Making a Global Impact on Trachoma

Published in Wilmer - Summer 2022

Don Neal came to the Wilmer Eye Institute four years ago specifically to see Albert Jun, M.D., Ph.D., the Walter J. Stark, M.D., Professor of Ophthalmology; chief of the Division of Cornea, Cataract and External Diseases; and an expert in Fuchs’ dystrophy. Neal’s physician thought he might have this hereditary condition, in which cells in the cornea that are responsible for clearing fluid begin to deteriorate. Bumps then form on the back of the cornea and fluid builds up, causing the cornea to swell, which leads to cloudy vision.

“I looked to see who in the world was the best at treating Fuchs’ dystrophy, and Dr. Jun’s name was at the top of the list,” says Neal. “I instantly felt comfortable with him, not only because of his expertise but also his chairside manner and his willingness to spend time with me.”

At the time, Neal, who works as the chief strategy officer at Smithbucklin, a professional services firm serving the nonprofit and industry association market, had especially cloudy vision in the morning, which prevented him from reading — his favorite activity to do after waking up. As a treatment option, Jun told him about corneal transplants, which are most commonly performed to treat the condition.

Corneal transplants have come a long way since just two decades ago, when it was common to replace the entire cornea, a more invasive procedure with a longer recovery time than the partial corneal transplants available today. For the latter, Jun removes only the damaged layer of the cornea and replaces it with healthy donor tissue to restore vision. During the surgery, he uses a tool he developed called DescePro, which gently unrolls the donor tissue in the patient’s eye without damaging the cells, providing a solution to one of the procedure’s biggest challenges.

“With these new transplants, the patient’s natural cornea continues to function, and the recovery time is a matter of a few weeks,” says Jun, who performs about 100 corneal transplants a year. “Patients get nearly full vision recovery in a short period of time.”

Neal had his first corneal transplant in his left eye in May 2021. Afterward, he started thinking about supporting the Institute, in part with encouragement from Beth Glassman, an acquaintance and Wilmer supporter. Neal expressed this interest to Jun, who invited him to his office to learn more about some of the work being done by the 20 faculty members in the cornea division, including the work of Meraf Wolle, M.D., M.P.H., who focuses on global public health.

Neal and his wife, Belle, decided to support Wolle’s research, which centers on trachoma, the world’s leading cause of blindness that affects people in some of the world’s poorest communities. “It struck me as something that is fixable,” says Neal. “It feels like Dr. Wolle and others like her could eliminate trachoma in their lifetimes.”

Trachoma is chronic conjunctivitis, or pink eye, caused by the bacterium Chlamydia trachomatis. It has currently led to the visual impairment of 1.9 million people, according to the World Health Organization. Forty-four countries are still struggling to prevent people from going blind from trachoma sequelae. Children can get this eye infection over and over again from direct personal contact, and for some, the frequent infections lead to scarring under their eyelids as they become young adults. The scarring causes trichiasis, which happens when the eyelashes turn inward, where they repeatedly hit against the eyes with each blink.

“People with trichiasis have this foreign body that’s constantly scratching their eyes, which results in the cornea breaking down,” says Wolle, an assistant professor of ophthalmology at Wilmer who was first introduced to trachoma when visiting family in Ethiopia, where it is found in many rural areas. “Those with trichiasis, if not treated, eventually get corneal opacification, or a clouding of the cornea, and that’s what makes them go blind. This happens over decades.”

Wolle’s research builds on the world-renowned work of her mentor, Sheila West, Ph.D., Pharm.D., professor emeritus at Wilmer, and has three components. She is studying the risk factors that lead people to develop scarring in hopes of halting this process, as well as creating a statistical model to determine how many people will develop trichiasis to assist programs with allocating limited resources that provide treatment and prevent blindness. She also is looking at ways to automate the diagnosis of trachoma using artificial intelligence technology, which could help diagnose those in hard-to-reach communities and provide treatment more quickly.

Wolle is grateful for the Neals’ gift, particularly because trachoma typically attracts very little attention or resources. “Anytime we can get support, it’s huge,” she says. “We’re going to use these funds to support projects that will help advance trachoma elimination. I can’t wait to implement these projects and share what we’ve accomplished.”