The Final Frontier
“Healthy aging is a universal topic of interest,” said Steve Tanne, Ph.D., executive director of development for the GW School of Medicine and Health Sciences (SMHS). “After all, we’re all aging — if we’re lucky,” Tanne joked as he welcomed community members to the Frontiers In Medicine lecture Dec. 12, part of an innovative lecture series that has connected members of the Washington metropolitan community with renowned health care experts since 2010.
The evening featured a panel of GW physicians specializing in hearing, sight, and skin — Ashkan Monfared, M.D., assistant professor of surgery and neurosurgery at SMHS and director of otology and neurotology at the GW Medical Faculty Associates (MFA); David Belyea, M.D., M.B.A., professor of ophthalmology at SMHS and vice chair of ophthalmology at MFA; and Alison Ehrlich, M.D. ’96, RESD ’97, professor and chair of dermatology at SMHS and director of clinical research at MFA.
Monfared opened the panel with an overview of human hearing, including the differences between conductive hearing loss (which occurs when sound is not conducted efficiently through the outer ear) and sensory hearing loss (which occurs when there is damage to the inner ear). As the founder of the Comprehensive Hearing Center — one of the only adult cochlear implant programs in the Washington, D.C. area — Monfared serves the needs of patients with any degree of hearing loss. He cited statistics indicating that 25 percent of adults over age 55 in the United States experience clinical hearing loss, and that only 1 in 5 of those affected use a hearing aid.
“Unfortunately, hearing aids have a huge stigma associated with them,” Monfared said. “Most patients don’t choose not to use hearing aids because they’re not accessible or because they don’t work well — it’s because they feel like they’re losing intelligence points as soon as they put a hearing aid on. Research shows the exact opposite is true,” he explained. “If you don’t stimulate the neurons with hearing sound and speech, they’ll eventually stop working.”
Monfared also discussed what he considers to be a true revolution in medicine — cochlear implants. “This is one of the only cures for sensory deficits we have in human beings,” he said. “I’m incredibly surprised that a Nobel Prize has not been awarded for this yet.” Cochlear implants, Monfared explained, directly stimulate the auditory nerve to generate signals that the brain can recognize as sound.
Monfared closed his talk by mentioning new products on the hearing device market that use recent technological advances, such as SoundBite, a non-surgical hearing device that uses the principle of bone conduction to transmit sound via the teeth. It is intended to help patients who are deaf in one ear regain spatial hearing ability.
“We’ve come very far,” Monfared remarked, but he said that genetic engineering to improve hearing is still a long way off. Our ability to hear relies on hair cells in the inner ear, and “hair cells are the only human cell that does not reproduce, so you can imagine how hard it’s going to be to do genetic engineering,” he said.
Next, Belyea discussed changes to sight that can during the aging process. “Unlike hearing aids, glasses are sexy, right?” he joked with the audience. Belyea went on to discuss cataracts, glaucoma, and macular degeneration — three conditions associated with aging that can cause loss of sight.
In the case of cataracts, “when your lens becomes cloudy with aging, instead of bending the light it refracts it and you can no longer see through it,” Belyea said. In ancient times, it was thought that such sight loss was caused by a “waterfall” in front of the pupil and iris. In fact, Belyea explained, the word cataract is from the Arabic word for waterfall.
Glaucoma, on the other hand, is what Belyea calls a very sneaky disease. “It happens very slowly, and we’re adaptable creatures, so we adapt quickly and don’t realize that we’re not seeing things that we should be seeing,” he said. Routine eye exams are important, he adds, because medications are available to slow glaucoma’s advance if it is caught early enough.
Finally, Belyea discussed macular degeneration, a condition that results in the loss of vision in the center of the visual field due to retinal damage. “The only macular degeneration we can treat is the wet form,” Belyea explained, referring to the condition where abnormal blood vessels leak fluid into the macula, or center of the retina. “But if you have the pre-wet form, vitamins can help reduce the incidence of the wet macular degeneration.”
Ehrlich, the final speaker for the evening, discussed skin cancers, as well as how to slow the aging process with cosmetic procedures. “The precursor to skin cancer is called actinic keratosis,” she explained. “Over time, 10 to 15 percent of keratoses will form into a skin cancer,” the two most common being basal cell carcinoma and squamous cell carcinoma. “The most important factor as far as causing these types of skin cancer is sun exposure, the effect of which is cumulative over time,” she said.
Ehrlich reminded the audience to avoid being out in the sun between 11 a.m. and 4 p.m., or at least to wear protective clothing. “If you’re out during those hours, wear a wide-brimmed hat. Baseball caps do not protect the sides of your face,” she explained. Additionally, sunscreen should be applied frequently to all areas of the body, including the face and neck. “One of the higher rates of metastasis from skin cancer is seen in the lips because they’re very vascular. You have a lot of blood supply in those areas.”
“Now for the fun part,” Ehrlich said, as she switched gears to discuss anti-aging cosmetic procedures. She described possible treatments for broken blood vessels, uneven pigmentation, and dynamic and static wrinkles. These treatments include topical retinoids, chemical peels, microdermabrasion, botox, fillers, and laser resurfacing. “We all want to look young,” Ehrlich said, “but rather than looking younger than your age, I think the more important thing is to look good for your age.”
The event, which was moderated by Alan Wasserman, M.D., M.A.C.P., Eugene Meyer Professor of Medicine and chair of the department of medicine at SMHS, was the first in an occasional series about healthy aging that will continue in 2014.