But, there is one exception.  Every one of those people in this movie are all 100% midgets in real life….that is, “Little People” under 4 feet 10 inches tall.  Mind you, I am 4 feet 10 inches tall too….but I am not a midget. :)

 The “Little People” in Tiny Town all ride on Shetland ponies instead of adult horses. They have voices obviously sounded like they are high on helium.  If you have seen the 1939 movie “The Wizard of Oz” with the Munchkins, you’d know what I mean (most of the actors in this movie played the Munchkins in the “Oz” movie a year later).  The movie sets (like the saloon doors) are all normal sized – one of these people walked UNDER the saloon doors!

 Here’s a website review of “The Terror of Tiny Town” movie from “Oh! The Humanity”, considering ‘it’s so bad it’s funny”:  http://www.ohthehumanity.com/review.php3?ID=400

This looks like an interesting movie to me, and I would like to watch it one day.  But some people out there thinks this movie is hilariously bad in a way for an “all midget western”, like the musical numbers. Like this guy's review:  http://www.thunderchunky.co.uk/tinytown.html

 Here's another site with the movie's dialogue, a mini-movie you can download, photos, and more: http://www.badmovies.org/movies/tinytown

Nancy 

I took the day off from work yesterday (Friday), so I had 2 appointments with my eye doctor and the audiologist. :)
     I went to the eye doctor first to get new glasses....so I had an eye examination, and then to check which is best vision for me using a tool that tests so people can get new glasses. He also did my eye pressure check and looked in the back of my eyes. :)
      So far, here's the results: The eye doctor said my pressure is good so keep using the eye drops....everything else looks great in my eyes. He said I am a little bit better in my nearsightness...and went on to explain that people in their 30s and 40s, their eyes gets better a little bit. :) So after he finished, he gave me a prescription for new glasses....which I picked out a pair in the same office. :) The new glasses are a bit smaller than the one I am wearing now, and will have anti-glare material, plus the lens being made lighter for my frames. :) I should get my new glasses in a week from now. :)
      Then I went to lunch at Arby's and then went home.

       At 2 pm, I went to the audiologist for the new hearing aid. I got a hearing test, which the results are consistent with all my old ones: severe to profound hearing loss. He said I can wear a hearing aid in my left ear but I will hear only sounds (voices sounded muffled in this ear). He then found out which aids is the best for me (Oticon -- just like my current one), by choosing a super power programmable aid or a super power digital aid...the audie said those aids are as strong as the one I am wearing now....I chose the Oticon programmable aid. The digital aid is expensive and may not have enough power for my kind of hearing loss...so I didn't choose that one.
      So, the final outcome is that I will be receiving a new Oticon powerful programmable BTE for my right ear. He made earmold impressions for both ears, so I will be using my current Oticon analog BTE for my left ear (it's still very good aid). He said if I wore in both ears, the volume controls won't be so high and other reasons. :) After a lifetime of analog hearing aids, I will be getting my first programmable aid! :) I don't know when I will be getting the hearing aid, perhaps next week or so....and then having the computer to set up the aid so I can use it...but I can't wait! :)

      The new earmolds will be soft material and full shell. :) This is the kind I had before my other audie switched it to the canal type earmold shell....I didn't like this kind because it didn't give a very good seal....so I prefer the full shell better, since I wore these kinds for many years and it stays in better. :)

      Well, that's how my day went! :)

    Do you like to work on puzzles such as Crosswords or Word Search?  Maybe you are one of the people who likes to work on Logic puzzles, or Fill-Ins?  How about other kinds of puzzles?

   There are two kinds of puzzle magazines that you can find in the stores -- but you can also get a subscription (1 or 2 year subscription) to be sent to your mailbox at home.  They are Penny Press and Dell Magazines.  Both are great magazines and are not expensive. :)  You can even order your kids or grandkids subscriptions to these magazines for the puzzles of their choice.

    Personally, I like working on Word Search and Fill-Ins.  Both are fun to do.  Crosswords are ok but some of the "clues" are hard to figure out. LOL

     While you visit either Penny Press or Dell Magazines,  both websites have FREE sample puzzles for you to work on at home to get a taste of what their magazines offer. :)

Nancy

    If you or someone you know who is visually-impaired or blind, and is looking for an online Bible, Gospelcom.net has one for you. :)  The "Large Print Bible" is a giant print online Bible with audio links so you can listen.  The Scriptures are typed in classic King James Version from Genesis to Revelation.

Click here to go to the Large Print Bible online. :)

Nancy

For Mozilla FireFox and Mozilla Thunderbird, they have a Mozilla Update page where you can find updated and new "extensions" for FireFox and Thunderbird.  If you are not satisfied, cannot find any older extensions listed, or just wants the very new extensions available, you can go to The Extension Mirror .

    The Extension Mirror has all of these:

Forums
Firefox Extensions (Latest)
Thunderbird Extensions (Latest)
Themes
Buttons
Goodies

    You can even go to their forum to post any suggestions, opinions, or just to get a problem solved on your FireFox or Thunderbird. :)

    This is an excellent source to go to if you ever want to "improve" your FireFox or Thunderbird....they have a list of other "extension" sites to go to if this one doesn't have what you are looking for (listed under "Recommended Sites"). :)

Nancy

Here are some excellent Christian homepages for everyone which has everything from holidays, free graphics, kid’s sections, Bible research and studies, games, and many more.  If you like, you can set these as your homepage – that’s how extensive they are! :)

Annie’s Homepage:

http://www.annieshomepage.com/index.html

Faith and Fun at Peggy’s Place:

http://peggiesplace.gospelcom.net

Perkins’ Family Homepage:

http://www.geocities.com/Heartland/Pointe/7623

Enjoy! :)

Nancy

 If you want a United States Flag waving on your desktop (or over all windows), here's a freeware for you below. :) In the link below has a screenshot of what the US Flag looks like.
     This is created in memory of those who perished in the 9/11 tragedy....enjoy having an American Flag on your computer if you want to download the freeware. As the FAQs in the link says, there is NO spyware or adware, so it is safe to download. :)

Click here for more information or to download this freeware:
http://www.deskflag.com

Nancy

 Here's a Christian ministry for the deaf/hard-of-hearing called "Silent Word Ministries". They have a free newspaper for the deaf/HOH that is mailed out quarterly if you are interested. They have "Fantastic Saturdays", free lessons from the Deaf Bible Institute (you can earn a certificate or a diploma if you complete half or all of the lessons from the Bible), and others.

Here's their website:
http://www.silentwordministries.org

Here's where you can get their free newspapers.
http://www.silentwordministries.org/subs-SWNP.htm

I get this Silent Word newspapers quarterly and I enjoyed it. Hope you will too if you subscribe to them.  I have met one of the missionaries in this organization a couple of years ago at a deaf revival -- a deaf guy named Ronnie Rice. He does great imitations of famous people -- and he looks a bit like a young Jerry Lewis!

Nancy

In honor of all the Dads all over the world for "Father's Day" on June 19th, here's a humorous site on "10 Things We'll Probably Never Hear Dad Say". :)

Click here for a good laugh, and "Happy Father's Day"!:

http://www.wrensworld.com/dadwontsay.htm

Nancy

Arkansas Family Expecting 16th Child

URL: http://news.yahoo.com/s/ap/20050617/ap_on_fe_st/sixteen_kids

Arkansas' best-known big family will be getting bigger in the fall. Michelle Duggar and her husband, former state Rep. Jim Bob Duggar, say they're expecting their 16th child.

Michelle Duggar was honored in April 2004 with the state's Young Mother award. At the time, she was pregnant with young Duggar No. 15, a boy named Jackson born May 23, 2004.

The next child, a girl, is expected in October.

"We love children," Jim Bob Duggar says. "We consider each one a blessing from the Lord and we would both love to have some more."

Michelle adds, "They're a gift."

Baby girl Duggar will join her family in a new, 7,000-square-foot house that the Duggars have been building for the last two years. When it's complete, the home will have a commercial kitchen, 10 bathrooms, master and guest bedrooms, a laundry room with four washers and eight dryers, and two dormitory-style bedrooms — one for the boys and one for the girls.

The Duggars say No. 16 might not be their last.

 It is with saddest heart that I pass on the following news.

Please join me in remembering a great icon of the entertainment community.

The Pillsbury Doughboy died yesterday of a yeast infection, and complications from repeated pokes in the belly.

He was 71.

Doughboy is survived by his wife, Play Dough, two children, John Dough and Jane Dough, who has a bun in the oven.

He is also survived by his elderly father, Pop Tart.

Doughboy was buried in a lightly greased coffin.

Dozens of celebrities turned out to pay their respects, including Mrs. Buttersworth, Hungry Jack, the California Raisins, Betty Crocker, the Hostess Twinkies and Captain
Crunch.

The grave site was piled high with flours.

Aunt Jemima delivered the eulogy, and lovingly described Doughboy as a man who never knew how much he was kneaded.

Doughboy rose quickly in show business, but his later life was filled with turnovers.

He was not considered a very smart "cookie", wasting much of his dough on half-baked schemes.

Despite being a little flaky at times, he still, as a crusty old man, was considered a roll model for millions.

The funeral was held at 3:50 for about 20 minutes.

Here's a Flash video you can view online called "Review Your Life" about how to know Christ and what happens when you die without Christ.

This video is worth watching and can make you think.  Feel free to share the link below to others who may be interested in knowing Jesus as our Savior. :)

Click here to "Review Your Life":
http://jove.prohosting.com/sfspot/THISLIFE.swf

Nancy

    The 1960s-early 1970s TV series "Bewitched" is one of my favorite classic sitcoms.  I used to watch this show after I got home from school growing up, and as an adult today, I still love the show. :)  The year I was born, in 1969, was the year they did the "Darrin switch" from Dick York to Dick Sargent.

     The main focus of this show is of an average family living in Connecticut named Darrin and Samantha Stephens.  Samantha (played by Elizabeth Montgomery) was actually a witch who was more than 200 years old but she looked about 30 years old. She married a mortal man named Darrin Stephens (played by Dick York, then later Dick Sargeant), who sometimes had to tell Sam not to use her witchcraft, which is by wiggling her nose. Sam does use her magic only to help Darrin and to help whenever is necessary on the show. What made matters worse for Darrin is Sam's mother, Endora (played by Agnes Moorehead) who is also a witch....and a meddling mother-in-law who never said his name right. Darrin and Sam had two children: a girl named Tabitha (a witch) and a boy named Adam (perhaps a warlock - we don't know). The actors who played the kids were 2 sets of twins.

There are other witches and warlocks in Samantha's family: her father, Maurice; her bumbling Aunt Clara; Uncle Arthur the prankster; Cousin Serena; and others.  There is also a doctor in the family, but he's no regular doctor -- he's a warlock named Dr. Bombay (played by Bernard Fox). There was also a "babysitter" who's a witch but a very nervous one, named Esmerelda (played by Alice Ghostley).   Here's one of the BEST characters in "Bewitched" - the nosy neighbor Gladys Kravitz. The actress who played her first, Alice Pierce, was hilarous...then after she died, Sandra Gould replaced her as Mrs. Kravitz.  Her long-suffering husband, Abner, was played by George Tobias, was also great.  Darrin's boss in the show was Larry Tate, a money-hungry man but also tries to please his clients, was played by David White.

Now coming out this month (in June 2005), there's a movie version of "Bewitched" with Nicole Kidman, this time as "Samantha", and Will Farrell as "Darrin" (I prefer Jim Carrey as Darrin because they favor each other so much and have the same rubbery expressions).  Here's the link for the movie: http://www.sonypictures.com/movies/bewitched/site

Here's a very good "Bewitched" site for both the TV show and the movie, plus all kinds of trivia and facts about the series and the stars: http://www.harpiesbizarre.com

Here's 2 thumbs up to Ms. Montgomery. :)

Nancy

     For a couple of weeks, I have been the owner of an EmotiPad Plus, an emoticon "keeper" that you can drag and drop smilies, emoticons, and other types of photos in your forums or emails that you post online.  I like the idea of separating and labeling emoticons in categories such as "Happy Birthday", "Christmas", "Weather", and more. :) You can also get FREE updates of EmotiPad Plus after you purchase it from SoulSoft. :)

     I love this program because it is easy to use, and you can collect as many smilies or emoticons you want, plus this is sold at a good price (not expensive). 

You can purchase it by credit card, money order, check, etc.  One thing I need to tell you about after you download the program...During the time you are using the "trial" for about 14 days, you need to send in the payment right away (if you use money order or US check). After the "trial" is over, you will not get it up again if you don't send in your payment.

Be sure to check the FAQs and information about each of the 3 neat programs from SoulSoft to see which is best for your needs in the main page, including the prices and how you are going to pay for it.

Here's the main page:  http://www.emotipad.com

Here's where you can download EmotiPad Plus: http://www.emotipad.com/eppdownload.php

Here's the forum of SoulSoft where the moderators can help you with any problems you have with your EmotiPad software -- you can even find cool new emoticons to add to your EmotiPad!: http://www.emotipad.com/phpBB2

Here's another way you can get help with your software - called "Help Desk": http://www.emotipad.com/cgi-bin/pd/pdesk.cgi

Enjoy! :)

Nancy

    If you want to find a cool online painting program, look no further! :)  You can go directly to Art.com ArtPad to paint your heart's desire.  You can choose from a small paintbrush to a very large painter's brush to paint your picture online.  After you are done, you can replay (actually, watch you paint) your painting from "slow" to "fast". :)  You can even view other people's paintings in a gallery from this program. :)

Enjoy painting in the link below! :)

Go here:
http://artpad.art.com/artpad/painter

Nancy

    Have you ever seen strange closed captioning on your TV...you know, words or sentences that didn't make sense? I did and I thought it was funny.

Well, the website master who created the website in the link below knows what you are talking about. :)  He created Captionese.net, a website full of weird closed captioning that he had seen, and other people who submitted their own are included in the archives.

Enjoy Captionese.net and have a good laugh! :) :

http://mysite.verizon.net/vze1waks

Nancy

     One of the most interesting famous people is Helen Keller, who was deaf and blind since infancy.  I have her autobiography "Story of My Life" which is a good read, and it is edited by John Macy, whom her teacher, Anne Sullivan had married once.

     There was a 1960s movie called "The Miracle Worker" that starred Patty Duke (as Helen) and Anne Bancroft (as Anne Sullivan).  It is one of my favorite movies because I loved some of the scenes (such as "feeling the facial expressions"), and it showed fingerspelling to help teach Helen new words.  I also like the fact that the nightmares Anne had in the movies were "grainy images", which is sort of like what the blind and visually-impaired people see first hand.

    In Amazon.com, I had written a review about this movie from "My Reviews", so here it is:

I enjoyed watching this movie because it is entertaining and I never got bored throughout the movie. I am deaf and I really enjoy the fingerspelling scenes, plus Annie Sullivan did wonders for Hellen by portraying her as a hard worker to help Hellen get a life from a soundless, sightless world. Both Patty Duke and Anne Bancroft did a great job on their parts. This is a good movie, both funny and heart-wrenching, and it is worth it to watch!

    Also, did you know that Helen had a Boston Terrier?  She also owned several other kinds of dogs in her lifetime.

From URL:  http://www.afb.org/braillebug/askkeller.asp?issueid=20051

One day, several girls invited Helen to go with them to Brookline to see some friends. This was all that they would tell Helen, and when they reached their destination, the girls were very mysterious. As Helen began to sniff, she realized that she was entering a kennel, the home of many Boston Terriers. Imagine Helen's surprise when the girls gave her one of the terriers named Sir Thomas Belvedere to take home.

Here's a picture of Helen with her BT -- photo from this link:  http://www.ioeba.net/ioebaobbhistory.htm

   Helen has written other books, including "Story of My Life".  It was said she had been typing (with a Braille typewriter) a book titled "Teacher" (concerning Anne Sullivan), but it was destroyed by a house fire.

   I think Helen is well-deserved in showing the world that people with disabilities can do anything they put their mind to it in an era when people were sent away to asylums and special schools.  Anne Sullivan is the true "Miracle Worker" since she had helped Helen to succeed in a world full of ignorance for those with special needs.

Nancy

 Students in an advanced biology class were taking a mid-term. The last question, worth 70 points or none at all was:

"Name seven advantages of mother's milk."

The student in question had also partied the night before, and was finding it hard to think of 7 advantages. He finally wrote:

1. It is a perfect formula for the child.
2. It provides immunity against several diseases.
3. It is always available as needed.
4. It is always at the right temperature
5. It is inexpensive.
6. It bonds the child to the mother, and vice versa.

And then, the student was stuck. Finally, just before the bell indicating the end of the test was rang, he wrote:

7. It comes in such cute containers.

He was the only student to make a 100 on the exam!

TURN OF THE CENTURIES

1900s vs. 2000s

Dog subpoenaed as witness in murder case
Suspect wrote his pooch a letter from prison, prosecutors say

URL: http://www.msnbc.msn.com/id/7138572

BENTONVILLE, Ark. - Prosecutors hoping for a witness in a murder case to roll over were barking up the wrong tree.

They sent out a batch of subpoenas for anyone who had contact with Albert K. Smith while he was jailed awaiting his murder trial. One of those subpoenas went out to 5-year-old Murphy Smith — Smith’s dog, it turned out.

The defendant had written his dog a letter from his cell, and that is how the shih tzu’s name got on the witness list.

Prosecutors realized the mistake on Tuesday after the defendant’s brother brought in Murphy to answer the subpoena and a deputy would not let them into the courthouse because no dogs were allowed.

Prosecutor Robin Green said she apologized to the brother for any inconvenience, and added: “The dog was friendly enough and probably would have been a very cooperative witness.”

Albert Smith is accused of shooting to death his ex-wife’s boyfriend.

    Here are some links that I think everyone, even adults, will enjoy! :)  Each link below are of movies that are running in 30 seconds by bunny actors doing re-enactments of the real movie that were shown in theaters! :)  It is very cute to watch so enjoy! :)

"It's a Wonderful Life":  http://www.angryalien.com/1204/wonderful_lifebuns.asp

"Titantic": http://www.angryalien.com/0604/titanicbunnies.html

"Jaws":  http://www.angryalien.com/0804/jawsbunnies.asp

"The Shining":  http://www.angryalien.com/0504/shiningbunnies.html

"Alien":  http://www.angryalien.com/0704/alienbunnies.html

"The Exorcist":  http://www.angryalien.com/0204/exorcistbunnies.html

Nancy

Nancy is a Florida Native (born and raised in Florida), and she is a never-married lady. She currently works at a local courthouse as a Support Specialst, and loves her job. She also interprets for deaf defendants who comes to the front counter in her department. She lived in the SE area of Florida for 31 years, and moved to Central Florida since January 2001.

Nancy's hobbies and interests are computers (and the Internet), watching good movies on VCR (with them closed captioned, of course!).  She also enjoys going to the movie theaters even though the area did not have closed captioning in their theaters...even though she didn't understand a lot of the conversations, she enjoyed the action and the plot of the movies. She also enjoys listening to older music/1980s music and gospel music (the lyrics to the songs helps Nancy understand what the songs are about). Nancy enjoyed going to deaf retreats in the past such as St. Augustine School for Deaf and Blind's "Total Immersion Silent Weekends".

Hearing Loss

Nancy was born with Congenital Rubella in 1969, but at the time she was born, she either could hear well or had a mild hearing loss. They didn't test newborns' hearing back then. She was born with a severe heart defect because of the condition which was corrected by surgery when she was a month old.

Nancy had several ear infections before 1 year old, and in October 1971 (almost 2 years old), she contracted bacterial meningitis. Her parents realized that Nancy could say only 1 or 2 words (most kids that age could say simple sentences), also not responding when called, took her to get a hearing test, which revealed a severe hearing loss in both ears. Today, Nancy's hearing loss is severe to profound.

Overcoming Hearing Loss

Nancy started wearing a binuaral body worn hearing aid from age 2 up to 3rd grade. In 3rd grade, she started wearing the BTEs up to present day...but lost some more hearing in the left ear at age 14. Since then, she did not wear a BTE in the left ear anymore but still wears one on the right ear.

Nancy grew up oral, but learned sign language in 4 years of high school with other deaf/HOH students. Nancy had speech therapy from age 2 to around 5th grade. She attended a preschool for handicapped children which included the deaf and hard-of-hearing kids. Nancy knew how to lipread, and in middle school, she used a tape recorder for a notetaker so she can study her lessons. In high school, she had an interpreter in her classes, plus being mainstreamed in both deaf and hearing classes. When Nancy takes off her hearing aid, she depends on lipreading and sign language at home because she could not hear any voices or most sounds.

I thought this is a very interesting chat transcript, because of what glaucoma treatment was like around 100 years ago. - Nancy

Glaucoma Down Through the Ages

From URL:
http://www.wills-glaucoma.org/supportgroup/20050112.php

On Wednesday, January 12, 2005, Dr. George Spaeth,
Director, Wills Glaucoma Service, and the glaucoma
chat group discussed "Glaucoma Down Through the Ages."

Moderator:  Welcome to chat, Dr. Spaeth. The topic
tonight is "Glaucoma Down Through the Ages."

Dr. George Spaeth:  Thank you.  Maybe I can start
things out.  The subject is really important. 

Moderator:  Please do. 

Dr. George Spaeth:  A thousand years ago, glaucoma was
"painless blindness." Later it became apparent that
most people who were thought to have glaucoma really
had cataracts.  About 1850 it became clear that eyes
with high intraocular pressure (IOP) were sick, and
high pressure became the definition of glaucoma.

About 100 years later, work began which eventually
showed that 95% of people with elevated pressure never
got glaucoma, and 50% of those with glaucoma had
normal pressure.  Wow!  Something was clearly wrong
with the old idea that glaucoma was elevated IOP.

Moderator:  What is the thinking now?

Dr. George Spaeth:  Now we think that pressure inside
the eye always plays a role in the development of the
damage to the optic nerve.  That is the hallmark of
glaucoma.  The pressure can be 10 or 15 or 50 mm Hg.

But glaucoma is NOT elevated pressure.  Glaucoma is a
process in which the optic nerve changes from healthy
to sick.  Some people never get really sick nerves and
other people do, but that is not related to the level
of pressure.

P:  In the 1800's, how was glaucoma diagnosed and what
was the treatment?

Dr. George Spaeth:  Doctors just measured the
pressure, and they treated with pilocarpine or similar
drugs that made the pupil small.

P:  At a conference last fall, Dr. Robert Ritch said
that when he first started practicing medicine,
glaucoma had three stages: eyedrops, surgery,
blindness. Can you elaborate?

Dr. George Spaeth:  If the pressure was above 21 mm
Hg, people got treated; if below 21 mm Hg, they were
not treated.  So 95% of the people were treated
unnecessarily.  Some people need surgery first, others
laser first, others drops first.  The care needs to be
individualized.

P:  Since it used to be common to treat patients for
glaucoma purely on the basis of elevated pressure, and
since a family history of glaucoma is considered a
risk factor, how can patients today really know
whether their grandparents or other relatives actually
had glaucoma?

Dr. George Spaeth:  Great question! You can't.  Most
people back then who were told they had glaucoma did
NOT have glaucoma.

P:  What do you consider to be the greatest advance in
the understanding of glaucoma during the last 50
years?

Dr. George Spaeth:  The understanding that glaucoma is
a complex disease, not just high pressure.

P:  How was the difference between blindness due to
glaucoma and other diseases, such as macular
degeneration, discovered?

Dr. George Spaeth:  It is not difficult to learn to
see the type of damage that occurs.  Glaucoma causes
the optic nerve to be damaged. In macular
degeneration, the macula is diseased.

P:  The chronic open-angle glaucomas have been studied
more extensively than any other types of glaucoma, but
is more known about the mechanisms of that type than
the other types?

Dr. George Spaeth:  No. The best understood glaucoma
is primary angle-closure glaucoma.  There the problem
is that the front of the eye is small and the iris
blocks the drain.  With the chronic glaucomas, we
still do not understand why some people get worse and
others don't.

P:  At the beginning of the 20th century, doctors had
only miotics for the medical treatment of glaucoma.
Pilocarpine, the oldest of today's glaucoma
medications, and the prostaglandin, Xalatan, one of
the newest, have opposite effects on uveoscleral
outflow. Are both drugs effective when used together?

Dr. George Spaeth:  Yes, but not additively.  Some
docs don't use them together.

P:  How confident are you that current classifications
and concepts of the glaucomas are correct and useful?
Are glaucoma researchers looking for new paradigms?

Dr. George Spaeth:  We are looking for new paradigms.
I have an editorial coming out about them in several
months.  It is clear that our present classification
system is not adequate.  The difference between
open-angle glaucoma and angle-closure glaucoma,
however, is valid and important.

P:  Where will your editorial appear?

Dr. George Spaeth:  In the journal "Ophthalmology."

P:  What types of surgeries for glaucoma were
available 60 years ago, and how successful were they?

Dr. George Spaeth:  Quite amazingly, the surgery that
we do today was started over 100 years ago.  It has
been refined and modified, but it is still basically
the same thing.  The so-called trabeculectomy is the
same operation that was done 100 years ago, except a
lid covers the drain.

P:  I recently had cataract surgery, which was vastly
different from my mother's cataract surgery.  It's
unfortunate that glaucoma surgery has changed so
little in all these years.

P:  Was the Scheie sclerectomy an early form of a
trabeculectomy?   My Mom had that done 32 yeas ago.

Dr. George Spaeth:  The Scheie procedure was a great
operation.   The problem was that it often (about 1/3
of the time) allowed too much drainage.  The front of
the eye collapsed, leading to cataract and other
problems.  The newer operations put a lid on the
drain, which prevents that kind of complication in
most people, but results in higher pressures.

Moderator:  When were lasers first used for glaucoma
surgery?

Dr. George Spaeth:  Now lasers are new and a great
addition.  About 25 years ago, a doctor in Oklahoma
found that pressure could be lowered by treating the
trabecular meshwork with very low levels of argon
laser energy.  That was a great contribution.

P:  Is it fair to say that advances in glaucoma
treatments have been slow in the last 100 years?

Dr. George Spaeth:  The changes have really been
dramatic, but they have been conceptual.  Think of
what it means that what everybody thought was right in
l950 everybody now knows is wrong. There are so many
misunderstandings.  For example, peripheral vision is
the LAST part of vision to be lost.  Also, surgery is
often the best first treatment, and so on.

P:  One of those misunderstandings is what
"peripheral" vision means.  For instance, the visual
field tests I've taken for years on Humphrey machines
test the central 30 degrees, not peripheral vision.

Dr. George Spaeth:  That depends upon the type of
visual field machine.  Some do test for peripheral
vision.

P:  Why isn't the full visual field tested?  Do
doctors think that the peripheral loss outside the 30
degrees is acceptable to most of us?

Dr. George Spaeth:  Testing outside the 30 degrees is
difficult, and that is not where early field loss
develops.  Thus, it would be time consuming and would
not tell us anything that we can't learn from testing
the more central portion.

[Editor's note:  The central 30 degrees of vision is
straight-ahead vision. It is the part you are using to
see your computer screen.]

P:  Although the visual field tests are now much less
tiring for patients than in earlier years, most
patients still dread taking those tests. Do you
foresee further advances in that area soon?

Dr. George Spaeth:  I think visual field testing has
gone as far as it can.  I predict that the tests we
use now will become increasingly less important in the
future.  They are too difficult and too nonspecific.
Objective field machines are being developed and they
may be a help. That is, the person does not push a
button, but just looks at a target.

Moderator:  Which is more important: the cup-to-disc
ratio or alterations in the topography of the optic
nerve head?

Dr. George Spaeth:  Cup-to-disc ratios are a rough
guide.  But the pattern is more important.  You
differentiate a Van Gogh from a Monet painting by the
pattern, not by the size of the frame.

P:  When my glaucoma was diagnosed in early 1988, I
was torn for years between the arguments of mechanical
versus ischemic theories.  That debate seemed to end
in a blind alley.  Now, Dr. Joseph Caprioli at the
University of California, who served a fellowship at
Wills, says we have to forget that argument, and think
about cellular and molecular pathways.  Do you agree?

Dr. George Spaeth:  Joe Caprioli took his training
with me.  He is very bright and knows a lot.  But he
is falling into the same trap that affected older
doctors.  He is looking for ONE answer. There is no
ONE answer.  Some people lose sight because of
mechanical damage to the nerve, some because there is
not enough blood flow, some because of an abnormal
gene, and so on.

P:  What you are saying is not only very informative,
but gives me hope.  I am so intimidated by the
ophthalmologists I have seen that I didn't dare
question the treatment.

Dr. George Spaeth:  The challenge is always to look at
the individual person -- who is always different from
every other person -- and to figure out what is
happening with that unique person.

P:  Doctor Spaeth, we live in an era where many --
both professionals in various fields as well as lay
persons -- search for the cures in the causes.  Often
it's assumed that if the cause is known, a cure can be
found.  I don't see that clearly in glaucoma research.
Perhaps there's not much to be gained from the popular
methodology. Can you comment, please?

Dr. George Spaeth:  In the 1800s people were dying
from cholera in London.  John Snow, an engineer, noted
that people died in certain areas and not in others.
He concluded that the water supply caused the deaths,
and saved the lives of millions without knowing
anything about the fundamental cause.

P:  If the pressure is high and drops won't lower it,
but the optic nerve is healthy, is surgery still
needed?

Dr. George Spaeth:  If the nerve is healthy, why do
you need any treatment at all?

P:  Don't data show that treating ocular hypertensives
preserves vision over the long term, as opposed to not
treating?

Dr. George Spaeth:  The data are the other way around.
Treating causes cataracts and introduces anxiety.
The only long-term study, by Linner and Stomber,
showed that after 25 years of not being treated,
ocular hyptensives rarely (5%) lost enough vision to
notice any visual loss.  But everybody who is treated
for ocular hypertension has some side effects from the
meds.

P:  How accurate are the tools, such as retinal flow
meters and color Doppler imaging, for measuring blood
flow of the optic nerve?

Dr. George Spaeth:  For populations, they are great.
For individuals, they are almost useless.  If you
measure the temperatures of a large group of people,
the average temperature is usually around 98.6
degrees.  But some people have temperatures that are
above that and others below that.  Some people's
healthy temperature differs from what is thought to be
normal.  And so it is with everything else, including
measurements of blood flow.  Some people go blind with
a pressure of 12 mm Hg, and other people need no
treatment with a pressure of 30 mm Hg. “Healthy” and
“average” are not synonyms, though those who know
nothing about life would have us believe they are.

P:  How do you define a healthy optic nerve?

Dr. George Spaeth:  A healthy optic nerve is one that
works well.

P:  What tests can help determine if an optic nerve
works well (is healthy)?

Dr. George Spaeth:  How well do you see?  How well
does the nerve transmit electrical impulses to the
brain (tested with VEP)? How well do you see colors,
movement, dark objects, etc.?

[Editor's note:  VEP stands for Visual Evoked
Potential, a test involving computerized recording of
the electrical activity at the back of the brain
(occipital cortex) that results from light flashes
stimulating the retina.  The test is used for
detecting defects of the retina-to-brain nerve
pathway, since they can change the brain-wave
patterns.]

P:  I read about the equilateral triangle: pressure,
visual fields, optic nerve scans.  So far, I have had
two optic nerve scans in three years and plenty of
pressure readings. Is that approach lopsided?

Dr. George Spaeth:  Field damage usually occurs after
nerve damage.   The most important thing is looking at
the optic nerve.  The scans are not as good as a good
examination of the optic nerve.  You can usually tell
if a nerve is healthy by the way it looks.  But it is
like looking at a painting.  It is the pattern, not
the cup-to-disc ratio or any other figure, that tells
you the answer.

P:  When do you think we might expect to see clinical
benefits from neuroprotectants and gene therapies?

Dr. George Spaeth:  Neuroprotectants?  We have a great
neuroprotective procedure now: lowering the pressure.
From drugs and so on, perhaps never. From gene
therapies, right now some gene theories work for other
diseases, but for glaucoma, perhaps never.

P:  Do you anticipate an increasing interest in
neuroprotective agents independent of intraocular
pressure?

Dr. George Spaeth:  Yes, but I think it is misguided.
That was a bad answer.  I think that preserving the
health of the nerve by means other than lowering
pressure is terribly important, but it may be diet,
exercise, chocolate.  Who knows?

P:  Is uncontrolled high pressure always a precursor
to optic nerve damage?

Dr. George Spaeth:  Ninety-five percent of people with
elevated pressure never get nerve damage.  Fifty
percent of people with nerve damage never have
elevated pressure.

Moderator:  At what pressure does damage definitely
occur?

Dr. George Spaeth:  The answer is that everybody is
different and some people get worse at low pressures
and others don't.  At pressures above 30 mm Hg, people
are predisposed to getting a clot in the veins of the
eye.  Therefore, I advise treatment in most people
with IOP over 30 mm Hg, not to prevent glaucoma, but
to prevent a blood clot.  When the pressure gets to 50
mm Hg, that's almost always bad.

P:  From what you've said, it seems to me that you do
not favor the use of medications for the treatment of
ocular hypertension, and maybe not even for glaucoma
(that is, when damage has occurred).  Please comment.

Dr. George Spaeth:  I favor the use of medications or
laser or surgery if it is clear that a person has a
condition that will cause visual disability.  If the
nerve is normal and staying normal, treatment is
rarely needed.  If the nerve is getting worse,
treatment is needed in most people.  If the person
already has visual disability, treatment is usually
essential.

P:  Where does early field loss develop?

Dr. George Spaeth:  That depends on the person.  In
some, the earliest field loss is almost straight
ahead; in others, it is near the natural blind spot;
in others, it is in the nasal periphery.

P:  Do doctors routinely look at the optic nerve at
each visit?   Maybe I'm missing that part.

Dr. George Spaeth:  Great question.  The answer is no,
but they should look at the optic nerve whenever there
is a question about determining the person's visual
stability.  Thanks for asking that question.

P:  My eye specialist measures my pressures, then
looks into my eyes briefly, and that's it.  Do you
think he is looking properly for any changes?

Dr. George Spaeth:  That's the usual approach.  If I
had my way, it would be reversed.  Boy!  Will your doc
hate me.

P:  I have seen four glaucoma docs and they all cue
into the high pressure as a red flag that must be
lowered or else optic nerve damage will or could
occur.  Why are so many docs fearful of high pressure
if 95% of those with it never get nerve damage?

Dr. George Spaeth:  Because that's what we all thought
for 150 years.  Habits change slowly.

P:  What has been the result of treating people once
their pressures got to 21 mm Hg?

Dr. George Spaeth:  All treatments cause problems.
Eyedrops cause impotence, heart block,
gastrointestinal upset, back aches, anemia, death, and
more.

P:  I know that the best technology is nothing if not
interpreted correctly.  How can you tell if your doc
is experienced in recognizing nerve changes?  What
questions should a patient ask?

Dr. George Spaeth:  Ask him or her how important
examination of the nerve is.

P:  Is it the preservatives in eyedrops, rather than
the eyedrops themselves, that have the most side
effects?  If so, why don't ophthalmologists insist
that preservative-free medications be developed?

Dr. George Spaeth:  Preservatives protect people from
getting infections. But preservatives are poisons.
Preservative-free drops are dangerous.  But the
preservatives are dangerous, too. It is always a
trade-off.

P:  When you began your training, were there many
glaucoma specialists in the U.S., and how has that
number changed over the years?

Dr. George Spaeth:  When I started training in 1960,
there was a handful of glaucoma specialists.  Now
every hospital or university has one or more. Wills
has 14 glaucoma specialists.

Dr. George Spaeth:  I'm still at work and my wife is
holding dinner for me. So I will say good-bye.  I hope
I have raised questions.  I hope all of you have a
great new year that is healthy and happy.

Moderator:  Dr. Spaeth, thank you for your time.  We
look forward to having you back in the chat room
again.

Dr. George Spaeth:  We doctors do not know as much as
we think we know or as patients believe we know.  If
that message comes across, this evening will have been
worthwhile.  I know that what I am saying will make
some people rethink their whole condition. GREAT!