Some one in six people over the age of 45 have a condition called low vision, where they have trouble reading, driving, or telling colors apart. And that number rises to one in four in those over the age of 75. Judith Goldstein, a low vision expert at Johns Hopkins, says fear often accompanies the vision loss.

Goldstein: People who are losing vision are quite scared. They don’t know who to turn to and they feel very alone. People are worried about am I going to go blind? They want to know why their vision is fluctuating, why are they having good days and bad days with their vision. They feel like their vision continues to decline even though their eye doctor tells them everything is stable. As part of this examination we develop a rehab plan. We might have people come back for additional visits to kind of try on the adaptations. What works in the clinic doesn’t always work in the real world. And so it’s very important that we make sure that it works for the patient.  :32

Goldstein says a patient, systematic approach to managing low vision is best. At Johns Hopkins, I’m Elizabeth Tracey.


Low vision, which affects one in four adults over 75, is often associated with damage to the macula, the part of the eye where our vision usually works best. Judith Goldstein, a low vision expert at Johns Hopkins, says there are well defined ways to help.

Judith Goldstein: What happens if that macula isn’t working so well? Glasses are probably not the answer, so we have to use specialty lenses, and lighting, magnification systems and telescopic systems, all with the aim of enhancing that image, not on the macula but maybe next to the macula where there’s a little bit healthier retina. What if the enhancement isn’t good enough? Then we have to rely on our other senses. We call this sensory substitution, the ability to use our other senses to help us accomplish our everyday activities.  :29

Goldstein says management of low vision requires a team approach, since there are multiple strategies in learning to live with the condition. Initial assessment of low vision should involve comprehensive testing and assessment so best techniques can be employed. At Johns Hopkins, I’m Elizabeth Tracey.


HPV causes cancer, and we have an effective vaccine against it. Now the World Health Organization is advocating for a single dose of the vaccine in places where completing the two dose regimen is challenging. Johns Hopkins Kimmel Cancer Center director William Nelson applauds the strategy.

Nelson: A single HPV dose might be effective for girls aged 9 to 20. The usual regimen is to have a dose of the vaccine, wait six months and then get another one. That requires a lot of health system effectiveness and coordination, which in the underresourced parts of the world is a little bit harder to achieve. So the notion that you can protect girls by giving them one vaccine is a very attractive one and could really help in that part of the world. What they do recommend still is that older girls if they’re going to get vaccinated have the two doses, boys still get the two doses.  :33

Nelson notes that the vaccine protects against cancers of the cervix, the mouth and throat, and several other rarer types. At Johns Hopkins, I’m Elizabeth Tracey.


Breakthrough infections, which occur in those who have been vaccinated against Covid-19, are more troubling for people with cancer than those without, a new study confirms. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, reviews the data.

Nelson: The severity was also concerning. If you looked among the people who got an infection who had been vaccinated, with cancer, 31 to 32% of them ended up in the hospital and 3.9% of them died as a result of this infection. Probably still need to be careful, even if you’re vaccinated, and you have a cancer. We had a pretty good understanding about hematologic malignancies. I think it’s a little surprising that that fraction of folks with pancreatic cancer, liver cancer, lung cancer, colorectal cancer, were vulnerable to get a breakthrough infection even if they’d been vaccinated.  :32

Nelson urges people with cancer to obtain all vaccinations and boosters they are eligible for, and to make thoughtful choices when it comes to socializing, traveling, and wearing a mask. At Johns Hopkins, I’m Elizabeth Tracey.


People with cancer who have been vaccinated against Covid-19 remain at increased risk for infection compared with people who don’t have cancer, a very large new study reveals. Johns Hopkins Kimmel Cancer Center director William Nelson describes the findings.

Nelson: In the end they had 45,000 or more cancer patients who had been vaccinated. And what they tried to see was who got infected, when did they get infected, was there any difference between one cancer and another? Overall there were 13.6% of the cancer patients had a breakthrough infection. Twenty-four to 25% of the pancreatic cancer patients had a breakthrough infection, 22 to 23% of liver cancer, 20-21% of lung cancer, a little bit less breast cancer patients. Only about 4.9 to 5% of the people who didn’t have cancer got a breakthrough infection.  :33

Nelson emphasizes that getting vaccinated and being careful remain the best strategies against Covid-19 infection. At Johns Hopkins, I’m Elizabeth Tracey.


An immunotherapy agent called nivolumab given before surgery in people with lung cancer dramatically lengthened the interval before cancer returned, a new study shows. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, is thrilled.

Nelson: Will we slowly but surely get to point where the treatments are good enough that maybe you don’t need the surgery at all. This is potentially transforming it’s already going to pay off, this is going to be the way people will get treated. Very exciting. :12

Nelson says this strategy has been on deck for some time.

Nelson: People have thought of this before. It’s always you need to get that surgery done as quickly as possible to remove as much of the cancer as you could. And then for those people in whom there was no evidence of cancer but you knew they were likely to have the cancer come back that you’d chase after that with hormonal therapy or chemotherapy or some combination. After a while they figured out that it was just as effective to give before the surgery as after the surgery.  :21

At Johns Hopkins, I’m Elizabeth Tracey.


Nivolumab is the name of an immunotherapy used to treat cancer, and a recent study of people with lung cancer using it before surgery shows it really helps. Johns Hopkins Kimmel Cancer Center director William Nelson explains.

Nelson: Three hundred fifty-eight people randomized to receive the immunotherapy or not, along with chemotherapy before surgery. It’s a significant clinical advance. The time when cancer is going to recur was significantly prolonged, and the most stunning finding is when they did the surgery, in the people who had chemotherapy about 2.2 percent of the time it looked like the cancer had completely disappeared. If you got the addition of the nivolumab 24 percent of those people had no sign of any cancer whatsoever in their surgery.  :34

Nelson says side effects were largely acceptable and manageable, and predicts this will be the new standard of care for people with this type of lung cancer. At Johns Hopkins, I’m Elizabeth Tracey.