At Press Time

Arizona Skydiving Mishap Claims Dr. Joel Shugar

He Invented a Widely Used Intracameral Anesthetic.

By Jerry Helzner, Senior Editor

■ Joel Shugar, M.D., 49, a highly respected Florida ophthalmologist and experienced competitive skydiver, died on May 26 when his parachute collapsed after a collision with another skydiver.

Dr. Shugar was performing a team formation exercise in Eloy, Ariz., when the accident occurred. The other individual was able to land safely.

Professionally, Dr. Shugar is best known as the developer of Shugarcaine, an intracameral anesthetic that is widely used in cataract surgery. He later invented epi-Shugarcaine for improving dilation when combating incidents of intraoperative floppy iris syndrome (IFIS). Dr. Shugar was also recognized for his strong emphasis on staff training for professional advancement and for his awarding of an annual scholarship to a deserving student.

The loss of a beloved doctor stunned the north Florida community near Tallahassee where Dr. Shugar headed the Nature Coast EyeCare Institute. Dr. Shugar was well known in the community for his humanitarian efforts, which included his "Gift of Sight" initiative of performing free cataract surgeries for uninsured patients each year just before Thanksgiving. Dr. Shugar's family and staff have expressed the wish that "Gift of Sight" become a national effort, with cataract surgeons around the country honoring Dr. Shugar's memory through their participation.

Scott Keeler, the Nature Coast practice administrator and a member of Dr. Shugar's skydiving team, told the Tallahassee Democrat newspaper that Dr. Shugar's death was "a huge loss because there are many more great things that would have come from him."

Joel Shugar, M.D.

Dr. Shugar, a graduate of SUNY Buffalo School of Medicine, is survived by his wife, Lindsey, and a son, Adam, 8.

A Woman at the Helm at Wills

Dr. Haller Makes History in Historic Philadelphia.

By René Luthe, Senior Associate Editor

■ When retinal specialist Julia A. Haller, M.D., came to Philadelphia in November of last year from professorships at Johns Hopkins University to become the first female physician to head Wills Eye Institute, she worried that the coming holiday rush would make for a harried beginning. The reality, she reports, was that it turned out to be the optimal time to settle into Wills's large yet close-knit milieu.

"There were so many get-togethers and parties," Dr. Haller reports. "And in some ways [starting just before the holidays] was better because there was less pressure at the end of the year. That gave me a little honeymoon time, I guess."

If so, the honeymoon seems to be continuing more than 7 months later. She calls her new city "A historic, cultural, sophisticated town. Right here at Wills, I'm looking out my window and there's Pennsylvania Hospital, the first hospital in the country," she says. "I look out my other window and there's Walnut Street Theater, which is the oldest theater in continuous operation in the country. I walk three blocks and I'm at Constitution Hall, the Liberty Bell is right there.

"There is so much art, so much theater, fabulous restaurants," she says. "I honestly don't think there is a better restaurant city in the world."

Dr. Haller's sense of history has helped her appreciate working at Wills, the nation's oldest eye institute.

"Just like any other place with a long history, the way things are done has evolved over many decades. So it has lots of quirky, interesting twists," she laughs. "For example, any time you ask why things are done a certain way, the explanation always starts with ‘Well, about 1950, we did this. And then this happened and then … this person retired and then we moved into a new building.’ It takes about half an hour to get to where you are in the present and finally you understand it, but it's a very evolutionary process."

Dr. Haller brings fresh ideas to Will Eye.

After serving at Johns Hopkins as director of the retina fellowship training program as well as holding the Katharine Graham and Robert Bond Welch, M.D., professorships in ophthalmology, Dr. Haller's first official function at Wills was to participate in selecting the newest group of residents. The process, she feels, was illustrative of the way the Institute operates, with great deal of input from its large faculty. A party scheduled on the night between the two interview days includes both full-time and part-time faculty, their spouses and interviewees. "It's very much the family and the team spirit as well as the excellence of the training program that makes the experience successful," Dr. Haller says.

She describes the residency program as continually evolving at Wills and one that elicits feedback from both residents and faculty. One plan for the future, Dr. Haller reports, is to add more research experience and electives. Another planned initiative involves Wills's development office and communications group updating the public face of the institution.

"Like a lot of other historic academic institutions, Wills has kind of downplayed publicity and we do need to start grappling with it more actively," Dr. Haller says. A new service chief for pediatrics is currently being recruited as well.

"And we're very interested in working on clinical research and recruiting a few key translational medicine people. Wills is the largest clinical practice in the country, and I would argue, the finest clinical practice in the world. It's such an obvious place to have the science that interfaces with that, the translational medicine. So I don't see hiring someone who's going to work on very basic science to begin with. It makes sense, at least starting out, to boost our presence in terms of scientific advances that have direct applicability to clinical problems."

The depth and breadth of experience of the Wills eyecare team, as well as its commitment to excellence, give Dr. Haller confidence that they can achieve that. While ophthalmology currently confronts many practice challenges, given the impending "epidemic" of AMD, glaucoma and diabetic retinopathy in an aging and increasingly overweight U.S. population, "We're equal to the task," Dr. Haller concludes.

Prism Glasses Combat Hemianopia

Dr. Peli's New Design Helps Patients in Daily Life.

■ Innovative prism glasses can significantly improve the vision and the daily lives of patients with hemianopia, the condition that blinds half the visual field in both eyes. The peripheral prism glasses, which were invented by Eli Peli, Ph.D., a senior scientist at Schepens Eye Research Institute, were evaluated in the first community-based multicenter trial of such a device, reported in the Archives of Ophthalmology.

"This is the first real breakthrough in the rehabilitation of patients with this condition," says Dr. Peli, a widely respected low-vision expert, the Moakley Scholar in Aging Eye Research at Schepens and a professor of ophthalmology at Harvard Medical School. Dr. Peli had searched for a solution for his hemianopia patients for many years before designing the peripheral prism glasses, creating a prototype in his laboratory.

More than a million Americans suffer from hemianopia, which is most commonly caused by strokes. It can also be the result of brain damage from tumors or trauma.

Dr. Peli's goal was to find a way to expand the visual field. He did this by attaching small, specially designed high-power prisms on the top and bottom of one spectacle lens, leaving the center of the lens untouched. The prisms pull in images missing from the visual field above and below the line of sight on the side of the vision loss and alert the patient to the presence of a potential obstacle or hazard. The patient can then move his/her head and eyes to examine the prism-captured image directly through the clear center of the lens.

Before Dr. Peli's invention, others had tried to develop prism glasses to bring the missing part of the patient's visual field into view. However, these previous techniques placed the prisms in the center of the glasses, which resulted in double vision, which is disturbing and confusing. Dr. Peli's solution was to keep the central part prism-free and place prisms above and below.

The study evaluated the glasses’ ability to improve a patient's walking mobility, which includes obstacle avoidance. Forty-three patients were fitted with prism glasses in 15 community-based clinics around the country. The clinicians interviewed them at 6 weeks and after 12 months. Success was measured by how many patients continued wearing the prism glasses and by their ranking of the prisms’ effectiveness in assisting with obstacle avoidance while walking.

Thirty-two participants (74%) continued wearing the glasses at week six. At 12 months, 20 (47%) were still donning the spectacles 8 hours a day and rating them as "very helpful" for obstacle avoidance. These 12-month-plus patients were reporting significant benefits for a variety of obstacle avoidance scenarios (e.g. walking in crowded areas, unfamiliar places, shopping malls). The results indicate that the prism glasses can be highly useful in helping hemianopia patients resume a normal daily life.