Charlotte Bush, at left, and with her mother, Amanda Bush, who was a patient of Paul Lichter, M.D.
Like Mother, Like Daughter A rare inherited eye disease brings a mother and daughter to the Kellogg Eye Center for treatment Charlotte Bush was just two years old when she made her first trip to the University of Michigan Kellogg Eye Center in 2009. A new experience for the toddler, such visits were more than familiar to her mother, Amanda Bush, of Marshall, Michigan, who has been treated at Kellogg for nearly 33 years for a condition known as Axenfeld-Rieger (A-R) syndrome—an inherited disease that predominantly affects the development of the eye. Ms. Bush suspected Charlotte might have the same disease and, if so, wanted to have it diagnosed and treated promptly; fifty percent of those with the disorder suffer from glaucoma. “Ever since I was a baby, I’ve been coming to Kellogg—it was just a normal part of my life,” says Ms. Bush. “And, I’ve always had great experiences so it was natural to bring my daughter here.” Unfortunately, the mother’s keen instincts proved correct. At Charlotte’s first appointment she was diagnosed with A-R by Paul R. Lichter, M.D., a highly respected glaucoma specialist and former Chair of the Department—and Ms. Bush’s childhood doctor. Once Charlotte’s vision and intraocular pressures were stabilized, she returned to her local ophthalmolo-
8
university of michigan kellogg eye center
gist for routine check-ups. All went well until Charlotte failed a pre-kindergarten vision screening during the summer of 2012. When Ms. Bush took her daughter to the ophthalmologist to be fitted for eyeglasses, the pressure in her left eye was again elevated and it was recommended that she return to the Kellogg Eye Center. This time, Charlotte was seen by pediatric glaucoma specialist Brenda L. Bohnsack, M.D., Ph.D., who adds her expertise to that of two other faculty who are nationally recognized in pediatric glaucoma, Dr. Lichter and Sayoko E. Moroi, M.D., Ph.D. Dr. Bohnsack decided on surgery to place a glaucoma drainage tube in Charlotte’s left eye so that fluid build-up could be drained off the eye. “The pressure in both of Charlotte’s eyes was elevated, but the left eye showed signs of damage from the glaucoma,” says Dr. Bohnsack. At Charlotte’s one-month check-up, the pressure in her left eye was controlled, but her vision remained somewhat reduced to 20/50 after sustaining vision loss due to the glaucoma. With 20/20 vision in her right eye, she was doing fine visually, but Dr. Bohnsack decided to treat that eye with drops to control the pressure before Charlotte experienced loss of vision. In the future, Dr. Bohnsack anticipates Charlotte may need surgery on the right eye as well. In the meantime, Charlotte will be examined every few months to keep the eye pressure in check. Long term, she has a good prognosis. “In these types of cases, we look at how her mother has lived with the disease, and she has done well,” says Dr. Bohnsack. “This is a good indicator of how Charlotte will do.” Ms. Bush reports that Charlotte has handled surgery and subsequent follow-ups very well.