Celebrating retina research, future generation of EyeMDs

February 5, 2019
Michelle Dalton, ELS
Michelle Dalton, ELS

Fifteen fellows, residents showed just why research in retina is on the cutting edge

The Research Scholar Honoree Program is dedicated to the education of retina fellows and residents by providing a unique opportunity for selected researchers to share their notable research and challenging cases with their peers and mentors.

The second annual Ophthalmology Times Research Scholar Honoree Program featured a wide range of research topics, from biosimilars to retinal changes during migraine episodes to retinal morphology and its effect on refractive lens exchange.

They also included research on ascorbic acid and diabetic retinopathy (DR), bile acid metabolites, and a validation of smartphone-based photography for DR screening.

Chairman Rishi P. Singh, MD, (Cleveland, OH) said he wanted the finalists to have “a really good sense of how much of a contribution you all have made to the field just by being here.” Dr. Singh and fellow judges Darius M. Moshfeghi, MD (Stanford, CA); Judy E. Kim, MD (Milwaukee, WI); and Charles C. Wykoff, MD, PhD (Houston), had pre-vetted 15 presenters from among 50 entrants-including one from Africa and one from Italy.

Each presenter was allowed 7 minutes to discuss his or her research, including what role he or she played in the research. The remaining 3 minutes were left for a question-and-answer session by the judges

CRAO, PGE1, and VA

The overall leading research presentation was on a novel method for treating central retinal artery occlusions (CRAOs). “These tend to have a very poor outcome, no matter what we do,” said Brett Malbin, MD (Detroit).

“We’ve tried a variety of treatments and, unfortunately, none of them has stood the test of time.”

A 2014 study of 244 patients found more than 90% of patients had initial visual acuity of counting fingers or worse; only 16% of patients showed any sort of improvement in visual acuity without therapy, and roughly 8% actually had a worsening of their visual acuity over the course of the disease.1

Therapies such as isosorbide dinitrate and pentoxifylline, hyperventilation of carbon dioxide, anterior chamber paracentesis, topical or systemic IOP medications, and ocular massage (with or without IOP-lowering medications) “have not stood the test of time,” Dr. Malbin said.

In 2013, Yasuyuki et al.2 used prostaglandin E1 and “10 of 10 eyes had a greater than one LogMAR increase in visual acuity at 1 month,” Dr. Malbin said.

Prostaglandin E1 “works as a peripheral vasodilator and it stays mostly peripherally, so there’s low risk of central hypotensive type side effects and there’s also low risk of infusion side effects.” Exclusionary factors were disease state, and included uncontrolled hypertension, hypotension, congestive or structural heart disease, but no specific medications.

Within the first 24 hours of a CRAO, patients were dosed with 40 mcg b.i.d. IV infusion until reaching a stable visual acuity for 24 hours; patients were treated for roughly 3 to 5 days. The average time to presentation was 8.33 hours, and the best-corrected visual acuity at presentation was 2.73 logMAR. Of the six patients the group studied, half had a “profound visual increase,” Dr. Malbin said, improving to 0.4, 0.7, and 1.3 logMAR, respectively.

“We think this was related to patients who were able to reperfuse their central retinal artery,” with the IV infusion helping the patient maintain that perfusion, he said. (The remaining patients improved to 2.3 or 2.7 logMAR.) Though winning was an honor, Dr. Malbin said, “it’s great to have something that we can offer our patients with acute CRAO. To finally have something that we can offer patients with such a devastating disease is nice.”

Dr. Malbin acknowledged both Xihui Lin, MD, as the principal investigator, as well as the Kresge Eye Institute and the Department of Neurology at the Detroit Medical Center.

In the top five

The remaining top five finalists (in alphabetical order):

> John Chancellor, MD, MS, (Little Rock, AR) who is researching the influence of diabetic retinopathy on the visual outcomes of cataract surgery;

> Kenneth C. Fan, MD, MBA, (Miami), who is researching in vitro susceptibilities of vitreous Candida isolates to novel and traditional antifungal agents;

> Nimesh A. Patel, MD, (Miami), who is researching the rapid detection of pathogens with fluorescence in situ hybridization (FISH), and

> Tapan P. Patel, MD, PhD, (Ann Arbor, MI), who is
researching smartphone-based fundus photography for the screening of plus-disease retinopathy of prematurity

For the love of research

Dr. Singh said “one of the most impressive things” about keynote speaker Harry W. Flynn Jr., MD (Miami) “has been his commitment in the field of endophthalmitis and infectious diseases.”

Dr. Flynn has been the author or co-author of more than 550 peer-review publications and 104 book chapters and has edited or co-edited more eight books. Dr. Flynn said “during the time when you are a resident or a fellow, you have a unique opportunity to do research with your faculty mentors.

I would encourage all of you to take advantage of this time so that you can put your name on research projects and present that data at local and national meetings.” Research (both basic science and clinical research) is a process of three steps, he said:

  • Posing a question,

  • collecting the data, to answer the question and

  • reporting the answer to the question.

For example, “you could add multimodal imaging using optical coherence tomography angiography images in your paper to describe new and unique findings,” he said. “Or you can review outcomes of treatment in a large clinical series.”

Dr. Flynn also noted researchers may need financial help, and they should be prepared to reach out for help “and persevere when you face frustrations.”

Paraphrasing Sherlock Holmes, Dr. Flynn said: “One should not twist the facts to suit theories, instead propose theories to reflect the facts.” He recommended interacting with colleagues at conferences-adding he often learns more while at lunch or dinner than he learns from podium presentations because of the “give-and-take” interaction.

References:

1. Hayreh SS. Ocular vascular occlusive disorders: natural history of visual outcome. Prog Retin Eye Res. 2014;41:1-25.
2. Yasuyuki Takai, Masaki Tanito, Yotaro Matsuoka, Katsunori Hara, Akihiro Ohira. Systemic prostaglandin E1 to treat acute central retinal artery occlusion. Invest Ophthalmol Vis Sci. 2013;54:3065- 3071. doi: 10.1167/iovs.12-11445