A New Method to Diagnose Glaucoma in the Peripheral Retina, An Area That Is Not Effectively Evaluated with Traditional Tests

John Hetling, PhD
University of Illinois at Chicago (Chicago, IL)

Co-Principal Investigators

Thasarat Vajaranant, MD
Jason McAnany, PhD
Year Awarded:
2019
Grant Duration:
July 1, 2019 to June 30, 2021
Disease:
Glaucoma
Award Amount:
$149,998
Grant Reference ID:
G2019356
Award Type:
Standard
Award Region:
US Midwestern
John Hetling, PhD

Diagnosing Glaucoma in the Peripheral Retina

Summary

 Early diagnosis of glaucoma is important because it leads to more effective treatment.  Early glaucoma can affect central vision or peripheral vision, so both areas of vision should be tested.  The best objective test for glaucoma evaluates only central vision.  Therefore, we developed a test to evaluate peripheral vision so that early detection is available to everyone.  This project will give the central vision and peripheral vision tests to a group of glaucoma patients, to show that the new peripheral vision test helps to diagnose the disease.

Details

The goal of this project is to evaluate a new testing technology for early diagnosis of glaucoma; this new approach looks for early signs of glaucoma in areas of the retina that are beyond the scope of traditional testing.

In Specific Aim 1, we will obtain test results from 25 patients with mid-stage glaucoma, 25 patients with early-stage glaucoma, and 25 glaucoma suspects (along with 75 normally-sighted subjects for comparison).  These results will allow us to make a quantitative comparison between our new test and the conventional tests. In Specific Aim 2, we will apply an analysis strategy to our testing results that should significantly boost sensitivity to the earliest effects of glaucoma.  This strategy exploits the fact that early glaucoma-related dysfunction is localized, as opposed to being uniformly spread across the retina.

The unique aspect of this work is the testing technology, which was developed in my lab.  We use a custom-built three-dimensional screen to present a precise visual stimulus in the peripheral visual field of the test subject.  This allows us to evaluate the health of the peripheral retina, where damage often begins but is missed by conventional testing (which focuses on the central retina).

At the end of this study, we will have the first meaningful evaluation of the importance of peripheral retina testing in glaucoma.  In our early results, one third of patients had more dysfunction in the peripheral retina than in the central retina; this implies that one third of glaucoma patients might be diagnosed earlier if peripheral retina testing is included in routine exams.  Earlier diagnosis would result in earlier management and greater preservation of sight for many patients.

About the Researcher

I graduated from Bates College with a BS in Biology in 1989.  After working for two years as a technician in an electrophysiology laboratory, studying modulation of central pattern generators, I entered the graduate program in Bioengineering at the University of Illinois at Chicago.  I graduated with a PhD in Bioengineering and Neuroscience in 1997, focusing on the use of electroretinography to study phototransduction in rod photoreceptor cells, under the guidance of Dr. David Pepperberg.  After a brief post-doc, I joined the faculty in Bioengineering at UIC in August 1998.  I currently have an adjunct appointment in the Department of Ophthalmology and Visual Sciences at UIC.  I am the director of the Neural Engineering Vision Laboratory (NEVL), where we focus on developing new technologies for the diagnosis, monitoring, and treatment of eye disease.  We take an integrated approach to addressing clinical needs and patient pain-points, combing our expertise in engineering and vision science with that of our clinician collaborators.  Translation of our technologies to clinical application is facilitated by a company that I co-founded, RetMap, Inc.  I also have a passion for teaching and engineering education and have served as the Director of Undergraduate Studies in Bioengineering for 17 years.

Personal Story

I grew up in a family of tradespeople, working with my father as a plumber from the time I could help carry stuff until I left for college (first in my family).  My father seemed to be able to do everything himself, and I spent a lot of time with him doing house projects, coming up with “inventions” to make life easier, or just tinkering.  Never once did my father step in to do something I was struggling with, even if I asked for help, saying instead, “you’ll figure it out,” or “you can do it as good as I can.”  Those years of having the freedom to try and fail and try again with nothing but subtle encouragement, of free experimentation with different tools and materials and approaches to new problems every day, gave me the foundation for being a very confident (overconfident?) engineer.  The most motivating words I ever hear are, “it can’t be done,” which is something I’ve heard for just about everything we have done.  I try to bring this teaching style, and this confidence in problem solving, into my research program, where we use solid engineering fundamentals and a deep understanding of the physiology of vision to develop solutions to real problems in ophthalmology.  As an engineer working on eye disease and injury, my role is to design, build, and validate new tools to help preserve our most precious sense.  The work supported by this BrightFocus project will eventually provide doctors with a more complete picture of the health of their patients, and I am extremely thankful for the donors who are allowing us to get closer to that goal.

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