagues with the fresh data and ideas Dr. Tsui offered regarding the outcomes for these medically fragile babies, born sometimes as early as 23 or 24 weeks of gestational age.
In rapidly developing countries with much emerging technological capacity, serious study, curiosity and hard work is needed to incorporate state of the art practice.
As more babies survive premature delivery and are born with ophthalmologic and other health challenges, greater expertise is needed. Dr. Tsui delivered information about advances in injectable and laser treatment, answered questions, and served as an authentic ambassador of what Doheny brings to the world. I wanted to share this remarkable event with you, because it embodies the Doheny promise.
SriniVas Sadda, MD
In India, Talks About Diabetic Retinopathy Echo Internationally
September 12, 2016
Diabetes is epidemic in India, and soon, the country will be home to the largest diabetic population in the world.
The concomitant increase in cases of diabetic retinopathy is alarming, making it one of the leading causes of blindness in the country. It seems that soon, the US will face similar issues. Globally, the implications for our work are enormous.
Poor diet and high blood sugars lead to damage to retinal blood vessels, and the damage is irreversible. But, the damage is preventable. So early detection and management of the disease is critical, nowhere more so than in India today. In Chennai, India over the summer, I met with ophthalmologists who gathered to hear experts from their country, the US, and worldwide to discuss and debate the latest developments in how to approach and treat patients and diabetic retinopathy.
Fortunately, many researchers, including Dr. Micheal Ip, recently appointed medical director of the Doheny Image Reading Center, are focused on accelerating the research in this area. But the meetings in India this summer also reminded me how critical screening is to the diagnosing and timely treatment of this disease.
Diabetics who also have diabetic retinopathy typically are asymptomatic. That means nothing seems “wrong” with their vision, so they never have it checked out. Even here in Los Angeles, fewer than 2% of diabetics are screened in some communities. To truly combat this disease, we need to begin by improving those numbers.
The conversation we had in India matters there, but it also matters here, and everywhere else in the world where we face questions of the impact of our modern diet on health and eye health.
SriniVas Sadda, MD