Tag Archives: Ophthalmology

Receptor that helps protect brain cells has important role in support cells for the retina

A receptor that is already a target for treating neurodegenerative disease also appears to play a key role in supporting the retina, scientists report.

Without sigma 1 receptor, the Müller cells that support the retina can’t seem to control their own levels of destructive oxidative stress, and consequently can’t properly support the millions of specialized neurons that enable us to transform light into images, scientists report in the journal Free Radical Biology and Medicine.

Without support, well-organized layers of retinal cells begin to disintegrate and vision is lost to diseases such as retinitis pigmentosa, diabetic retinopathy and glaucoma, said Dr. Sylvia Smith, retinal cell biologist and Chairwoman of the Department of Cellular Biology and Anatomy at the Medical College of Georgia at Georgia Regents University

The surprising finding makes the sigma 1 receptor a logical treatment target for these typically progressive and blinding retinal diseases, said Smith, the study’s corresponding author. It has implications as well for other major diseases, such as cardiovascular disease and cancer as well as neurodegenerative disease, where oxidative stress plays a role.

What most surprised the scientists was that simply removing sigma 1 receptor from Müller cells significantly increased levels of reactive oxygen species, or ROS, indicating the receptor’s direct role in the oxidative stress response, Smith said. They expected it would take them giving an oxidative stressor to increase ROS levels.

So they looked further at the sigma 1 receptor knockouts compared with normal mice, and found significantly decreased expression in the knockouts of several, well-known antioxidant genes and their proteins. Further examination showed a change in the usual stress response.

These genes that make natural antioxidants contain antioxidant response element, or ARE which, in the face of oxidative stress, gets activated by NRF2, a transcription factor that usually stays in the fluid part of the cell, or cytoplasm. NRF2 is considered one of the most important regulators of the expression of antioxidant molecules. Normally the protein KEAP1 keeps it essentially inactive in the cytoplasm until needed, then it moves to the cell nucleus where it can help mount a defense. “When you have oxidative stress, you want this,” Smith said of the stress response, which works the same throughout the body.

Deleting the sigma receptor in the Müller cells altered the desired response: NRF2 expression decreased while KEAP1 expression increased. The unhealthy bottom line was that ROS levels increased as well.

The study is believed to provide the first evidence of the direct impact of the sigma 1 receptor on the levels of NRF2 and KEAP1, the researchers write.

“We think we are beginning to understand the mechanism by which sigma 1 receptor may work and it may work because of its action on releasing antioxidant genes,” Smith said.

While the ubiquitous receptor was known to help protect neurons in the brain and eye, its impact on Müller cell function was previously unknown. The significant impact the MCG scientists have now found helps explain the dramatic change they documented after using pentazocine, a narcotic already used for pain relief, in animal models of both retinitis pigmentosa and diabetic retinopathy. Pentazocine, which binds to and activates the sigma 1 receptor, seems to preserve functional vision in these disease models by enabling many of the well-stratified layers of photoreceptor cells to survive.

Next steps include clarifying whether it’s actually preservation or regeneration of the essential cell layers and how long the effect lasts. “We do see some retention of function, that is clear and that I am very excited about,” Smith said.

Müller cells are major support cells for the retina, helping stabilize its complex, multi-layer structure, both horizontally and vertically; eliminating debris; and supporting the function and metabolism of its neurons and blood vessels. Typically bustling Müller cells can become even more activated when there is an insult to the eye, such as increased oxidative stress, and start forming scar tissue, which hinders rather than supports vision. Problems such as diabetes, can increase ROS levels.

ROS are molecules produced through normal body function such as breathing and cells using energy. The body needs a limited amount of ROS to carry out additional functions, such as cell signaling. Problems, from eye disease to cancer, result when the body’s natural system for eliminating excess ROS can’t keep up and ROS start to do harm, such as cell destruction.

Normally humans have about 125 million night-vision enabling rods intermingled with about 6 million cones that enable us to respond to light and see color.

The research was supported by the National Eye Institute and the James and Jean Culver Vision Discovery Institute at GRU. MCG Assistant Research Scientist Dr. Jing Wang is the study’s first author.

14 GRU docs are tops in nation

AUGUSTA, Ga. – Fourteen physicians at Georgia Regents University and GRHealth have been included in the 14th edition of “America’s Top Doctors,®” a national patient reference guide published by Castle Connolly Medical Ltd. that identifies the top 1 percent of doctors in the nation by specialty, helping patients find recognized experts. For more than a decade, Georgia Regents Medical Center, which specializes in tertiary and quaternary health care, has been the only hospital in the Augusta-Aiken area with physicians included in this prestigious list.

This year’s specialists include:

Dr. Cargill H. Alleyne Jr., Neurosurgery: Alleyne is Marshall Allen Distinguished Chair and Professor of Neurosurgery and Director of the Neurosurgery Residency Training Program at GRU’s Medical College of Georgia. He is Chief of Neurosurgery at Georgia Regents Medical Center, Georgia’s first Joint Commission-designated Advanced Comprehensive Stroke Center, where he specializes in skull base surgery and in treating blood vessel diseases of the brain and spinal cord, including strokes, aneurysms, and AVMs. Alleyne investigates novel treatments for cerebral vasospasm, strokes, and aneurysms.

Dr. Ricardo Azziz, Reproductive Endocrinology and Surgery: Azziz, President of Georgia Regents University, has clinical and research interests in endoscopic pelvic reconstruction and reproductive endocrinologic disorders in women, particularly androgen excess, such as polycystic ovary syndrome, non-classic adrenal hyperplasia and hirsutism. Azziz also serves as CEO of the Georgia Regents Health System.

Dr. Sharad A. Ghamande, Gynecology/Oncology: Ghamande is Professor and Chief of Gynecologic Oncology at GRU’s Medical College of Georgia and Associate Cancer Center Director at the GRU Cancer Center. His clinical and research interests include robotic surgery for gynecologic cancers and chemotherapy trials in recurrent ovarian cancer. Ghamande has worked with the National Cancer Institute-funded Georgia Gynecologic Oncology Group studying innovative ways to prevent and treat pelvic malignancies and is currently the principal investigator on the NCI-funded Minority-Based Community Clinical Oncology Program.

Dr. David C. Hess, Neurology: Hess is Professor, Chairman of the MCG Department of Neurology and Presidential Distinguished Chair. His research focuses on novel treatments for acute ischemic stroke, including cell and restorative therapies. Recently, he is working on developing remote limb ischemic conditioning as a therapy for stroke and vascular dementia. He co-founded REACH Health, Inc., a telemedicine company based in Georgia, and the REACH telestroke system is now being used in many academic medical centers and integrated delivery networks throughout the country, enabling stroke and other specialists to provide timely care to patients in rural and underserved areas.

Dr. Walter J. Moore, Rheumatology: Moore is a Professor of Medicine and Pediatrics in the Section of Rheumatology and Adult Allergy. He is MCG’s Senior Associate Dean for Graduate Medical Education and Veterans Affairs. He treats inflammatory soft-tissue and connective-tissue disorders and provides medical staff leadership with his engagement in Patient- and Family-Centered Care with patient, resident, and medical student education.

Dr. Julian J. Nussbaum, Ophthalmology and Vitreo-Retinal Disorders: Nussbaum is Professor and Chairman of the MCG Department of Ophthalmology; Co-Director of GRU’s James and Jean Culver Vision Discovery Institute; and Assistant Dean for Ambulatory Care Services. He treats diabetic eye disease, age-related macular degeneration, and other degenerative and vascular disorders of the retina.

Dr. Gregory N. Postma, Voice and Swallowing Disorders: Postma is Professor and Director of the Georgia Regents Center for Voice, Airway and Swallowing Disorders. He treats voice disorders (including those of professional singers), swallowing disorders, airway disorders, gastroesophageal reflux and chronic cough. He helped pioneer in-office surgery and also researches extraesophageal reflux and swallowing disorders.

Dr. Satish S. C. Rao, Gastroenterology: Rao is a Professor, Chief of the Section of Gastroenterology and Hepatology, and Director of the GRHealth Digestive Health Center. His research focuses on the pathophysiology and treatment of irritable bowel syndrome, constipation, fecal incontinence and visceral pain, particularly esophageal chest pain. Rao has pioneered biofeedback therapy for dyssynergic defecation and several techniques for evaluating esophageal, gastric, colonic, and anorectal function, in particular the brain-gut axis.

Dr. Kapil D. Sethi, Neurology: Sethi is Professor and Director of the Movement Disorders Program. His clinical interests are movement disorders, including Parkinson Disease and botulinum toxin injections. His research interests include identifying better therapies for PD, Dystonia, and other movement disorders.

Dr. Sandra G. B. Sexson,* Child and Adolescent Psychiatry: Sexson is Professor and Chief of the Section of Child, Adolescent, and Family Psychiatry in the MCG Department of Psychiatry and Health Behavior. She specializes in psychosocial aspects of children and adolescents with chronic diseases such as diabetes, cystic fibrosis and cancer. Her research interests include pediatric oncology, attention deficit/hyperactivity disorder and school continuity for ill children. She is a national leader in psychiatric education.

Dr. Robert A. Sorrentino, Cardiac Electrophysiology: Sorrentino is the Creel Professor of Medicine at MCG and Director of the Georgia Regents Heart Rhythm Center at the hospital. He evaluates and treats patients with heartbeat abnormalities, fainting and assesses patient’s risks for cardiac arrest. He has particular expertise in the implantation and management of pacemakers, defibrillators, biventricular ICDs and laser-assisted extraction of pacemaker or defibrillator wires.

Dr. David J. Terris, Thyroid and Parathyroid Surgery: Terris is a Regents Professor and the Surgical Director of the GRU Thyroid/Parathyroid Center. He performs robotic and minimally invasive thyroid and parathyroid surgery. He investigates surgery techniques for thyroid and parathyroid tumors, has published 5 books on endocrine surgery topics, and pioneered a technique that eliminates a visible scar.

Dr. Martha K. Terris, Urology: Terris is Professor and Chief of the Section of Urology, holding the Witherington Distinguished Chair in Urology. She also serves on the urology faculty at the Charlie Norwood Veterans Affairs Medical Center. She performs open, laparoscopic and robotic surgery to treat kidney, bladder and prostate cancer. She also performs nerve-sparing prostatectomy and radical cystectomy with neobladder (creating a new bladder out of intestine).

Dr. Jack C. Yu,* Pediatric Plastic Surgery: Yu is the Milford B. Hatcher Professor of Surgery and Chief of the Section of Plastic Surgery at MCG and Director of the Craniofacial Center at Children’s Hospital of Georgia. He performs cleft lip, cleft palate, and craniosynostosis corrections, as well as aesthetic surgeries such as facelift, blepharoplasty, lip augmentation and rhinoplasty. He is the Editor of the Cleft Palate-Craniofacial Journal and his research focuses on stem cell therapy in ischemia-reperfusion and the anti-inflammatory effects of whole body vibration therapy.

Three of these physicians – Ghamande, David Terris, and Martha Terris – were also named to “America’s Top Doctors for Cancer®” in 2015, ranking in the top 1 percent of cancer doctors in the nation. The book by the same name is now in its 10th edition.

Published annually by Castle Connolly Medical Ltd., the “America’s Top Doctors” guides are based on nominations from tens of thousands of doctors and healthcare executives across the country. A physician-led research team then reviews the credentials of each nominated doctor before the Castle Connolly selection team makes the final choices.

The most important criterion for physician selection is excellence in patient care. Other criteria include experience, education, board-certification, fellowships, hospital affiliation, medical school faculty appointments, honors and awards, and professional reputation. Learn more at www.castleconnolly.com.
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*Denotes Children’s Hospital of Georgia physicians

About Castle Connolly
Castle Connolly Medical Ltd. is America’s trusted source for identifying top doctors. Founded in 1991 by John K. Castle, (Chairman) and John J. Connolly, Ed.D. (President and CEO), who served as board chairman, President and CEO of New York Medical College, respectively, its mission is to help consumers find the best healthcare. They achieve that mission through their consumer guides such as America’s Top Doctors their web site and various consumer and business-oriented print and online partnerships. Under the direction of its physician-led research team, Castle Connolly surveys tens of thousands of physicians and hospital executives in order to identify, screen, and, ultimately, select those physicians regarded by their peers as leaders – among the very best in their specialties and for specific diseases and techniques. Doctors do not and cannot pay to be included in any Castle Connolly guide or online directory. Learn more at www.castleconnolly.com.

Dr. Bogorad talks screen time, eye health in AUGUSTA Magazine

Screen Time Savvy: AUGUSTA Magazine Feb./March issue

You’ve probably heard the warning most of your life: “Don’t sit too close to the TV! You’ll hurt your vision.” But the only real issue is that you may be blocking someone’s view.

“When you’re awake in a lit environment, your eyes are always receiving. This idea that using your eyes damages them is not valid. The eye is doing its thing no matter how much you’re concentrating on what it’s receiving,” says David Bogorad, M.D., professor and vice chairman of the Department of Ophthalmology at Georgia Regents University.AMAGFebMar2015

Computers and handheld devices require users’ eyes to adjust to looking at material close. “In order not to see double, our eyes have to converge so that both eyes look at the same thing at the same time,” explains Bogorad. “That requires a certain amount of effort by the eye muscles and the brain.” Prolonged close-up visual work, whether it’s reading a book, knitting a scarf or playing Candy Crush, can lead to eye fatigue, but it does not damage the vision system, he says. The effects of eye fatigue resolve shortly after resuming activities that don’t lean heavily on a person’s ability to see up close.

He also recommends frequent blinking to protect the health of the corneas.

Read Screen Time Savvy

Martial arts event planned for children with visual impairment

AUGUSTA, Ga. – The Georgia Regents University division of Pediatric Ophthalmology is partnering with Superior Academy Self-Defense School this summer for a fun, safe, confidence-bolstering event for children with visual impairment. The one-day Visionary Warriors Training camp will be held from 8 a.m. to 4 p.m. Tuesday, July 9 at Superior Academy on 4158 Washington Road in Evans.

Organizers of the camp aim to empower children who suffer from visual disorders by teaching them the basics of self-defense through specially tailored martial arts classes. Intended for children ages 6-14, the program will also teach participants the benefits of physical training as it pertains to lifelong healthy living.

Sifu Jason Herrera, owner and operator of Superior Academy and a hall-of-fame martial arts expert, will provide the instruction. Herrera and his staff of martial arts experts will provide comprehensive supervision throughout the day to ensure every child remains safe.

“When it comes to people’s fears of health problems, blindness is second only to cancer,” said Dr. Julian Nussbaum, Chair of GRU’s Ophthalmology Department and Co-Director of the James and Jean Culver Vision Discovery Institute. “Watching Sifu Jason train children at Superior Academy, I realized the martial arts atmosphere gives kids, especially those with visual impairment, a certain discipline – a certain self-confidence they might not receive anywhere else.”

There is no charge for children to participate, but participants are asked to call ahead to reserve a spot. For more information, call 706-364-8127 or send an email to admin@superioracademy.com.

Proceeds from any donations or sponsorships will support pediatric eye research at the Culver Vision Discovery Institute at GRU.

Martial arts event planned for children with visual impairment

AUGUSTA, Ga. – The Georgia Regents University division of Pediatric Ophthalmology is partnering with Superior Academy Self-Defense School this summer for a fun, safe, confidence-bolstering event for children with visual impairment. The one-day Visionary Warriors Training camp will be held from 8 a.m. to 4 p.m. Tuesday, July 9 at Superior Academy on 4158 Washington Road in Evans.

Organizers of the camp aim to empower children who suffer from visual disorders by teaching them the basics of self-defense through specially tailored martial arts classes. Intended for children ages 6-14, the program will also teach participants the benefits of physical training as it pertains to lifelong healthy living.

Sifu Jason Herrera, owner and operator of Superior Academy and a hall-of-fame martial arts expert, will provide the instruction. Herrera and his staff of martial arts experts will provide comprehensive supervision throughout the day to ensure every child remains safe.

“When it comes to people’s fears of health problems, blindness is second only to cancer,” said Dr. Julian Nussbaum, Chair of GRU’s Ophthalmology Department and Co-Director of the James and Jean Culver Vision Discovery Institute. “Watching Sifu Jason train children at Superior Academy, I realized the martial arts atmosphere gives kids, especially those with visual impairment, a certain discipline – a certain self-confidence they might not receive anywhere else.”

There is no charge for children to participate, but participants are asked to call ahead to reserve a spot. For more information, call 706-364-8127 or send an email to admin@superioracademy.com.

Proceeds from any donations or sponsorships will support pediatric eye research at the Culver Vision Discovery Institute at GRU.