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Dr. Brian J. Song already had an interest in public health when he chose to become a glaucoma specialist. During his ophthalmology residency at the Edward S. Harkness Eye Institute of Columbia University Medical Center, he became intrigued by the global impact of glaucoma, especially in areas with limited access to care.
“Glaucoma is the second leading cause of blindness worldwide,” he notes. “In the U.S., 50 percent of individuals with the disease are unaware of their diagnosis because the early stages of glaucoma are largely asymptomatic. That number jumps to 90 percent in countries like China and India. When left untreated, glaucoma causes irreversible vision loss – and this can become a societal issue because visual impairment can leave patients dependent on others for assistance. By the year 2020, an estimated 11 million people worldwide will be bilaterally blind from glaucoma.”
Concerned about those trends, Dr. Song completed subspecialty training in glaucoma at the Jules Stein Eye Institute at the University of California at Los Angeles. Today, he is a full-time member of Mass. Eye and Ear’s Glaucoma Service and sees patients at both the Longwood and Charles Street locations. As a K12 Scholar in the Harvard-Vision Clinical Scientist Development Program, Dr. Song also conducts research on the feasibility of using telemedicine to improve glaucoma screening.
Dr. Song’s clinical practice is primarily focused on the management of complex glaucoma cases. “Many patients are referred to us at Mass Eye and Ear because they have advanced eye disease that requires more specialized attention,” he explains.
Glaucoma is, first and foremost, a disease of the optic nerve. While high intraocular pressure is often associated with glaucoma, this is not always the case. Patients with a form of glaucoma called normal tension glaucoma experience optic nerve damage, but do not have elevated eye pressures.
“So there are other issues at play,” Dr. Song says. “Some studies indicate that blood-flow may be an issue. Here at Mass. Eye and Ear, we have researchers who are doing work to better understand some of these other risk factors for glaucoma, such as genetics.”
“But intraocular pressure remains the only proven, modifiable risk factor for treating glaucoma,” he adds, “so the mainstay of glaucoma treatment remains focused on lowering eye pressure.”
There are a number of ways to lower a patient’s intraocular pressure. Medications, such as prostaglandin analogues and beta blockers, are the primary treatments to lower pressure in most patients. Laser treatment can help alleviate issues with drainage in patients with certain forms of glaucoma. Surgical therapy, such as trabeculectomy and glaucoma tube-shunts, helps to lower pressure in cases that are unresponsive to medications or laser.
For people who live in medically-underserved areas of the U.S. and worldwide, early, accessible glaucoma screening may be a solution. Dr. Song believes that telemedicine has the potential to help bridge that gap for glaucoma, citing the success of the Joslin Vision Network in helping to establish validated telemedicine protocols for diabetic retinal disease. The program at the Joslin Diabetes Center enables retinal imaging done in a physician’s office – both in the U.S. and overseas – to be sent to Joslin’s Beetham Eye Institute for expert evaluation.
“Once the results are interpreted by an eye care provider,” Dr. Song explains, “they decide whether that patient can continue with routine monitoring or if urgent follow-up care in an office setting is needed.”
Working closely with Dr. Louis Pasquale, who directs Mass. Eye and Ear’s Glaucoma Service, and Dr. Lloyd Paul Aiello, Director of Joslin’s Beetham Eye Institute, Dr. Song hopes to establish a telemedicine model that can be effective for glaucoma screening.
“This approach won’t replace the live eye exam,” he says. “But an early detection tool like this could help us better identify patients who might otherwise lose their vision without glaucoma treatment.”
In addition to his clinical and research activities, Dr. Song is an Instructor in Ophthalmology at Harvard Medical School, where he teaches residents and fellows about the diagnosis and management of glaucoma. “Working with trainees is one of the aspects of my job that I enjoy the most,” he says. “It is rewarding to see them gain new skills, knowledge, and confidence as they progress in their training.”
Contact Dr. Song’s office at 617-573-3670
View Dr. Song’s online bio for more information.