In it Together

Two pairs of family members—one linked by blood, one by marriage—look to Kellogg for urgent glaucoma treatment

Glaucoma has been called the silent thief of sight. It can be inherited or result from other diseases, trauma, aging, or many other causes. Glaucoma can present at birth or develop late in life. Glaucoma’s hallmark characteristic, elevated intraocular pressure, can be manageable for years, and then spike rapidly and unpredictably.

At a high-volume referral center like Kellogg, our glaucoma experts expect to encounter these variations. But it’s not every day that they come along in pairs.

Tierra and Makayla

Tierra Richardson, 25, and her sister Makayla Miller, 17, both of Grand Rapids, Michigan, share an inherited form of glaucoma. Makayla’s glaucoma was discovered at birth, and surgery was performed on one of her eyes as an infant. Tierra was diagnosed at age six and underwent her first operation at age 16.

In the ensuing years, both sisters’ intraocular pressures were watched closely, first by their local ophthalmologist, then by a Kellogg team led by glaucoma specialist Manjool Shah, M.D.

“My glaucoma was well-monitored near home,” says Tierra. “But I chose to travel to Kellogg for access to more options to keep my eye pressure down. I encouraged my mom, who has lost much of her vision to glaucoma, to allow me to bring Makayla to Kellogg too.”

At an evaluation in the spring of 2020, both Makayla and Tierra registered dangerously high intraocular pressures. “Both patients required prompt interventions,” recalls Dr. Shah. “Because of the distance they traveled, and despite the fact that Kellogg was operating at limited capacity due to the pandemic, we scheduled their procedures right away, arranging to operate on both sisters on the same day.”

Glaucoma had already cost Makayla virtually all of the vision in one eye. Dr. Shah recommended that a drainage tube be implanted to manage the pressure in the other eye.

Elevated pressure was jeopardizing both of Tierra’s eyes. Dr. Shah performed cyclophotocoagulation on the eye that had undergone a prior surgery. The procedure applies laser energy to the part of the eye that produces intraocular fluid. That essentially ‘turns down the faucet,’ lowering eye pressure.

Her other eye was a candidate for microinvasive glaucoma surgery, or MIGS. “We chose to implant the XEN® gel stent, a flexible tube the size of an eyelash,” Dr. Shah explains. Kellogg was among the first U.S. centers to implant this stent when it first earned FDA approval in 2017.

“At the time, I was a full-time college student,” Tierra recalls. “The thought of surgery in the middle of the semester made me anxious. But I was intrigued when Dr. Shah described the MIGS option. Being involved in the decision made me feel more comfortable.”

Throughout the day, the sisters worried about each other. But Dr. Shah kept each updated on the other’s progress. “We felt better knowing we were in it together,” says Makayla.

Charles and Sallie

Sallie and Charles Sanislow

Charles and Sallie Sanislow’s ties to the University of Michigan and the Kellogg Eye Center date back decades. Charles, age 90, a retired vascular surgeon, and Sallie, age 85, a retired nurse, both received their medical training at U-M, and both had been patients of Kellogg’s Founding Director, Professor Emeritus Paul Lichter, M.D., M.S.

In recent years, an ophthalmologist near their home in Midland, Michigan, oversaw their eye care. But early in spring 2021, the Sanislows experienced different—but equally troubling—consequences of glaucoma. After consulting with their local ophthalmologist, they decided to return to Kellogg, this time under the care of glaucoma specialist Joshua Stein, M.D., M.S.

“The Sanislows’ each have difficultto-manage glaucoma, but it developed in two different ways,” explains Dr. Stein. “Within months of each other, for different reasons, both needed swift interventions to stabilize their intraocular pressures. These cases show just how unpredictable glaucoma can be.”

Retinal scarring from an earlier condition left Charles with limited vision in his right eye. As Dr. Stein explained, both eyes contribute to depth perception, even when the vision in one eye is limited.

“To preserve that depth perception, I was open to whatever could be done to maintain the remaining vision in that eye,” says Charles.

Dr. Stein performed laser trabeculoplasty in April and more laser in June, successfully stabilizing the pressure in the eye. Not long after the second procedure, Charles again reached out to Dr. Stein, this time with an urgent concern about Sallie.

Sallie was experiencing a serious flare-up of uveitis, inflammation in the eye. “When it comes to glaucoma, uveitis is a double threat,” explains Dr. Stein. “Both the inflammation and the cortico- steroids used to treat it can inhibit the eye’s ability to drain fluid, accelerating glaucoma.”

At Kellogg, retinal and uveitis specialists K. Thiran Jayasundera, M.D., M.S., and Mark Johnson, M.D., collaborated with Dr. Stein to determine the origin of Sallie’s inflammation and map a path to treat it. “Conditions like Sallie’s require detective work,” says Dr. Stein. “To treat the flare-up effectively, we needed to understand what was causing it.”

Once the inflammation was controlled, Dr. Stein performed a laser trabeculoplasty to stabilize her eye pressure.

“I was impressed by how the doctors and staff worked together, how much time they spent with me, and how mindful everyone was—especially Dr. Stein—of our time and travel,” Sallie recalls.

Charles agrees. “Having practiced a demanding type of surgery for many years, I know the importance of really listening to a patient’s concerns,” he adds. “In our experience, Dr. Stein is truly a physician’s physician.”

Since their procedures, both patient pairs are doing well. And all have made a lasting impression on their providers.

“Tierra and Makayla are inspiring,” Dr. Shah says. “They are so supportive of each other, and both are amazingly resilient and committed to doing what it takes to manage their glaucoma.” “I would describe Charles and Sallie Sanislow exactly the same way,” adds Dr. Stein. Sallie and Charles Sanislow