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With Award from NIH, Neurologist Switches Her Career Focus

Tuesday, June 15, 2004

            A physician at the University of Rochester Eye Institute has won a major award from the National Eye Institute to focus more on research aimed at helping people with brain disorders that affect their vision.

            Deborah Friedman, M.D., a neuro-ophthalmologist – a neurologist who focuses on visual disorders – has won a career development award from the institute, a division of the National Institutes of Health (NIH). The five-year award, which could be worth up to about $900,000, will give Friedman the opportunity to devote most of her time to research that could ultimately affect many more patients worldwide than she could ever see personally in a lifetime of one-on-one patient care.

            Friedman had spent a decade building a thriving medical practice in Syracuse and teaching medical students about neurology at Upstate Medical Center. But a lifelong interest in research – everything from science projects in elementary school to medical research on weekends and evenings at Upstate – led her down the road to the University of Rochester, where her former mentor, Steven Feldon, M.D., took the helm of the eye institute three years ago. Friedman joined in 2002 as associate professor of ophthalmology and neurology.

            The award gives Friedman resources to change the focus of her career so she can concentrate on research. She will work closely with neurologist Karl Kieburtz, M.D., who heads the Department of Neurology’s Clinical Trials Coordination Center, to learn how to run large clinical trials where doctors test the effectiveness of proposed new treatments for diseases.

            One of the first diseases she hopes to target is idiopathic intracranial hypertension (IIH) or pseudotumor cerebri, better known as “false brain tumor” because patients have symptoms like those of a brain tumor. Patients usually have a severe headache, and they often have blurred vision or see double.

            But there is no tumor. Instead, the cerebrospinal fluid that bathes the brain and spinal cord is under abnormally high pressure, pushing on vital structures like the optic nerve and sometimes causing permanent visual loss. The same fluid that normally acts like a shock absorber, keeping the brain safely cushioned in the skull, suddenly begins doing damage.

            The course of the disease varies widely. For some patients, symptoms go away with minimal treatment, such as a spinal tap. Other patients have headaches for months or years afterwards. For a few, the disease moves so quickly that even rapid eye surgery isn’t enough to stop permanent visual loss or even blindness. Friedman recently led a study with doctors from five academic medical centers who examined 109 patients with the disorder; six months after their initial diagnosis, half still had some visual problems.

            “When you meet a patient with symptoms like a severe headache and blurry vision, the first thing you worry about is a brain tumor. It turns out not to be – but even so, this condition is very serious and even causes blindness for a fair number of patients.”

            While doctors don’t know the exact cause of the disease, they do know that weight gain increases the risk that people, particularly women, will get IHH. The disease strikes heavy young women most often – overweight women of child-bearing age are nearly 20 times as likely as others to get IIH. Some medicines, such as those used to treat severe acne, also put a person at higher risk.

            “Awareness of this disorder is really increasing,” Friedman says. “The bad news is that it’s becoming more common, as the population gets fatter and more people are at risk. It’s now twice as common as it was in the 1980s.”

            Friedman hopes to do a large study comparing treatments for the disease, including dieting, medication, and eye surgery. Previously she was part of a team at Syracuse that discovered that many women with the condition also retain salt and water at abnormal levels. That condition is often treated with diuretics and by encouraging women to lose weight. In related research, Friedman has shown that in rats, common acetaminophen can raise the pressure of spinal fluid, and that like people, obesity somehow puts animals at risk.

             Besides her work with IIH, Friedman is an expert on migraines and other types of headaches. She studies a phenomenon where patients who take over-the-counter pain medications like acetaminophen or ibuprofen can actually create a chronic headache for themselves, something doctors call a “rebound” headache. She is also earning a master’s degree in public health.

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