Sound Medicine -- March 22, 2003

Hosts Barbara Lewis, Dr. Steve Bogdewic, and Dr. Mike Koch talk to physicians and researchers about:

Infant eyesight

Innovative therapy for high-cholesterol patients

Infant eyesight

Because a baby's eye-to-brain circuitry is immature at birth, explains Indiana University researcher Rowan Candy, PhD, infants have foggy vision for the first few months of life. She likens a newborn's visual acuity to a washed-out TV signal. RDr. Candy, assistant professor of optometry at IU, studies normal and abnormal visual development in infants, and she joins us to discuss eyes and potential eye problems in children.

Five percent of children have one weak eye she says. Called amblyopia, or lazy eye, it is an "experience dependent" problem that causes the stronger eye to dominate brain development. The problem can be addressed by patching the good eye, which strengthens the weaker one. Children compensate well for the weak eye, Dr. Candy says, often making the condition difficult to recognize. Parents can check for this by covering the child's eyes one at a time and noting if the child sees or tracks the same objects.

She talks about testing for other conditions, and how eye tests have improved over the years. Although 90% to 95% of children have unimpaired vision, Candy suggests parents look at family history, especially for lazy eye. A strain of amblyopia in the family may warrant a thorough eye exam.

Dr. Candy also addresses the issue of children's eyes overexposed to TV and computer screens, ultraviolet ray (UV) protection for kids, and the proper construction material for glasses.

Resources:

The National Eye Institute provides basic facts and resources for amblyopia (lazy eye).

Read a technical overview of visual development written by a researcher at the University of California at San Francisco.

Upload a picture and see how your baby sees it at Tiny Eyes.

Find out more about Dr. Rowan Candy's research on her Web page.

Innovative therapy for high cholesterol patients

Patients with alarmingly high cholesterol get help from a machine that filters LDL (bad) cholesterol from the blood. It's called the Heparin-induced extracorporeal LDL precipitation (or H.E.L.P.) procedure, a type of LDL apheresis treatment. The machine withdraws a patient's blood, cleanses the plasma of LDL cholesterol, then returns the blood to the patient. The treatment can remove up to 60% of LDL cholesterol. Mark Deeg, MD, PhD, associate professor of medicine, biochemistry and molecular biology at the IU School of Medicine provides details. He uses the H.E.L.P. Procedure in his practice.

Dr. Deeg first defines HDL ("happy") and LDL ("lousy") cholesterol, their ideal levels, and how to determine your levels from a standard lipid panel test. The LDL apheresis procedure is for people with very high LDL, usually those with a genetic defect in the LDL receptor, a condition Dr. Deeg explains.

He details the two-hour, outpatient procedure, which patients tolerate very well. Treatments are every 2 weeks, and after a year patients -- who are also on cholesterol-lowering medication -- are down to very low level LDL. It is a life-long, life-saving treatment; so far studies show no serious side effects. Dr. Deeg explains how heart transplant, heart attack, and even acute hearing-loss patients also can benefit from this apheresis treatment.

Resources:

See the new National Institutes of Health guidelines concerning cholesterol treatment.

Find out more about familial hypercholesterolemia and about cholesterol in general at MEDLINEplus.

Medical professionals and patients can learn about apheresis therapies, including a brief discussion of LDL apheresis, at the well-organized Hemapheresis ONline Web site.

Interested in the gizmo Dr. Deeg refers to? Find out about the H.E.L.P. machinery from the manufacturer, B.Braun.

Is there a medical topic you'd like us to cover? Reach us by email: soundmed@iu.edu
or by phone:
(317) 274-4848.

We use large figures when we talk about medical school -- from the number of years it takes to earn an M.D., to the amount of hours spent in residency training, to the number of dollars spent on tuition. No doubt about it, a medical education is a costly affair. Do you know the average annual tuition for a student entering a public medical school in the U.S.?

A. about $13,000
B. about $25,000
C. about $37,000

Find out!

We've heard about "runner's high," a euphoria caused by the rush of endorphins after intense physical exercise. And many of us have experienced a "sugar rush" or "caffeine buzz." But there's another high you may NOT have heard of: "helper's high." This good feeling -- unlike the brief high supplied by caffeine and sugar -- is not followed by a low, and the euphoria lasts a week or more. What is a "helper's high"?

Find out!

A study published in the February 1, 2003 issue of the Journal of Clinical Investigation discovered a gene that regulates good cholesterol, or HDL -- a finding that could eventually reduce the risk of heart disease. Scientists found that mice without the endothelial lipase gene had higher levels of HDL. The levels of HDL cholesterol increased by 57% in these mice while the levels decreased by 19% in the control group with copies of the human gene.

Researchers are preparing a study on humans. "The gene is going to be a real target for the prevention and treatment of heart disease," said Dr. Thomas Quertermous, lead author of the study and chief of cardiovascular medicine at Stanford University School of Medicine. "My hypothesis -- and strong suspicion -- is that if you knock out the gene, your chance of disease development is decreased."