DETECTION IS KEY FOR GLAUCOMA PATIENTS

Laurie McCallum Is Calling Attention To The Need For Early Screening.

But for a routine eye exam in her 20s, Wisconsin first lady Laurie McCallum
may have been a statistic: one of millions of people who don't detect
glaucoma until the darkness settles.

"For many people, you never know you have it until you are just about
blind," UW Medical School ophthalmologist Todd Perkins said last week.

"Half the people who go blind in an eye from glaucoma have done so before
they ever sought care. It's not sudden - in fact, the changes occur so late
in the disease that people can be blind in one eye and not know it."

There is no "cure" for glaucoma, a chronic disease in which abnormally high
pressure inside the eye causes irreparable damage to the optic nerve and
vision loss.

McCallum, now 50, has been taking a daily battery of eye drops for more
than 20 years to treat her glaucoma. Wednesday, Perkins will perform a
surgery, called a trabeculectomy, at University Hospital to ease the
pressure on her left eye and stall the loss of retinal cells.

In McCallum's case, Perkins said, the drains that allow fluid to leave the
eye don't work well. "No fluid can get out," he said. "It's like a bathtub
drain that gets backed up." Perkins will make a flap in the eye to allow
fluid to drain, he said.

The surgical risks are real, McCallum said. "But people really don't look
at worst-possible scenarios," she said.

McCallum, who is seeking to call attention to the need for early screening
for glaucoma, will have the surgery as an outpatient. Recuperation will
crimp her driving duties as a soccer mom. Otherwise, the surgical risks are
mostly confined to infection, Perkins said. "Going blind in surgery is like
getting struck by lightning," he said.

Researchers at the UW-Madison and other laboratories are chasing genetic
solutions, but a cure is likely to be a dozen years away from the doctor's
office, UW-Madison molecular biologist Robert Nickells said.

"Within the next five years, we will have in place in laboratories a bona
fide treatment that may cure the disease or at least halt the progression
of the disease at a level like we've never seen before," Nickells said.

"But getting it from the laboratory to patients in the clinic is a little
more difficult simply because we are talking about a disease that
progresses very slowly."

That means it will take a while for any drug being tested to show solid
results, he said. "A 'cure' is more like 10 to 15 years down the line."

Yet, new drugs come on the market almost weekly. "Research in glaucoma has
just blossomed," Nickells said. "The UW-Madison has a glaucoma research
group that's considered one of the highest-profile glaucoma research
centers in the United States.

"There's a starburst of new stuff that's come out."

Lumigan and Travatan, for example, are two drugs that won federal approval
last month - Travatan, in particular, showed greater effectiveness among
African Americans, for whom glaucoma is the leading cause of blindness.

It's also a leading cause of blindness in all adults over 60, according to
the Glaucoma Research Foundation.

Up to 3 million Americans age 40 and over have glaucoma, the foundation
says, and by the year 2000, nearly 67 million people worldwide will likely
have it.

Glaucoma is considered an "old person's disease," but McCallum is unusual:
only 2 percent to 3 percent of glaucoma patients contract the disease in
their youth, Perkins said, and the cause is almost certainly genetic.

Still, with baby boomers aging, physicians are expecting a larger and
larger pool of glaucoma patients.

Perkins said 1 percent to 2 percent of white Americans will get it, as will
7 percent to 10 percent of African Americans.

But what's scary about glaucoma is its silence. "It doesn't hurt," Nickells
said. "It causes little blind spots. But you don't see that because the
brain paints in all the holes."

For McCallum, a routine eye exam in Arizona flagged intraocular pressure
that was higher than normal. "But I didn't really start on the drops until
I was 27."

Since then, the pharmaceutical war against glaucoma has been increasingly
successful. Perkins said newer drugs have fewer side effects, and the need
for glaucoma surgery is declining across the country.

The problem's not treatment. It's detection, Perkins said.

Many people without symptoms fail to get eye examinations, especially if
the exams are not covered by insurance.

In Wisconsin, either optometrists or ophthalmologists can test for
glaucoma. But just measuring eye pressure isn't enough, Perkins said.

"You need to go to somebody who is competent to dilate and look at the back
of the eye as well," he said.

The traditional "puff-in-the-eye" test is outdated. "If you're getting a
puff in the eye, you're probably not getting a proper glaucoma screening,"
Perkins said.

And what about medical marijuana, often touted as relief for glaucoma?

Forget it, Perkins said. "If you stayed stoned 24 hours a day, it will have
a moderate effect, but it's not a winner. It's just not that potent."