Q&A | Ophthalmologist Paolo Antonio S. Silva
Tuesday, March 02, 2010
Paolo Antonio S. Silva, M.D., is staff ophthalmologist and assistant chief of the Center for Ocular Telehealth at Joslin’s Beetham Eye Institute. He holds an affiliate appointment as an associate surgeon at the Brigham and Women’s Hospital and is an investigator in the Diabetic Retinopathy Clinical Research Network.
In more than 100 years of Joslin history, Dr. Silva is the third Filipino ophthalmologist appointed as an active staff member. He splits his time between seeing patients, acting as assistant chief of telemedicine, and pursuing research endeavors to ultimately eliminate visual loss from diabetic eye disease. Here, Dr. Silva answers seven questions about his background and his work at Joslin.
What led you to be a doctor?
My father had a very rare eye condition and for a significant period of time both he and his twin brother were legally blind. Advances in ophthalmology finally provided a treatment and my dad can now see because of successful corneal transplants and several other eye surgeries that were performed here in Boston in the 1980s. It is this background that got me interested in medicine and in particular ophthalmology. My coming to Boston for my training and eventually working at the Joslin to help other people see again is like coming full circle.
Why have you specialized in diabetic eye disease?
During my training as an ophthalmologist, I was particularly fascinated by the retina and how diabetes affects it. Diabetes is a systemic disease that affects nearly all the parts of the body but its effects are particularly evident in the retina. The retina is the only part of the body where you can observe living blood vessels with the blood flowing through them, in real time and in a living, breathing patient. The retina is our “window” to the rest of the body; it gives us a “real picture” of the effects of diabetes. This has always fascinated me.
How did you end up at Joslin?
Since I was interested in diabetic eye disease, where else should I study it? In 2007, I joined the Beetham as a clinical retina fellow and I served as chief fellow the following year. Upon completion of my fellowship, I was invited to stay as part of the staff and I have remained at the Joslin ever since.
What eye research are you doing?
I have basically three main interests in my field right now: wide-field retinal imaging, clinical outcomes research and clinical trials for proliferative diabetic retinopathy
In wide-field retinal imaging, we want to develop novel ways to image the retina and to recognize new lesions in the retina that haven’t been identified before. We now have the capability to acquire images of the retinal periphery, which was not readily evaluated in the past. The early changes from diabetic retinopathy occur in the retinal periphery and these early lesions may be either predictive or protective to progressive eye disease. These developments could potentially revolutionize the field of ocular telemedicine.
Another of my interests is looking at patient outcomes. We have a large diabetes patient population with varying severity levels of eye disease. Utilizing current electronic medical records, we can meticulously review each patient’s outcomes and determine which medical characteristics can be predictive of severe retinal eye disease in the future.
I am also principal investigator in a clinical trial evaluating the use of novel pharmacologic agents that are injected into the eye to treat proliferative diabetic retinopathy and vitreous hemorrhage, which despite effective means of treatment remain the leading cause of severe visual loss from diabetic retinopathy.
Which are today's best tools for preventing eye disease?
The key to preventing eye complications is blood glucose control, blood pressure control, control of blood lipids and regular lifelong eye examinations. It is very important to follow up regularly with an eye doctor so eye disease can be identified early. Work here at Joslin in the 1960s and 1970s, pioneered laser treatment for the eye. If you combine that treatment with appropriate follow-up, the risk for visual loss for patients with diabetes is reduced to less than four percent.
What’s the role of telemedicine in diabetic eye disease?
Current estimates are that 50% of diabetes patients here in the United States don’t have access to appropriate eye care. But there’s really no reason not to receive appropriate eye care.
In ophthalmology, telemedicine can allow us to take images of the retina and formulate a diagnosis and treatment plan without physically being with the patient. This has huge potential to deliver diabetes eye care on a global scale. Virtually no region will be too remote to receive diabetes eye care. Images can be sent through the Internet and these images can be evaluated from any location by an expert in diabetes eye care, who will provide the same high standard of evidence-based eye care available at major academic institutions, without any regard for physical boundaries.
The Joslin Vision Network (JVN) employs a standardized protocol in obtaining patient information and retinal images. The patient information and retinal images are evaluated and a diagnosis and evidence-based treatment plan is provided for each patient.
Dr. Lloyd M. Aiello, who pioneered the JVN more than 12 years ago, has a program evaluating children with diabetes in Caracas, Venezuela. These patients don’t have access to eye care, so we provide their eye care.
Does telemedicine also help Joslin patients?
Yes, the practice of telemedicine can be across the street or thousands of miles away. In addition to the 70 JVN sites across the U.S., we have a JVN site at the adult diabetes clinic, and at Healthcare Associates at Beth Israel Deaconess Medical Center.
When patients in the Joslin’s adult diabetes clinic have their endocrinology visit, they have retinal images taken as soon as the endocrinology visit ends, or just before it starts. Patients don’t lose time waiting for an appointment at the Beetham and their eyes are evaluated almost immediately. If they have severe eye disease, they are prioritized and provided with an appointment at an appropriate date.
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