A truly enlightened speech by an American visionary, who happens to be our President
NPR.org, May 17, 2009 · President Obama delivered the commencement address to University of Notre Dame’s Class of 2009 on Sunday afternoon at the South Bend, Ind., campus. Below are his remarks, as provided by the Office of the White House press secretary.
Well, first of all, congratulations, Class of 2009. (Applause.) Congratulations to all the parents, the cousins – (applause) – the aunts, the uncles – all the people who helped to bring you to the point that you are here today. Thank you so much to Father Jenkins for that extraordinary introduction, even though you said what I want to say much more elegantly. (Laughter.) You are doing an extraordinary job as president of this extraordinary institution. (Applause.) Your continued and courageous – and contagious – commitment to honest, thoughtful dialogue is an inspiration to us all. (Applause.)
Good afternoon. To Father Hesburgh, to Notre Dame trustees, to faculty, to family: I am honored to be here today. (Applause.) And I am grateful to all of you for allowing me to be a part of your graduation.
And I also want to thank you for the honorary degree that I received. I know it has not been without controversy. I don’t know if you’re aware of this, but these honorary degrees are apparently pretty hard to come by. (Laughter.) So far, I’m only 1 for 2 as President. (Laughter and applause.) Father Hesburgh is 150 for 150. (Laughter and applause.) I guess that’s better. (Laughter.) So, Father Ted, after the ceremony, maybe you can give me some pointers to boost my average.
I also want to congratulate the Class of 2009 for all your accomplishments. And since this is Notre Dame –
AUDIENCE MEMBER: Abortion is murder! Stop killing children!
THE PRESIDENT: That’s all right. And since –
AUDIENCE: We are ND! We are ND!
AUDIENCE: Yes, we can! Yes, we can!
THE PRESIDENT: We’re fine, everybody. We’re following Brennan’s adage that we don’t do things easily. (Laughter.) We’re not going to shy away from things that are uncomfortable sometimes. (Applause.)
Now, since this is Notre Dame, I think we should talk not only about your accomplishments in the classroom, but also in the competitive arena. (Laughter.) No, don’t worry, I’m not going to talk about that. (Laughter.) We all know about this university’s proud and storied football team, but I also hear that Notre Dame holds the largest outdoor 5-on-5 basketball tournament in the world – Bookstore Basketball. (Applause.)
Now this excites me. (Laughter.) I want to congratulate the winners of this year’s tournament, a team by the name of “Hallelujah Holla Back.” (Laughter and applause.) Congratulations. Well done. Though I have to say, I am personally disappointed that the “Barack O’Ballers” did not pull it out this year. (Laughter.) So next year, if you need a 6’2″ forward with a decent jumper, you know where I live. (Laughter and applause.)
Every one of you should be proud of what you have achieved at this institution. One-hundred-and-sixty-three classes of Notre Dame graduates have sat where you sit today. Some were here during years that simply rolled into the next without much notice or fanfare – periods of relative peace and prosperity that required little by way of sacrifice or struggle.
You, however, are not getting off that easy. You have a different deal. Your class has come of age at a moment of great consequence for our nation and for the world – a rare inflection point in history where the size and scope of the challenges before us require that we remake our world to renew its promise; that we align our deepest values and commitments to the demands of a new age. It’s a privilege and a responsibility afforded to few generations – and a task that you’re now called to fulfill.
This generation, your generation is the one that must find a path back to prosperity and decide how we respond to a global economy that left millions behind even before the most recent crisis hit – an economy where greed and short-term thinking were too often rewarded at the expense of fairness and diligence and an honest day’s work. (Applause.)
Your generation must decide how to save God’s creation from a changing climate that threatens to destroy it. Your generation must seek peace at a time when there are those who will stop at nothing to do us harm, and when weapons in the hands of a few can destroy the many. And we must find a way to reconcile our ever-shrinking world with its ever-growing diversity – diversity of thought, diversity of culture and diversity of belief.
In short, we must find a way to live together as one human family. (Applause.)
And it’s this last challenge that I’d like to talk about today, despite the fact that Father John stole all my best lines. (Laughter.) For the major threats we face in the 21st century – whether it’s global recession or violent extremism; the spread of nuclear weapons or pandemic disease – these things do not discriminate. They do not recognize borders. They do not see color. They do not target specific ethnic groups.
Moreover, no one person or religion or nation can meet these challenges alone. Our very survival has never required greater cooperation and greater understanding among all people from all places than at this moment in history.
Unfortunately, finding that common ground – recognizing that our fates are tied up, as Dr. King said, in a “single garment of destiny” – is not easy. And part of the problem, of course, lies in the imperfections of man – our selfishness, our pride, our stubbornness, our acquisitiveness, our insecurities, our egos; all the cruelties large and small that those of us in the Christian tradition understand to be rooted in original sin. We too often seek advantage over others. We cling to outworn prejudice and fear those who are unfamiliar. Too many of us view life only through the lens of immediate self-interest and crass materialism; in which the world is necessarily a zero-sum game. The strong too often dominate the weak, and too many of those with wealth and with power find all manner of justification for their own privilege in the face of poverty and injustice. And so, for all our technology and scientific advances, we see here in this country and around the globe violence and want and strife that would seem sadly familiar to those in ancient times.
We know these things; and hopefully one of the benefits of the wonderful education that you’ve received here at Notre Dame is that you’ve had time to consider these wrongs in the world; perhaps recognized impulses in yourself that you want to leave behind. You’ve grown determined, each in your own way, to right them. And yet, one of the vexing things for those of us interested in promoting greater understanding and cooperation among people is the discovery that even bringing together persons of good will, bringing together men and women of principle and purpose – even accomplishing that can be difficult.
The soldier and the lawyer may both love this country with equal passion, and yet reach very different conclusions on the specific steps needed to protect us from harm. The gay activist and the evangelical pastor may both deplore the ravages of HIV/AIDS, but find themselves unable to bridge the cultural divide that might unite their efforts. Those who speak out against stem cell research may be rooted in an admirable conviction about the sacredness of life, but so are the parents of a child with juvenile diabetes who are convinced that their son’s or daughter’s hardships can be relieved. (Applause.)
The question, then – the question then is how do we work through these conflicts? Is it possible for us to join hands in common effort? As citizens of a vibrant and varied democracy, how do we engage in vigorous debate? How does each of us remain firm in our principles, and fight for what we consider right, without, as Father John said, demonizing those with just as strongly held convictions on the other side?
And of course, nowhere do these questions come up more powerfully than on the issue of abortion.
As I considered the controversy surrounding my visit here, I was reminded of an encounter I had during my Senate campaign, one that I describe in a book I wrote called The Audacity of Hope. A few days after I won the Democratic nomination, I received an e-mail from a doctor who told me that while he voted for me in the Illinois primary, he had a serious concern that might prevent him from voting for me in the general election. He described himself as a Christian who was strongly pro-life – but that was not what was preventing him potentially from voting for me.
What bothered the doctor was an entry that my campaign staff had posted on my Web site – an entry that said I would fight “right-wing ideologues who want to take away a woman’s right to choose.” The doctor said he had assumed I was a reasonable person, he supported my policy initiatives to help the poor and to lift up our educational system, but that if I truly believed that every pro-life individual was simply an ideologue who wanted to inflict suffering on women, then I was not very reasonable. He wrote, “I do not ask at this point that you oppose abortion, only that you speak about this issue in fair-minded words.” Fair-minded words.
After I read the doctor’s letter, I wrote back to him and I thanked him. And I didn’t change my underlying position, but I did tell my staff to change the words on my website. And I said a prayer that night that I might extend the same presumption of good faith to others that the doctor had extended to me. Because when we do that – when we open up our hearts and our minds to those who may not think precisely like we do or believe precisely what we believe – that’s when we discover at least the possibility of common ground.
That’s when we begin to say, “Maybe we won’t agree on abortion, but we can still agree that this heart-wrenching decision for any woman is not made casually, it has both moral and spiritual dimensions.
So let us work together to reduce the number of women seeking abortions, let’s reduce unintended pregnancies. (Applause.) Let’s make adoption more available. (Applause.) Let’s provide care and support for women who do carry their children to term. (Applause.) Let’s honor the conscience of those who disagree with abortion, and draft a sensible conscience clause, and make sure that all of our health care policies are grounded not only in sound science, but also in clear ethics, as well as respect for the equality of women.” Those are things we can do. (Applause.)
Now, understand – understand, Class of 2009, I do not suggest that the debate surrounding abortion can or should go away. Because no matter how much we may want to fudge it – indeed, while we know that the views of most Americans on the subject are complex and even contradictory – the fact is that at some level, the views of the two camps are irreconcilable. Each side will continue to make its case to the public with passion and conviction. But surely we can do so without reducing those with differing views to caricature.
Open hearts. Open minds. Fair-minded words. It’s a way of life that has always been the Notre Dame tradition. (Applause.) Father Hesburgh has long spoken of this institution as both a lighthouse and a crossroads. A lighthouse that stands apart, shining with the wisdom of the Catholic tradition, while the crossroads is where “differences of culture and religion and conviction can co-exist with friendship, civility, hospitality, and especially love.” And I want to join him and Father John in saying how inspired I am by the maturity and responsibility with which this class has approached the debate surrounding today’s ceremony. You are an example of what Notre Dame is about. (Applause.)
This tradition of cooperation and understanding is one that I learned in my own life many years ago – also with the help of the Catholic Church.
You see, I was not raised in a particularly religious household, but my mother instilled in me a sense of service and empathy that eventually led me to become a community organizer after I graduated college. And a group of Catholic churches in Chicago helped fund an organization known as the Developing Communities Project, and we worked to lift up South Side neighborhoods that had been devastated when the local steel plant closed.
And it was quite an eclectic crew – Catholic and Protestant churches, Jewish and African American organizers, working-class black, white, and Hispanic residents – all of us with different experiences, all of us with different beliefs. But all of us learned to work side by side because all of us saw in these neighborhoods other human beings who needed our help – to find jobs and improve schools. We were bound together in the service of others.
And something else happened during the time I spent in these neighborhoods – perhaps because the church folks I worked with were so welcoming and understanding; perhaps because they invited me to their services and sang with me from their hymnals; perhaps because I was really broke and they fed me. (Laughter.) Perhaps because I witnessed all of the good works their faith inspired them to perform, I found myself drawn not just to the work with the church; I was drawn to be in the church. It was through this service that I was brought to Christ.
And at the time, Cardinal Joseph Bernardin was the Archbishop of Chicago. (Applause.) For those of you too young to have known him or known of him, he was a kind and good and wise man. A saintly man. I can still remember him speaking at one of the first organizing meetings I attended on the South Side. He stood as both a lighthouse and a crossroads – unafraid to speak his mind on moral issues ranging from poverty and AIDS and abortion to the death penalty and nuclear war. And yet, he was congenial and gentle in his persuasion, always trying to bring people together, always trying to find common ground. Just before he died, a reporter asked Cardinal Bernardin about this approach to his ministry. And he said, “You can’t really get on with preaching the Gospel until you’ve touched hearts and minds.”
My heart and mind were touched by him. They were touched by the words and deeds of the men and women I worked alongside in parishes across Chicago. And I’d like to think that we touched the hearts and minds of the neighborhood families whose lives we helped change. For this, I believe, is our highest calling.
Now, you, Class of 2009, are about to enter the next phase of your life at a time of great uncertainty. You’ll be called to help restore a free market that’s also fair to all who are willing to work. You’ll be called to seek new sources of energy that can save our planet; to give future generations the same chance that you had to receive an extraordinary education. And whether as a person drawn to public service, or simply someone who insists on being an active citizen, you will be exposed to more opinions and ideas broadcast through more means of communication than ever existed before. You’ll hear talking heads scream on cable, and you’ll read blogs that claim definitive knowledge, and you will watch politicians pretend they know what they’re talking about. (Laughter.) Occasionally, you may have the great fortune of actually seeing important issues debated by people who do know what they’re talking about – by well-intentioned people with brilliant minds and mastery of the facts. In fact, I suspect that some of you will be among those brightest stars.
And in this world of competing claims about what is right and what is true, have confidence in the values with which you’ve been raised and educated. Be unafraid to speak your mind when those values are at stake. Hold firm to your faith and allow it to guide you on your journey. In other words, stand as a lighthouse.
But remember, too, that you can be a crossroads. Remember, too, that the ultimate irony of faith is that it necessarily admits doubt. It’s the belief in things not seen. It’s beyond our capacity as human beings to know with certainty what God has planned for us or what He asks of us. And those of us who believe must trust that His wisdom is greater than our own.
And this doubt should not push us away our faith. But it should humble us. It should temper our passions, cause us to be wary of too much self-righteousness. It should compel us to remain open and curious and eager to continue the spiritual and moral debate that began for so many of you within the walls of Notre Dame. And within our vast democracy, this doubt should remind us even as we cling to our faith to persuade through reason, through an appeal whenever we can to universal rather than parochial principles, and most of all through an abiding example of good works and charity and kindness and service that moves hearts and minds.
For if there is one law that we can be most certain of, it is the law that binds people of all faiths and no faith together. It’s no coincidence that it exists in Christianity and Judaism; in Islam and Hinduism; in Buddhism and humanism. It is, of course, the Golden Rule – the call to treat one another as we wish to be treated. The call to love. The call to serve. To do what we can to make a difference in the lives of those with whom we share the same brief moment on this Earth.
So many of you at Notre Dame – by the last count, upwards of 80 percent – have lived this law of love through the service you’ve performed at schools and hospitals; international relief agencies and local charities. Brennan is just one example of what your class has accomplished. That’s incredibly impressive, a powerful testament to this institution. (Applause.)
Now you must carry the tradition forward. Make it a way of life. Because when you serve, it doesn’t just improve your community, it makes you a part of your community. It breaks down walls. It fosters cooperation. And when that happens – when people set aside their differences, even for a moment, to work in common effort toward a common goal; when they struggle together, and sacrifice together, and learn from one another – then all things are possible.
After all, I stand here today, as President and as an African American, on the 55th anniversary of the day that the Supreme Court handed down the decision in Brown v. Board of Education. Now, Brown was of course the first major step in dismantling the “separate but equal” doctrine, but it would take a number of years and a nationwide movement to fully realize the dream of civil rights for all of God’s children. There were freedom rides and lunch counters and Billy clubs, and there was also a Civil Rights Commission appointed by President Eisenhower. It was the 12 resolutions recommended by this commission that would ultimately become law in the Civil Rights Act of 1964.
There were six members of this commission. It included five whites and one African American; Democrats and Republicans; two Southern governors, the dean of a Southern law school, a Midwestern university president, and your own Father Ted Hesburgh, President of Notre Dame. (Applause.) So they worked for two years, and at times, President Eisenhower had to intervene personally since no hotel or restaurant in the South would serve the black and white members of the commission together. And finally, when they reached an impasse in Louisiana, Father Ted flew them all to Notre Dame’s retreat in Land O’Lakes, Wisconsin – (applause) – where they eventually overcame their differences and hammered out a final deal.
And years later, President Eisenhower asked Father Ted how on Earth he was able to broker an agreement between men of such different backgrounds and beliefs. And Father Ted simply said that during their first dinner in Wisconsin, they discovered they were all fishermen. (Laughter.) And so he quickly readied a boat for a twilight trip out on the lake. They fished, and they talked, and they changed the course of history.
I will not pretend that the challenges we face will be easy, or that the answers will come quickly, or that all our differences and divisions will fade happily away – because life is not that simple. It never has been.
But as you leave here today, remember the lessons of Cardinal Bernardin, of Father Hesburgh, of movements for change both large and small. Remember that each of us, endowed with the dignity possessed by all children of God, has the grace to recognize ourselves in one another; to understand that we all seek the same love of family, the same fulfillment of a life well lived. Remember that in the end, in some way we are all fishermen.
If nothing else, that knowledge should give us faith that through our collective labor, and God’s providence, and our willingness to shoulder each other’s burdens, America will continue on its precious journey towards that more perfect union. Congratulations, Class of 2009. May God bless you, and may God bless the United States of America. (Applause.)
U.S. Department of Health and Human Services (HHS)
NATIONAL INSTITUTES OF HEALTH (NIH)
National Eye Institute (NEI)
For Immediate Release: Tuesday, May 19, 2009
The most common vision problems are refractive errors, more commonly known as nearsightedness, farsightedness, astigmatism and presbyopia. Refractive errors occur when the shape of the eye prevents light from focusing directly on the retina. The length of the eyeball (either longer or shorter), changes in the shape of the cornea, or aging of the lens can cause refractive errors. Most people have one or more of these conditions.
The cornea and lens bend (refract) incoming light rays so they focus precisely on the retina at the back of the retina at the back of the eye.
What is refraction?
Refraction is the bending of light as it passes through one object to another. Vision occurs when light rays are bent (refracted) as they pass through the cornea and the lens. The light is then focused on the retina. The retina converts the light-rays into messages that are sent through the optic nerve to the brain. The brain interprets these messages into the images we see.
What are the different types of refractive errors?
The most common types of refractive errors are nearsightedness, farsightedness, astigmatism and presbyopia.
Nearsightedness (also called myopia) is a condition where objects up close appear clearly, while objects far away appear blurry. With nearsightedness, light comes to focus in front of the retina instead of on the retina. Learn more about nearsightedness.
Farsightedness (also called hyperopia) is a common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience farsightedness differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any distance, near or far. Learn more about farsightedness.
Astigmatism is a condition in which the eye does not focus light evenly onto the retina, the light-sensitive tissue at the back of the eye. This can cause images to appear blurry and stretched out. Learn more about astigmatism.
Presbyopia is an age-related condition in which the ability to focus up close becomes more difficult. As the eye ages, the lens can no longer change shape enough to allow the eye to focus close objects clearly. Learn more about presbyopia.
Who is at risk for refractive errors?
Presbyopia affects most adults over age 35. Other refractive errors can affect both children and adults. Individuals that have parents with certain refractive errors may be more likely to get one or more refractive errors.
What are the signs and symptoms of refractive errors?
Blurred vision is the most common symptom of refractive errors. Other symptoms may include:
§ Double vision
§ Glare or halos around bright lights
§ Eye strain
How are refractive errors diagnosed?
An eye care professional can diagnose refractive errors during a comprehensive dilated eye examination. People with a refractive error often visit their eye care professional with complaints of visual discomfort or blurred vision. However, some people don’t know they aren’t seeing as clearly as they could.
How are refractive errors corrected?
Refractive errors can be corrected with eyeglasses, contact lenses, or surgery.
How we see
There are many different parts of the eye that help to create vision. Light passes through the cornea, the clear, dome-shaped surface that covers the front of the eye. The cornea bends – or refracts – this incoming light. The iris, the colored part of the eye, regulates the size of the pupil, the opening that controls the amount of light that enters the eye. Behind the pupil is the lens, a clear part of the eye that further focuses light, or an image, onto the retina. The retina is a thin, delicate, photosensitive tissue that contains the special “photoreceptor” cells that convert light into electrical signals. These electrical signals are processed further, and then travel from the retina of the eye to the brain through the optic nerve, a bundle of about one million nerve fibers. We “see” with our brains; our eyes collect visual information and begin this complex process.
This confocal microscope image shows the cells of the retinal pigment epithelium (RPE), a layer in the back of the eye behind the retina. Fluorescent probes have been used to tag the nuclei of the cells (blue) and the actin cytoskeleton (green), which helps maintain cell structure. The orderly packing of these cells gives the RPE its characteristic honeycomb-like appearance.
The RPE plays a vital role in the vision process by nourishing photoreceptor cells, which respond to light, and by regenerating visual pigments, which detect light that strikes the retina.
Degenerative changes in the RPE cell layer can occur in some forms of age-related macular degeneration and in many other eye diseases. These changes may cause severe visual impairment.
(Image of bovine eye tissue, courtesy of Robert N. Fariss, Ph.D., National Eye Institute Biological Imaging Core)
What is a comprehensive dilated eye exam?
A comprehensive dilated eye exam is a painless procedure in which an eye care professional examines your eyes to look for common vision problems and eye diseases, many of which have no early warning signs. Regular comprehensive eye exams can help you protect your sight and make sure that you are seeing your best.
What does a comprehensive dilated eye exam include?
A comprehensive eye examination includes:
Dilation: Drops are placed in your eyes to dilate, or widen, the pupils. Your eye care professional uses a special magnifying lens to examine your retina to look for signs of damage and other eye problems, such as diabetic retinopathy or age-related macular degeneration. A dilated eye exam also allows your doctor to check for damage to the optic nerve that occurs when a person has glaucoma. After the examination, your close-up vision may remain blurred for several hours.
Tonometry: This test helps to detect glaucoma by measuring eye pressure. Your eye care professional may direct a quick puff of air onto the eye, or gently apply a pressure-sensitive tip near or against the eye. Numbing drops may be applied to your eye for this test. Elevated pressure is a possible sign of glaucoma.
Visual field test: This test measures your side (peripheral) vision. It helps your eye care professional find out if you have lost side vision, a sign of glaucoma.
Visual acuity test: This eye chart test measures how well you see at various distances.
Eye Health Tips
Read these tips for keeping your eyes healthy and your vision at its best.
Have a comprehensive dilated eye exam. You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really make sure. When it comes to refractive errors, some people don’t realize they aren’t seeing as well as they could with glasses or contact lenses. In terms of eye disease, many common eye diseases (glaucoma, diabetic eye disease and age-related macular degeneration) often have no warning signs. Your eye care professional is the only one who can determine if your eyes are healthy and if you’re seeing your best.
Eat right to protect your sight. You’ve heard carrots are good for your eyes. But eating a diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale, or collard greens is important for keeping your eyes healthy, too. Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids.
Maintain a healthy weight. Being overweight or obese increases your risk of developing diabetes and other systemic conditions which can lead to vision loss, such as diabetic eye disease or glaucoma. If you are having trouble maintaining a healthy weight, talk to your doctor.
Wear protective eyewear. Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do sporting goods stores.
Quit smoking or never start. Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to increased risk of developing age-related macular degeneration, cataract and optic nerve damage, all of which can lead to blindness.
Be cool and wear your shades. Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun’s ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.
Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, your eyes can get fatigue and you sometimes forget to blink. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain.
Clean your hands and your contact lenses…properly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect them as instructed and replace them as appropriate.
Know your family’s eye health history. Talk to your family about their eye health history. It’s important to know if anyone has been diagnosed with a disease or condition since many are often hereditary. This will help you determine if you are at higher risk for developing an eye disease or condition.
Vision-Related Terms, Selected Online Sources
National Library of Medicine, National Institutes of Health
Glossary of Ocular Terms
Anatomy, Physiology and Pathology of the Human Eye (Ted M. Montgomery, O.D.)
This is a fun tutorial, test yourself at own speed, on medical terms.
Not as easy as you might think, from the beginning.
Diabetic Eye Disease FAQ
Diabetes is a very serious disease that can cause problems such as blindness, heart disease, kidney failure, and amputations. But by taking good care of yourself through diet, exercise, and special medications, you can control diabetes. And there is more good news. Diabetic eye disease, a complication of diabetes, can be treated before vision loss occurs.
All people with diabetes need to get a comprehensive dilated eye exam at least once a year.
What is diabetic eye disease?
Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of this disease. All can cause severe vision loss or even blindness.
Diabetic eye disease includes:
- Diabetic retinopathy: Damage to the blood vessels in the retina.
- Cataract: Clouding of the lens of the eye.
- Glaucoma: Increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.
What is the most common diabetic eye disease?
Diabetic retinopathy. This disease is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.
What are its symptoms?
There are often no symptoms in the early stages of diabetic retinopathy. There is no pain and vision may not change until the disease becomes severe. Blurred vision may occur when the macula (the part of the retina that provides sharp, central vision) swells from the leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. Even in more advanced cases, the disease may progress a long way without symptoms. This symptomless progression is why regular eye examinations for people with diabetes are so important.
Who is most likely to get diabetic retinopathy?
Anyone with diabetes. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40-45 percent of those with diagnosed diabetes have some degree of diabetic retinopathy.
How is diabetic retinopathy detected?
If you have diabetes, you should have your eyes examined at least once a year. Your eyes should be dilated during the exam, which means eyedrops are used to enlarge your pupils. This dilation allows the eye care professional to see more of the inside of your eyes to check for signs of the disease.
Can diabetic retinopathy be treated?
Yes. Your eye care professional may suggest laser surgery in which a strong light beam is aimed onto the retina.
Laser surgery and appropriate followup care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost, which is why finding diabetic retinopathy early is the best way to prevent vision loss.
Can diabetic retinopathy be prevented?
Not totally, but your risk can be greatly reduced. The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.
The study found that the group that tried to keep their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. This level of blood sugar control may not be best for everyone, including some older adults, children under 13, or people with heart disease. So ask your doctor if this program is right for you.
How common are the other diabetic eye diseases?
If you have diabetes, you are also at risk for other diabetic eye diseases, such as cataract and glaucoma. People with diabetes develop cataract at an earlier age than people without diabetes. Cataract can usually be treated by surgery.
A person with diabetes is nearly twice as likely to get glaucoma as other adults. And, as with diabetic retinopathy, the longer you have had diabetes, the greater your risk of getting glaucoma. Glaucoma may be treated with medications, laser surgery, or conventional surgery.
What research is being done?
Much research is being done to learn more about diabetic eye disease. For instance, the National Eye Institute is supporting a number of research studies in the laboratory and with patients to learn what causes diabetic retinopathy and how it can be better treated. This research should provide better ways to detect and treat diabetic eye disease and prevent blindness in more people with diabetes.
What can you do to protect your vision?
Finding and treating the disease early, before it causes vision loss or blindness, is the best way to control diabetic eye disease. So if you have diabetes, make sure you get a comprehensive dilated eye examination at least once a year.
Diabetes is a disease that can cause very serious health problems. If you have diabetes:
1. Know your ABCs: A1C (blood glucose), blood pressure (BP), and cholesterol numbers.
2. Take your medicines as prescribed by your doctor.
3. Monitor your blood sugar daily.
4. Reach and stay at a healthy weight.
5. Get regular physical activity.
What is glaucoma?
Glaucoma is a group of eye diseases in which the normal fluid pressure inside the eyes slowly rises, leading to vision loss or even blindness. Open-angle glaucoma is the most common form of the disease.
What causes it?
Clear fluid flows in and out of small space at the front of the eye called the anterior chamber. This fluid bathes and nourishes nearby tissues. If this fluid drains too slowly, pressure builds up and damages the optic nerve. Though this buildup may lead to an increase in eye pressure, the effect of pressure on the optic nerve differs from person to person. Some people may get optic nerve damage at low pressure levels while others tolerate higher pressure levels.
Who is most likely to get it?
Glaucoma is a leading cause of blindness in the United States. Although anyone can get glaucoma, the following people are at higher risk:
- African Americans over age 40
- Everyone over age 60, especially Mexican Americans
- People with a family history of glaucoma.
What is the optic nerve?
The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina to the brain. (See diagram below.) The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision.
|A cross-sectional diagram of the eye, showing the
optic nerve at the back (left side of diagram).
How does open-angle glaucoma damage the optic nerve?
In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. (See diagram below.) When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.
|Fluid pathway is shown in blue.|
Sometimes, when the fluid reaches the angle, it passes too slowly through the meshwork drain. As the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma-and vision loss-may result. That’s why controlling pressure inside the eye is important.
What You Should Know About Glaucoma
Does increased eye pressure mean that I have glaucoma?
Not necessarily. Increased eye pressure means you are at risk for glaucoma, but does not mean you have the disease. A person has glaucoma only if the optic nerve is damaged. If you have increased eye pressure but no damage to the optic nerve, you do not have glaucoma. However, you are at risk. Follow the advice of your eye care professional.
Can I develop glaucoma if I have increased eye pressure?
Not necessarily. Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another.
Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. That’s why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.
Can I develop glaucoma without an increase in my eye pressure?
Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is not as common as open-angle glaucoma.
A comprehensive dilated eye exam can reveal more risk factors, such as high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy. In some people with certain combinations of these high-risk factors, medicines in the form of eyedrops reduce the risk of developing glaucoma by about half.
Can glaucoma be cured?
No. There is no cure for glaucoma and vision lost from the disease cannot be restored.
How is glaucoma treated?
Immediate treatment for early stage, open-angle glaucoma can delay progression of the disease. That’s why early diagnosis is very important.
Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.
Medicines. Medicines, in the form of eyedrops or pills, are the most common early treatment for glaucoma. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.
Before you begin glaucoma treatment, tell your eye care professional about other medicines you may be taking. Sometimes the drops can interfere with the way other medicines work.
Glaucoma medicines may be taken several times a day. Most people have no problems. However, some medicines can cause headaches or other side effects. For example, drops may cause stinging, burning, and redness in the eyes.
Many drugs are available to treat glaucoma. If you have problems with one medicine, tell your eye care professional. Treatment with a different dose or a new drug may be possible.
Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important.
Make sure your eye care professional shows you how to put the drops into your eye. See How should I use my glaucoma eyedrops?
Laser trabeculoplasty. Laser trabeculoplasty helps fluid drain out of the eye. Your doctor may suggest this step at any time. In many cases, you need to keep taking glaucoma drugs after this procedure.
Laser trabeculoplasty is performed in your doctor’s office or eye clinic. Before the surgery, numbing drops will be applied to your eye. As you sit facing the laser machine, your doctor will hold a special lens to your eye. A high-intensity beam of light is aimed at the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This procedure allows the fluid to drain better.
Like any surgery, laser surgery can cause side effects, such as inflammation. Your doctor may give you some drops to take home for any soreness or inflammation inside the eye. You will need to make several followup visits to have your eye pressure monitored.
If you have glaucoma in both eyes, only one eye will be treated at a time. Laser treatments for each eye will be scheduled several days to several weeks apart.
Studies show that laser surgery is very good at reducing the pressure in some patients. However, its effects can wear off over time. Your doctor may suggest further treatment.
Conventional surgery. Conventional surgery makes a new opening for the fluid to leave the eye. (See diagram below.) Your doctor may suggest this treatment at any time. Conventional surgery is often done after medicines and laser surgery have failed to control pressure.
Conventional surgery is performed in an eye clinic or hospital. Before the surgery, you will be given medicine to help you relax. Your doctor will make small injections around the eye to numb it. A small piece of tissue is removed to create a new channel for the fluid to drain from the eye.
For several weeks after the surgery, you must put drops in the eye to fight infection and inflammation. These drops will be different from those you may have been using before surgery.
As with laser surgery, conventional surgery is performed on one eye at a time. Usually the operations are four to six weeks apart. Conventional surgery is about 60 to 80 percent effective at lowering eye pressure. If the new drainage opening narrows, a second operation may be needed. Conventional surgery works best if you have not had previous eye surgery, such as a cataract operation. In some instances, your vision may not be as good as it was before conventional surgery. Conventional surgery can cause side effects, including cataract, problems with the cornea, and inflammation or infection inside the eye. The buildup of fluid in the back of the eye may cause some patients to see shadows in their vision. If you have any of these problems, tell your doctor so a treatment plan can be developed.
|Conventional surgery makes a new opening for
the fluid to leave the eye.
What are some other forms of glaucoma?
Open-angle glaucoma is the most common form. Some people have other types of the disease.
In low-tension or normal-tension glaucoma, optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsen in others despite low pressures.
A comprehensive medical history is important in identifying other potential risk factors, such as low blood pressure, that contribute to low-tension glaucoma. If no risk factors are identified, the treatment options for low-tension glaucoma are the same as for open-angle glaucoma.
In angle-closure glaucoma, the fluid at the front of the eye cannot reach the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately. This is a medical emergency. If your doctor is unavailable, go to the nearest hospital or clinic. Without treatment to improve the flow of fluid, the eye can become blind in as few as one or two days. Usually, prompt laser surgery and medicines can clear the blockage and protect sight.
In congenital glaucoma, children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery is typically the suggested treatment, because medicines may have unknown effects in infants and may be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.
Secondary glaucomas can develop as complications of other medical conditions. These types of glaucomas are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). Pigmentary glaucoma occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes. Corticosteroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. Treatment includes medicines, laser surgery, or conventional surgery.
What can I do if I already have lost some vision from glaucoma?
If you have lost some sight from glaucoma, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.
By Lynn Welch
May 13, 2009
MADISON – In the future, it’s possible that medicine will become less one-size-fits most, and more personalized, based on proof of what works best for you.
Health care industry initiatives driving advances in personalized medicine include technologies linking informatics with genotype and phenotype data to produce custom-built solutions to illnesses.
Milwaukee-based Aurora Health Care highlighted two of its programs through which data is used to build a more personal health care system for patients at WTN Media’s seventh annual Digital Healthcare Conference 2009 last week. Speaking on the topic, “Research Driven Genetic Sampling: A Step Toward Personalized Medicine,” Aurora chief information officer Philip Loftus said this early-stage work is an effort to use resources to improve care.
“Personalized Medicine: what does it really mean? There’s growing literature around evidence-based best practices in medicine to personalize it,” said Loftus, noting that Aurora is attempting to link phenotype and genotype information to enhance patient experience.
Loftus called Aurora a “numbers driven” organization, in presenting how it approached developing its personal medicine initiatives. The non-profit health care organization, in fact, has been named one of the“100 Most Wired hospitals” for several years running by a trade magazine, singling out the organization for its good use of information technology.
It made sense, Loftus said, to tie performance metrics to care, which led to a partnership with the University of Wisconsin-Milwaukee School of Nursing and Cerner Corporation. The Knowledge-Based Nursing Initiative involves researchers, computer engineers, nurses and information technology professionals in applying informatics to the work nurses perform.
This project, in part, is developing a “nursing knowledge repository” that turns a wealth of information into “actionable knowledge,” which is embedded into an electronic information system.
“They liked this because for the first time they collected data relevant to them,” Loftus said of the practicing nurses’ experience. “It gives them direct recommendation and advice on treatment in real time.”
Aurora this year also launched a robot-enabled biorepository to collect and store tissue samples. This ORBIT (Open-Source Robotic Biorepository and Informatics Technology) biobank will enable Aurora to collect large amounts of tissue from consenting patients for use in individual patient care, and also for research.
Loftus explained that ORBIT’s automated collection, storage and analysis of tissue – blood samples to start – will enable the ability to link to electronic health records, and also to link it to a genetic sequence database. Tissues used in the open biobank will be stripped of identifying information by two “Honest Brokers” at Aurora, who are the only individuals that funnel the samples.
“It always was planned to be open and loop to collaborate with other researchers,” Loftus noted.
What does it mean for patient care? Loftus explained that such a databank could provide early warning of a genetic risk, and information on effectiveness of certain treatments, some of them high cost therapies which may not have an individual benefit.
“If a physician is faced with multiple therapeutic options, if you can do it as evidence based, you can get the most effective treatments and avoid the cost of trying all the treatments,” Loftus said, noting that companies benefit from biorepositories by being able to better market drugs based on known side effects to patients.
Aurora this winter began collecting blood samples from patients at its St. Lukes Medical Center in Milwaukee. Loftus said so far, about 75 percent of patients have agreed to add their blood to the repository. Consent is gained at the time of tissue collection and renewed annually, and patients are able to withdraw consent at any time. About one patient pulls consent each day, according to Loftus.
In addition to blood, other specimens such as saliva or tissue could be collected down the road. After collection, a robot extracts DNA from the blood, bar codes the specimen and stores it in a freezer that holds up to 76,800 vials. Bar coding links the specimen with an individual’s electronic medical record. When used for research, however, identifying information is stripped, ensuring patient privacy and complying with privacy laws.
“Most patients, not surprisingly, say why not submit a sample for research purposes. At what point do you go back with another consent that says we want this to be used for something specific? You wonder whether you need to have genetic counseling up front,” questioned Dr. Tom Handler, research director with Gartner Inc.
Loftus explained that the consent piece turned out to be the longest part of the ORBIT project, saying, “In the end, it made sense to make this close to the standard consent form for any treatment in our organization. Quite a few organizations have looked at it as focusing research data in use of clinical trials and that’s where the internal review board started out in their reviews.”
Dr. Barry Chaiken, DHC conference chair, questioned how ORBIT is related to data mining projects such as controversial commercial ventures at companies like Google, asking, “If you do monetize this, will there be the ability for an individual to benefit?”
Loftus said Aurora does not envision using ORBIT as a revenue stream, but rather a research tool.
ORBIT also can “support personalized medicine at an individual patient level,” Loftus said. As such, Aurora joins a growing field, according to a new report by the Personalized Medicine Coalition. The Case for Personalized Medicine, highlights advances that have helped improve the way serious conditions such as cancer, cardiovascular disease, infectious diseases, and transplantation medicine can be prevented, diagnosed, and treated.
Tuesday, May 19, 2009
Sebelius Congratulates New FDA
Commissioner Peggy Hamburg
Former NYC Commissioner of Health
Health and Human Services Secretary Kathleen Sebelius today congratulated new Food and Drug Administration Commissioner Dr. Margaret “Peggy” Hamburg after her nomination was unanimously confirmed by the United States Senate.
“Dr. Hamburg is an inspiring public health leader with broad experience in infectious disease, bioterrorism, and health policy,” said Sebelius. “Her expertise and judgment will serve FDA well.”
Sebelius also praised Acting Commissioner and Principal Deputy Josh Sharfstein and the career professionals who serve at the FDA for their hard work and dedication.
“Josh and the employees at FDA have worked diligently to protect the American people,” added Sebelius. “Time and again, they have demonstrated their professionalism and commitment to ensuring the food we eat and the medicines and products we use are safe.”
A brief biography of Dr. Hamburg is included below:
Dr. Hamburg is a nationally and internationally recognized leader in public health and medicine, and an authority on global health, public health systems, infectious disease, bioterrorism and emergency preparedness. She served as the Nuclear Threat Initiative’s founding Vice President for the Biological Program. Before joining NTI, she was the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Prior to this, she served for six years as the Commissioner of Health for the City of New York and as the Assistant Director of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health.
“Both my parents are physicians. I grew up right on the Stanford campus, surrounded by many friends and families that were related to the field of medicine… so it was always part of part of my experience. But because it was so much a part of my experience, I did have to go through the re-thinking: Is this something I really want to do, or was I just raised to think that of course I would be a doctor?”
Margaret Hamburg, one of the youngest people ever elected to the Institute of Medicine (IoM, an affiliate of the National Academy of Sciences), is a highly regarded expert in community health and bio-defense, including preparedness for nuclear, biological, and chemical threats. As health commissioner for New York City from 1991 to 1997, she developed innovative programs for controlling the spread of tuberculosis and AIDS.
Margaret Hamburg is the daughter of Beatrix and David Hamburg, both distinguished physicians and early role models for her career in medicine. Her mother was the first African-American woman to attend Vassar College and to earn a degree from the Yale University School of Medicine (which had previously excluded black students). Her Jewish father and grandmother taught her to value education and family and to fight discrimination and oppression.
When she was inducted into the prestigious Institute of Medicine in 1994, she had followed the path of her parents, both IoM members since the 1970s. “There was a sense of real fun that the father-mother-daughter constellation had been formed,” said Hamburg.
Hamburg is a graduate of Radcliffe College. She earned her M.D. from Harvard Medical School, and completed her training at the New York Hospital/Cornell University Medical Center. She did research in neuroscience at Rockefeller University in New York from 1985 to1986 and in neuropharmacology (the study of the action of drugs on the nervous system) at the National Institute of Mental Health in Bethesda, Maryland.
From 1986 to 1988, she served in the U.S. Office of Disease Prevention and Health Promotion, and from 1989 to 1990 she was assistant director of the National Institute of Allergy and Infectious Diseases at NIH, where her work focused on AIDS research.
In 1990, she left the NIH to serve as deputy health commissioner for New York City. Within a year, she was promoted to health commissioner. It was a difficult, complex, and demanding job, with severe budget constraints and many responsibilities, ranging from clinical services to environmental health. She strove to improve health services for women and children, instituted needle-exchange programs to combat HIV infection, made inroads into curbing the spread of tuberculosis, and initiated the nation’s first public-health bio-terrorism defense program. During her term as health commissioner, she also held academic positions at Columbia University School of Public Health and Cornell University Medical College, both in New York City.
While commissioner Dr. Hamburg’s innovative treatment plan for tuberculosis (TB) became a model for health departments around the world. In the 1990s, TB was the leading infectious killer of youths and adults and had become resistant to standard drugs. To be effective, new drugs required patients to take pills every day for up to two years, but failure to complete the full course of treatment allowed the bacteria to mutate into drug-resistant strains. Hamburg sent healthcare workers to patients’ homes to help manage their drug regimen, and between 1992 and 1997, the TB rate for New York City fell by 46 percent, and by 86 percent for the most resistant strains.
In 1993, Dr. Hamburg was President Clinton’s first choice for the newly created post of federal AIDS coordinator. Pregnant with her first child at that time, Hamburg declined, putting motherhood first. President Clinton selected her in 1997 to be assistant secretary for policy and evaluation at the U.S. Department of Health and Human Services. This time she accepted.
Since 2001, she has been vice president for biological programs at the Nuclear Threat Initiative, a foundation dedicated to reducing the threat to public safety from nuclear, chemical, and biological weapons. She is a leading advocate for changes in the nation’s public health policies and infrastructure, from local health departments to the highest levels of government, to meet the challenges presented by modern bioterrorism. She is a distinguished senior fellow with the Center for Strategic and International Studies.
Dr. Hamburg is married to Peter Fitzhugh Brown, an artificial intelligence expert, and the couple have two children. Interestingly, she was the first New York City health commissioner to give birth while in office, so her children’s birth certificates bear her name in two places: as their mother and as health commissioner.
Margaret Hamburg with New York City Mayor David Dinkins and her family after being sworn in as health commissioner, 1992
Margaret Hamburg, M.D.
Margaret Hamburg with her daughter and her mother, Beatrix Hamburg, M.D., 1993
Margaret Hamburg, M.D., photograph by Rick English
Margaret Hamburg, at her Harvard Medical School graduation with her mother, Beatrix Hamburg, M.D. and father David Hamburg, M.D., 1983
Margaret Hamburg, M.D.
GoogleNews.com, May 19th 2009 by Beth Gaston Moon — Ed Begley, Jr. will soon have more options should he be in need of a new electric car. Daimler AG has announced the acquisition of an equity stake of nearly 10% in Tesla Motors (not to be confused with these guys — five man electrical band, indeed).
The German-based automaker is teaming up with the California company to work on making electric cars “a reality.” Tesla is a visionary on the electric-car front; its Roadster, which runs on battery power, is the only electric vehicle approved for highway use in both Europe and North America. (Of course, it also comes with a price tag of $101,500 — you’d have to save a lot on gas to make up for not buying a Taurus).
Thomas Weber, Board Member of Daimler AG, told the press: “Our strategic partnership is an important step to accelerate the commercialization of electric drives globally.” This news is certainly timely, as the Obama administration is pushing to enforce higher fuel economy standards.