SWORDS FOR THE EYES AND BRAINS

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Two awesome Swords Into Plowshares developments deserve special
attention for the obvious way in which military technology was directly
transformed into urgently needed medical cures. One helps the
nearly-blind see, and the other is a cure for cancer.  By Prof. Shimon
Silman, RYAL Institute and Touro College


OPENING THE EYES - LITERALLY

Some three million Americans suffer chronic visual impairments known to
ophthalmologists as "low vision," which means that they are not totally
blind but retain some degree of useful vision. These disabling
impairments cannot be corrected medically, surgically, or with
conventional eyeglasses. But now, technology used in the first Persian
Gulf War has been transformed into a high technology visual aid to help
these people see.

Pilots in the Persian Gulf War wore head-mounted units which displayed
before their eyes the region on the ground containing their target. By
merely focusing their eyes on the image of the target on the display
before their eyes, and then pressing a button, a missile would be shot
at the target on the ground below.

This technology is the basis for the Low Vision Enhancement System
(LVES), a video headset that offers people with low vision a view of
their surroundings equivalent to the image on a five-foot television
screen four feet distant from the viewer.

The LVES was developed by scientists at the Johns Hopkins Wilmer Eye
Institute in collaboration with the National Aeronautics and Space
Administration and the Veterans Administration.

The device is designed to enhance and compensate for low vision in
people whose eyesight with conventional eyeglasses is worse than 20/100
in their better eye, but better than 20/800.

"LVES does not fix vision or restore vision. Instead, it alters images
to make them easier for people to see with the vision they still have,"
says Dr. Robert W. Massof, professor of ophthalmology at Hopkins and
lead inventor. He also directs the Lions Vision Research and
Rehabilitation Center at Wilmer.

The lightweight headset, worn like goggles, is fitted with three
miniature, black-and-white video cameras. Two of the cameras, one over
each eye, provide a normal, 3-D view to observe what's happening in
their environment. A third, more complex camera is used for seeing
facial features, fine details of objects, distant objects, or for
close-up, detailed work and reading. A control unit allows the user to
select and control the cameras, and to adjust contrast and image
polarity to suit the user's needs. The cameras feed the images to a
computer that corrects for the particular vision problem of the user,
then sends the images to the video display in the goggles.

Visionics Corporation of Minnesota, the manufactures of LVES, gives the
following description of the technology: "The LVES does for video images
what headphones do for sound. It presents the enlarged image of a video
screen to each eye in a way that creates a sense of being immersed in a
video scene." Brad Blankenship, president of Visionics, says, "Our
engineers are experienced in building vision systems for the military,
like the helmet mounted displays that helicopter pilots used during
Operation Desert Storm. To use such high technology for this uniquely
peaceful, beneficial application is very satisfying."

Controls built into a battery pack worn on the belt let the wearer
adjust contrast and magnify images from 1.5 to 10 times. The unit
automatically compensates for changes in lighting to reduce glare in
bright light. In addition to displaying images from the built-in video
cameras, a cable connection lets the LVES become a personal large screen
display for input from televisions, videocassette recorders or
computers.

The system is used by people with a variety of low vision conditions,
particularly those who have experienced loss of central vision, the part
of vision normally used for reading. These patients may have macular
degeneration associated with aging or diabetic retinopathy, in which
diabetes causes swelling and leakage of fluid in the center of the
retina, the macula. The system also has benefited people who have lost
peripheral or side field vision, a problem associated with glaucoma, an
increase of fluid pressure inside the eye that damages the retina and
optic nerve, and people suffering from retinitis pigmentosa, a
progressive degeneration of the retina that results in tunnel vision and
extreme sensitivity to light. Persons with optic nerve disease and
congenital damage to the retina also use the LVES successfully.

LVES was introduced to the commercial marketplace in 1994. In the year
following more than 200 of these video-based systems were successfully
dispensed by some 30 clinics across North America. The LVES has been
accepted by the medical and user communities as an effective and
credible device. Its dramatic effectiveness has been experienced by
almost everyone who has viewed their environments through it. Many users
enjoy the improved quality of life the LVES has provided in their daily
activities.

BRAINS OF CRUISE MISSILES INTO A CURE FOR THE BRAIN

An alternative to an operation to remove a brain tumor is often the use
of radiation to destroy the tumor. This has the obvious advantage of not
having to open the patients skull to operate on his brain. But there
have also been some problems associated with it. As we mentioned in the
section on nuclear medicine, the calculations used to model the human
body have often been inaccurate. This problem was solved by adapting
mathematical methods used in the development of atomic bombs to model
the human body more accurately - a Swords Into Plowshares development.

But there is another problem. Assuming the body has been modeled
accurately and the location of the tumor has been identified and the
correct dose of X-ray radiation is then shot at the tumor, what if the
patient moves after the radiation is sent? Small movements of the body
are normal and cannot be avoided, while even the slightest movement will
cause the radiation to miss its target and destroy normal tissue
instead.

The traditional solution to this problem in the procedure known as
Stereotaxic Radiosurgery has been to screw the patient's skull into a
frame to prevent movement, a process that necessitates anesthesia and
post surgical hospitalization while the bolt wounds heal.

Surgeons are not the only ones who face this problem. In a war, military
personnel may need to destroy an enemy ship by shooting a Cruise missile
at it. But again, after the location of the target is identified and the
missile is shot, the target may move and the missile will miss it. To
solve this problem the Cruise missile is designed with special software
that continuously tracks the target. If the target moves, the software
recalculates the path of the missile and redirects it to the target's
new position.

Now back to the operating room. In an awesome Swords Into Plowshares
development, Professor John Adler of the Stanford University Medical
Center, has adapted this military software to control the X-ray beams
being directed at tumors.

Dr. Adler's method, called Computer Mediated Stereotaxic Radiosurgery
(CMSR), works as follows: First, a CT scan is taken of the patient. The
CT scan identifies the location of the tumor in relation to the bones in
the body. This information is then fed into a computer which stores an
accurate map of the surgical target and locks the radiation beam on the
tumor. Then, a computer controlled robotic arm, known as a Cyber Knife,
moves around the patient, shooting beams of radiation from several
different angles. The cumulative effect of the beams is a high dose of
radiation at the target point.

The tracking software guiding the robot arm matches what it sees with
the computer-stored map and reconfigures the angles of the beam and
redirects the robotic arm if the patient moves slightly during
treatment.

Unlike most modern procedures in radiation oncology, CMSR relies on
powerful but precisely aimed doses that can kill malignant tumors with a
few - often only one - treatment sessions, Prof. Adler explained. In
traditional radiation therapy, physicians administer small doses of
radiation over weeks or months in order to allow healthy tissue
surrounding the tumor to recover from the onslaught. But CMSR attacks
the tumor with short pulses of high-energy radiation.

"Because we crossfire in many different directions, we can minimize the
radiation dose reaching healthy tissue and prevent injury," Prof. Adler
said.

"The robot arm is extremely flexible and can position the beam at any of
a large variety of angles to treat a small site."

CMSR can be applied to tumors that could not be treated by ordinary
Stereotaxic Radiosurgery. The spine, for example, cannot be screwed into
a frame to prevent it from moving so traditional radiosurgery would not
be attempted, and in regular surgery of the spine there is a risk of
damaging nerves and causing paralysis. But with CMSR movement of the
patient is not a problem since the tracking system redirects the beam to
follow the patients movements.

Other conditions can also be treated with CMSR. An arteriovenous
malformation (AVM) is an abnormal connection between an artery and a
vein. When an AVM occurs, blood from arteries, where the blood pressure
is higher, flows through the abnormal connections into the vein where
the pressure is lower. This causes weakened blood vessels to form in the
area and, because of the higher pressure of blood from the artery, these
weakened blood vessels are prone to rupture.

Usually AVM's are treated with surgery but if they are located in areas
that are inaccessible - 90% of them occur in the brain - or in areas
where surgery is too risky, such as the spinal cord, CMSR can be
applied.