Voodoo & the Evil Eye

This past Saturday I was invited to speak to the local meeting of the Barbados Society of Central Florida. I'd spoken to them before on diabetes and I thought retinal detachments might be an interesting and important subject, but I threw in a little bit about voodoo magic as well.

Most of don't give much serious thought to voodoo, but there are mechanisms by which it can really cause disease. Years ago, I had a suggestible young fellow from Jamaica as a patient who believed his wife was hexing him. Supposedly, she had placed a hex on him which would make him blind, and shrotly thereafter he began to notice symptoms in his right eye. Well, lo and behold, when I examined him he really did have a retinal detachment, a type called central serous retinopathy which can be seen in individuals under stressful situations. But was it voodoo?

Certainly, common sense would have us believe otherwise and no physician would admit to a direct relationship between disease and curses, in this case voodoo, but an indirect connection has been recognized for years. We've all heard stories of voodoo death. Just stories right? Well, that’s what you’d like to believe.

Back in World War I, physicians were witness to peculiar cases of soldiers dying on the battlefields of the Western Front. These traumatized soldiers hadn’t suffered any mortal wounds but they inexplicably died of shock, a medical disorder normally brought on by a critical drop in blood pressure from excessive bleeding. Some of these same physicians later became familiar with cases of supposed voodoo death, and they recognized a connection with the soldiers. They suggested that, just like individuals morbidly terrified by a magic spell, the soldiers suffered from an over stimulation of the nervous system which led to a form of fatal shock. Fear, in other words, stimulated the nervous system to such a degree that the excessive release of tremendously potent biological hormones caused vital hemostatic alterations and, in those susceptible, death.

Voodoo, essentially, is the sinister opposite of the placebo response, whereby a patient’s belief that a medicine will work, even if no actual medication is administered, results in improvement of a medical condition – a phenomenon well documented in medicine. In voodoo and related phenomena, individuals believe that something bad will happen to them and, even if there is no physical stimulus, it does. So, in this fellows case, and that of central serous retinopathy, acute stress likely induces a similar, but more locally acting, hormonal imbalance that alters the hemodynamics of the retina and result in a retinal detachment with vision loss. My patient's detachment eventually resovled as he came to grip with his stresses - as you can imagine he was in a very difficult marriage - and in the end, there really was some truth to voodoo magic in this old wife’s tale – evil eye and all.

Diabetes & Brain Surgery

I posted this article here because it is a striking reminder of how far we have come in the treatment of diabetes. Just a few decades ago, articles were being published that seriously suggested brain surgery as a treatment for diabetic retinal disease. In this 1968 issue alone of the Journal of the American Medical Association, three separate papers reported on the beneficial role of surgical removal or radioactive ablation of the pituitary gland (the part of our brain that controls hormone production) for severe cases of diabetic retinopathy. At the time, medical thinking held that certain hormones released by the pituitary gland may make the disease worse, and, in what now seems a less than brilliant leap of deduction, some reasoned the pituitary gland must go. So not more than three decades ago, you might not only have lost your vision from diabetes but your mind as well.

Fortunately, a generation of astute physicians recognized that patients who had diabetes and at the same time certain other retinal diseases that naturally damaged the peripheral retina, such as syphilitic retinitis, rarely developed the complications of diabetic retinopathy. This was because the concomitant retinal diseases had already wiped out the areas subject to severe ischemia in diabetic retinopathy. Like Einstein, physicians made their own quantum leap – without the ischemic stimulus, diabetic retinopathy did not seem to progress into its advanced stages. If only they could treat or cauterize the ischemic retina that develops in diabetes then they might be able to slow down the progression of disease. Meanwhile, they could also cauterize any leaking blood vessels present in order to decrease retinal swelling. All of this might prevent the severe loss of vision that was, up until then, part and parcel of diabetes. Well reasoned indeed but what was missing was a safe and effective tool by which these outcomes might be achieved – and we all now know that turned out to be the laser.

Einstein and Lasers

Albert Einstein conceived the principles of the laser nearly a century ago. Though many would argue his greatest contribution to science remains the theory of relativity, Einstein did not receive the Nobel Prize for that body of work. He did receive it, though, for his work on the photoelectric effect. For decades, scientists had observed and wondered why electrons were emitted when light shines on a metal surface. In a 1905 paper, Einstein demonstrated how matter could absorb and emit light energy, the energy of photons, and he provided a theoretical explanation for the photoelectric effect. That work would form the basis of Einstein’s 1917 paper where he proposed that a photon of energy, or light, might be emitted by excited atoms - the laser effect.

Today, the treatment of diabetic retinopathy to prevent blindness is one of the leading applications of lasers in ophthalmology. Just half a century ago, a diagnosis of diabetic retinopathy meant you would probably end up blind. It was just a matter of when. Due to lasers alone, diabetic retinal disease, and for that matter a number of retinal and ophthalmic conditions such as retinal tears, detachments, tumors, and glaucoma, are no longer the threat to eyesight they once were. The laser has truly been a remarkable vision of science and ophthalmologists continue to explore new possibilities for its use even today.

When a patient with diabetic retinopathy presents with loss of vision, lasers can be very helpful in recovering lost vision and minimizing the progression of disease. Depending on the extent and type of treatment required, an anesthetic shot and multiple treatment sessions may be necessary. The treatment is often done right in the doctor's office, takes no more than 15-20 minutes and you can go home the same day - and if the patient takes good care of their blood sugars and health, it has a very good chance of limiting disease progression

The intellectual quest that led to the realization of Einstein's seminal 1917 thesis in the laser and its subsequent application in the treatment of eye diseases makes for one of the truly remarkable stories of the 20th century and modern medicine . . . but that's a story for another blog.