Medical students are seeking to uncover a silent killer, glaucoma

Like private eyes, a group of medical students at the College of Medicine are seeking to uncover a silent killer attacking unsuspecting citizens of Tucson: glaucoma.

Known as the "Student Sight Savers," they meet each month at the St. Elizabeth of Hungary Clinic in Tucson to examine patients for evidence of this blinding eye disease that some do not even know they have.

Without warning — and often without symptoms — glaucoma gradually steals sight by damaging the optic nerve. It is the second-leading cause of blindness in the U.S. and the leading cause of preventable blindness, according to the Glaucoma Research Foundation.

Glaucoma most often occurs due to elevated pressure in the eye or to a deficient blood supply to the optic nerve. Although there is no cure for glaucoma, treatment can control eye pressure and prevent blindness, which is why glaucoma screenings are so important.

The UA College of Medicine is one of 24 medical schools throughout the country participating in the Student Sight Savers Program (SSSP), a community service project funded and administered by the Friends of the Congressional Glaucoma Congress Foundation. SSSP, which was started in the early 1990s at the University of Michigan Medical School by Eve Higginbotham, involves medical students and ophthalmologists who volunteer to provide free glaucoma screenings to community members.

The UA SSSP was established in 2002 by Dr. Robert Snyder, chairman of the department of ophthalmology, who saw the program as an opportunity to expose medical students to the field of ophthalmology early in their training. SSSP is part of the UA's Commitment to Underserved People (CUP) program, a medical student-directed service learning program that provides clinical experience in the context of community service to rural and underserved populations in Arizona.

Through SSSP, UA medical students are introduced to the group of eye diseases that comprise glaucoma and to screening methods used to detect it. They learn to conduct eye exams and to use ophthalmic equipment, such as a panoptic ophthalmoscope (to examine the back of the eye), tonopen (to measure eye pressure) and Frequency Doubling Technology (FDT) (to test the visual field for signs of glaucoma).

UA SSSP clinics are held the third Saturday of each month at St. Elizabeth of Hungary Clinic, an agency of Catholic Community Services of Southern Arizona. Located near downtown Tucson, the clinic provides health care services for community members who are not eligible for public assistance yet are unable able to afford private care or private insurance coverage.

Working one-on-one with volunteer ophthalmologists from the UA or in private practice in the community, the medical students conduct screenings at the clinic, taking patient histories to uncover glaucoma risk factors, measuring blood pressure, performing visual acuity exams, measuring eye pressure and checking peripheral vision.

"The clinics provide a valuable learning experience for the students," says UA SSSP coordinator Shameema Sikder, second-year UA medical student. "The ophthalmologists have provided interesting views on current medicine and shared some of their medical training experiences. On one occasion, some patients canceled their appointments at the last minute and Dr. Snyder brought out his laptop and went through several interesting presentations, including emergency eye cases and eye problems in the elderly. It was quite a unique occasion to spend some quality time with a physician so interested in teaching."

About four medical students staff each UA SSSP clinic, which have been successful in uncovering potential (as well as actual) cases of glaucoma. A recent clinic screened 18 patients and found 12 at risk for glaucoma and one with glaucoma that left untreated would have caused blindness in about a year, says Shameema. "Because the screenings are held at the St. Elizabeth clinic, we are able to refer these patients back to the clinic for a follow-up visit with an ophthalmologist, if needed."

The students also have learned that glaucoma suspects can be deceptive. "We had a father come in with his 15-year-old daughter and while he was fine, the daughter was at risk," notes Shameema.

The Student Sight Savers clinic has become a family affair, Shameema says. "A good experience for one family member often brings spouses, children or cousins to a subsequent clinic. The patients love the attention from the medical students and the opportunity to share some of their concerns with an ophthalmologist."

Ophthalmologists who volunteer in the program

• Jack Aaron
• Norman Ahl
• Todd Alterbernd
• Dean Brick
• Harry Carrozza, assistant professor, ophthalmology
• Harold Cross, clinical professor, ophthalmology
• Sean McCafferty
• Harry Schlosser
• Robert Snyder, head, department of ophthalmology
• Jill Brickman-Kelleher, senior program manager, University Physicians Department of Ophthalmology, is community coordinator for the UA SSSP.