Research
Summary
Glaucoma
Glaucoma is a potentially blinding eye disease that affects over two
million Americans. Often, loss of vision due to glaucoma can be prevented
by appropriate treatment; but since most types of glaucoma have no
symptoms, early diagnosis is key to treating the disease before vision
loss occurs. My research has taken several tracks: finding new, simpler
and better ways to make the diagnosis early; finding better ways to
monitor for glaucoma progression; and assessing new pharmacological
and surgical ways to prevent vision loss. |
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Better
diagnosis.
Current methods of assessing the peripheral vision loss in glaucoma
are time-consuming, frustrating and difficult. We are evaluating
several
new technologies to see if they can do the job better and faster,
with less patient frustration. A totally new concept, the multifocal
electroretinogram, measures the electrical signals produced by the
eye when something is seen; for the first time, it may allow an objective
measurement of peripheral vision without any need for patient input.
We are also evaluating a new type of perimeter (peripheral vision
testing device) that is significantly faster than the older
types; the frequency doubling
perimeter uses flickering patterns to test peripheral vision.
Heidelberg Retinal Tomography (HRT) and Ocular Coherence Tomography
use laser scanners to map the optic nerve and the layer of the retina
that is affected early in glaucoma. We are evaluating new analyses
of these units to see if we can detect changes produced by glaucoma
earlier.
Genetic Studies.
In collaboration with the UCSF genetics team, we are looking at different
types of glaucoma to see which have significant genetic backgrounds.
Exfoliation glaucoma is an aggressive and difficult to manage glaucoma
that seems to be very prevalent in patients of Northern European extraction,
including Russian immigrants. Our studies to determine if it is genetic
in nature, or if it is triggered by environmental conditions, will
help to predict who will get it and, hopefully, to determine how to
reduce the severity.
Better Pharmacological Agents.
Until now, our efforts to control glaucoma have focused on medications
or surgery to lower eye pressure. Recently, we have found that some
glaucoma medications can also protect optic nerve tissue from injury.
We are currently evaluating brimonidine and a new class of agent (hypotensive
lipids) to see if either drug has protective properties in patients
with glaucoma.We are also assessing, in collaboration with Jacob Dan,
MD, PhD, of the Weitzman Institute in Israel, a revolutionary new
method for reducing eye pressure, using a tiny amount of enzyme (collagenase)
that could be applied in a 5-minute office procedure, to open the
drainage pathway.
Assessing Surgical Techniques.
Current surgical treatment for glaucoma is trabeculectomy with or
without anti-scarring medication. Together with collaborators in
medical
centers from Maine to Israel, we are evaluating the long-term effects
of trabeculectomy with one anti-scarring Medication. We are
also evaluating several new approaches to glaucoma surgery. |
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