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The GCE has made substantial contributions to our understanding and treatment of glaucoma. Its investigators have defined glaucoma’s basic nature, measured its prevalence in populations throughout the world, developed widely used animal models of glaucoma in monkeys, rats and mice, carried out the first successful gene therapy to decrease neuronal loss in animal models of glaucoma, helped patients to take glaucoma eyedrop medication better through improved physician communication and reminder systems, and pioneered methods to measure and mitigate the loss in quality of life caused by glaucoma’s damage.
a. Early Nerve Cell Death in Glaucoma
GCE studies of human glaucoma eyes proved that many nerve cells are lost prior to the detection of damage by standard clinical testing. This research stimulated the field to develop more accurate testing for early glaucoma damage. Our studies found that certain types of nerve cells die early in glaucoma—providing a rationale to develop tests that diagnose glaucoma’s visual loss by a method called frequency doubling--the translation from lab bench science to commercial glaucoma diagnostic instrument.
b. Nerve Fiber Layer Imaging for Diagnosis
The examination of the retinal nerve fiber layer was shown in a 10 year long study to be a most effective method to find the early injury of glaucoma. Again, laboratory evidence from donated post-mortem human eyes and animal research was translated into clinical testing that now serves as the most commonly used instrument-based method to follow glaucoma’s structural damage.
c. Examining the President of the United States
When President George H.W. Bush was thought to have glaucoma, GCE staff were called to Washington DC to evaluate his eyes and provided care throughout his Presidency.
The visual field test that every glaucoma patient undergoes regularly was improved dramatically by research from the GCE and biostatisticians of the Johns Hopkins Bloomberg School of Public Health. The Software now called the Glaucoma Hemifield Test was conceived and first reported by GCE investigators.
e. International Glaucoma Studies
GCE investigators working together with colleagues from London, Singapore, and China conducted major surveys to determine the basic mechanisms of angle closure glaucoma. In addition, we have clarified the true rate of angle closure glaucoma and have developed novel screening strategies for identifying persons at risk before they lose vision. We are also carrying out the single largest clinical trial in this area.
f. Improving Patient’s Eye Drop Taking
We conducted studies to identify personal, financial, and social barriers to glaucoma care. We demonstrated that adherence to glaucoma eyedrops is suboptimal by looking at huge insurance databases and then also used electronic monitoring of patients to confirm the findings. We successfully demonstrated for the first time in a randomized clinical trial that improved cooperation with care is possible with a limited intervention, improving the effectiveness of drop use by 50%.
g. Helping Hispanic-Americans with Eye Disease
Hispanic Americans were documented to have higher rates of open angle glaucoma than European-derived persons, and much higher rates of undiagnosed eye disease. Programs to improve care access and delivery were found to be effective and well accepted.
h. Studies That Improve Glaucoma Public Health
The rate at which persons develop glaucoma over time (incidence) and the true rate at which glaucoma progressively worsens were determined by sophisticated modeling techniques. The most quoted paper in the field during the last 10 years came from GCE work that shows the distribution of glaucoma patients in the world. The GCE consults in glaucoma diagnosis and treatment to the World Health Organization, the National Society for the Prevention of Blindness, and the National Eye Institute/National Institutes of Health.
i. Testing The Success of Glaucoma Surgery
A national survey of the outcomes of glaucoma surgery clarified how many persons have vision-threatening complications and how to identify these persons before they have vision loss. A recent review of nearly 1000 glaucoma operations performed at the GCE has set a standard for the outcomes of surgery, how the success should be judged, and showed that a newer method for trabeculectomy and distinct advantages.
j. Community Service for Baltimore’s City Seniors
The Hoffberger Program for the Prevention of Blindness screened 10,000 elderly Baltimore City residents for glaucoma and other eye diseases, facilitating their eye care, eyeglasses, and surgery. It formed a partnership between 3 local hospitals, non-profit community organizations, and inner city churches that represent important social anchors in economically disadvantaged communities.
k. Determining How Much More Glaucoma Affects African-descent Persons
The Baltimore Eye Survey examined 5,000 black and white citizens in neighborhoods surrounding Hopkins Hospital, discovering high rates of glaucoma and untreated cataract among the urban poor, especially African-Americans. This landmark study also first documented that half of those with open angle glaucoma have normal levels of eye pressure. Similar study by GCE researchers in Africa found a high rate of glaucoma as well. Methods to combat glaucoma in Africa and the U.S. are now a major priority.
l. Gene Therapy for Glaucoma
The insertion of genes using viral carriers into the eyes of animals with experimental glaucoma produced protection from nerve cell loss. This gene therapy approach will soon provide suggested methods for neuroprotection treatment to supplement the lowering of eye pressure.
m. Imaging of the Iris to Detect Angle Closure Glaucoma
The iris of the eye was found to act like a sponge, drawing in water as the pupil becomes small and losing the water as the pupil enlarges. This feature of iris volume change has been shown by GCE investigators to explain why some persons develop angle closure glaucoma.
n. Stem Cells and Progenitor Cells to Restore Vision Lost from Glaucoma
Progenitor cells that could potentially replace lost nerve tissue from glaucoma were found to reside in the interior of all human eyes, and GCE research showed that such cells could be removed from a living eye, stimulated to produce thousands of new cells, and injected back into the eye. Since the cells are derived from the person ultimately receiving them, graft rejection is not a problem in this approach.
o. Why Glaucoma Damages Particular Parts of the Vision
Glaucoma causes vision loss in the mid-peripheral field of vision. GCE research showed that this occurs because the human optic nerve head has a weaker support where the nerve fibers from this area of the field pass through it.
p. How and Where Glaucoma Kills Nerve Cells
Laboratory studies found that glaucoma leads to a blockade of movement of vital molecules within the fiber of retinal ganglion cells, initiating a programmed cell death process called apoptosis. This death mechanism was shown to be prevented by providing one or more of the blocked neurotrophic substances.
q. How Glaucoma Affects Daily Life Activities
The later stages of glaucoma injury to the peripheral visual function were documented to interfere with safe walking, to slow reading ability, and to force patients to stop driving an automobile. Studies to evaluate methods to prevent these effects or to work around them are ongoing.
r. Development of the Laser Methods for Treating Glaucoma
The most commonly used laser method to produce a laser opening in the iris for prevention of angle closure glaucoma was developed by GCE scientists.
s. Imaging the Choroid Layer to Detect Glaucoma
The role of expansion of the choroid layer of the eye in angle closure glaucoma and the part played by the vitreous humor in malignant glaucoma were explained by both theoretical descriptions and later by imaging data.