UMKC vision researchers repurpose technology to identify early symptoms of multiple sclerosis

Changes in vision detected by microperimetry can be related to early signs of multiple sclerosis.

Technology used in eye exams called microperimetry could prove to be an effective, non-invasive method of identifying early symptoms of multiple sclerosis.

An article recently published by researchers at the UMKC School of Medicine Vision Research Center reports the effective use of microperimetry during routine clinical assessments of multiple sclerosis patients. The article appeared in the research journal BioMed Central Ophthalmology.

Multiple sclerosis is a disease of the brain and spinal cord that affects nearly 400,000 people in the United States and more than 2 million throughout the world. There is no known cure for the potentially disabling disease, but treatment can help manage symptoms and speed up recovery from attacks.

Therefore, a non-invasive, clinically relevant and cost-effective method of identifying damage early would be invaluable to patients and health care providers. It would enable prompt therapy that may slow the progression of the disease and its ocular manifestations before irreversible damage occurs.

The testing method studied by the team of UMKC researchers, students and residents, microperimetry, measures light sensitivity of the center of a patient’s vision and can detect specific areas of decreased sensitivity. It typically takes less than half an hour.

Researchers from the school’s Vision Research Center have previously found the technology to be effective in diagnosing early stages of other diseases of the nervous system such as mild cognitive impairment in Alzheimer’s.

The vision research team of Landon J. Rohowetz, Qui Vu, Lilit Ablabutyan, Sean M. Gratton, Nancy Kunjukunju, Billi S. Wallace and Peter Koulen collaborated to determine subtle changes in visual function related to otherwise undetectable signs of multiple sclerosis. It is the first peer-reviewed study to assess the use of microperimetry, a straightforward and non-invasive vision test, as a tool to detect disease progression in early stage multiple sclerosis patients.

“The findings from this study provide a rationale for the use of microperimetry in the clinical assessment of patients with multiple sclerosis,” said Rohowetz, the study’s lead author. “By identifying visual dysfunction associated with multiple sclerosis, we hope physicians and researchers are able to use this technology to ultimately preserve and improve quality of life for patients with this often-disabling disease.”

More than 80 percent of the patients with multiple sclerosis show signs of impaired vision and 73 percent of MS patients experience visual impairment within the first 10 years of diagnosis, which is comparable to the prevalence of abnormal or impaired muscle function in the disease.

This initial study indicates that light sensitivity measured by microperimetry is lower among multiple sclerosis patients who have otherwise normal vision and no other history of issues with the optic nerve, which connects the eye to the brain. It also revealed a significant correlation between this impaired function and a reduced thickness of the retina in MS patients that is not seen in control subjects.

The report says further studies would look to monitor and evaluate ongoing changes in retina sensitivity and thickness as they correlate to a progression of multiple sclerosis. It will also broaden the approach to include MS patients who have a history of optic neuritis, where measurable damage to the optic nerve has already occurred.

New Discoveries & Developments

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  • In collaboration with organic chemists, we discovered a new promising approach to treat the inflammatory component of glaucoma. This could help us generate new glaucoma drugs complementary to existing therapies and protecting the vision of patients more effectively.
  • One new compound with the potential to become a novel drug for diabetic retinopathy by protecting the nerve cells in the eye.
  • A medical device for patients with diabetes that would allow the physician to assess the risk for diabetic retinopathy, and would allow the patient to continuously monitor the disease’s progress and therapy success through a simple blood test requiring only a finger prick blood sample.
  • Two new potential drugs to treat the dry form of AMD , one new potential drug to treat diabetic retinopathy caused by Type 1 diabetes and two new potential drugs to treat glaucoma are in advanced stages of development.
  • Two new drug delivery approaches for established wet AMD drugs that would eliminate the need for frequent injections in the eye.
  • A medical device for AMD patients and those with occlusion of their retinal blood vessels which could ultimately eliminate lengthy, invasive procedures.
  • A new drug delivery approach for established glaucoma drugs that would eliminate the need for daily eye drops– specifically, we are looking to turn glaucoma drugs into a slow release version administered only a few times per year.
  • A medical device that will reduce the pressure in the eye of patients for which conventional glaucoma drug treatment failed and surgery is the only option.

Leadership & Faculty

Nelson Sabates, M.D.

Professor, Department Chair, President of the Vision Research Foundation, President and CEO - Sabates Eye Centers, P.C.
Department(s) of Ophthalmology
Vision Research Center

Specialties and Research/Medical Interests

Retina and Vitreous

Sabates, Nelson
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Peter Koulen, Ph.D., FARVO

Professor, Felix and Carmen Sabates / Missouri Endowed Chair in Vision Research, Director of Basic Research, Vision Research Center
Department(s) of Biomedical Sciences, Ophthalmology
Section: Neurosciences
Vision Research Center Koulen, Peter
Koulen, Peter
235-6773
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Vision Research Center at UMKC Faculty

Chairman
Nelson R. Sabates, MD

Vice-Chairman Clinical Services
David B. Lyon, MD

Director of Basic Research
Peter Koulen, PhD,
Felix and Carmen Sabates Missouri Endowed Chair

Residency Program
Matthew Sniegowski, MD, Program Director
Katie J. Macaluso, MD, Associate Program Director

Comprehensive Ophthalmology
Komal K. Desai, MD
Mahendra K. Rupani, MD
Timothy A. Walline, MD

Cornea
Katie J. Macaluso, MD

Glaucoma
Rohit Krishna, MD
Kevin P. Pikey, DO

Neuro-Ophthalmology
Sean Gratton, MD

Ocular Oncology
Komal K. Desai, MD

Ocular Pathology
Mahendra K. Rupani, MD

Oculoplastics & Orbital Surgery
David B. Lyon, MD
Matthew C. Sniegowski, MD

Pediatric Ophthalmology
Michelle Ariss, MD
Denise Hug, MD
Scott Atkinson, MD
Laura S. Plummer, MD
Erin Stahl, MD
Justin Marsh, MD
Timothy Hug, OD

Refractive Surgery
Katie Macaluso, MD
Timothy A. Walline, MD

Retina & Vitreous
Felix N. Sabates, MD
Nelson R. Sabates, MD
Abraham K. Poulose, MD
Michael A. Cassell, MD

Contact Lens & Low Vision
Ramona Baumfalk, OD

Vision Research Center
Nelson R. Sabates, MD, Director
Peter Koulen, PhD, Director of Basic Research, Endowed Chair
Simon H. Friedman, PhD
William G. Gutheil, PhD
Thomas P. Johnston, PhD
Chi H. Lee, PhD
Mridul Mukherji, D Phil
Dhananjay Pal, PhD
Ting Xie, PhD

Glaucoma

Glaucoma affects over four million people in the United States. It is the most common cause of vision loss in persons of African-American descent and a leading cause of blindness in the U.S. In the U.S. and other developed countries, rates of glaucoma are rising as the population ages. Glaucoma damages the eye’s optic nerve. It usually happens when the fluid pressure inside the eyes slowly rises, damaging the optic nerve. Often there are no symptoms at first, but a comprehensive eye exam can detect it. More effective long-term treatment options are needed.

The Malette Family – Making A Difference

Triplet and her sisters raise money and awareness

Seventeen-year-old Emily Mallette is a typical teen-ager. She worries about what to wear. She studies hard. She wonders where she’ll go to college and what she’ll be when she grows up.

Mallettes“It’s fun to think about the possibilities,” said the straight-A student, a junior at Lee’s Summit North High School.

Medical research is the reason those possibilities exist for Emily. State-of-the-art glaucoma treatments through Sabates Eye Centers and the Vision Research Center at the University of Missouri-Kansas City, part of the School of Medicine’s Department of Ophthalmology, have preserved her limited and fragile eyesight.

Emily’s life was always atypical, even before her diagnosis. By only seconds, Emily was born the oldest of triplets. Three identical girls.

“Second happiest day of my life,” said Jodi Mallette, the girls’ mother and principal of Highland Park Elementary School in Lee’s Summit. “The first being when their older brother was born.”

Jodi did not undergo fertility treatments and started calling her daughters miracles when she discovered she was pregnant with triplets. She snaps photos of her smiling girls growing up in birth order: Emily, Morgan, Abigail.

The triplets were 8 when Jodi found out Emily failed her vision test at a school health fair. She had started holding books closer to her eyes.

“We’ll get you some cute purple eyeglasses – your favorite color,” Jodi told her daughter. Jodi had started wearing glasses in third grade, so it didn’t seem like any big deal.

But Emily’s diagnosis was much different than they imagined.

“Doctors told us she probably would be blind in five years,” Jodi said. “They said our lives, going forward, would be all about glaucoma.”

Glaucoma results in optic nerve damage caused by abnormally high but painless pressure inside the eye. The condition is a leading cause of blindness in the U.S. About 2.2 million Americans have glaucoma but only half know they have it. Everyone from birth through their senior years is at risk for glaucoma but some more than others. People older than 60 are six times more likely to get glaucoma. And glaucoma is six to eight times more common in African Americans than Caucasians. Because nearly one out of every four Jackson County residents is African American, the population is at higher risk for glaucoma than most other parts of Missouri and many other areas in the U.S.

There is no cure — yet — for glaucoma and vision lost cannot be regained. With medication and/or surgery, it is possible to halt further loss of vision. That’s why Emily’s family advocates that people regularly get their eyes tested.

Nelson Sabates, professor and chair of the UMKC Department of Ophthalmology and founder of its Vision Research Center, and his team of researchers are working to find better treatments and potential cures for eye diseases.

“There is an urgent need to accelerate the research in order to stop the adverse effects of eye diseases like glaucoma,” Sabates said. “At the Vision Research Center, we wish to enhance the ability of eye disease treatment and altogether remove blinding eye diseases as a threat to our quality of life. With a significant number of individuals in Jackson County suffering from glaucoma and other priority eye diseases of the Vision Research Center – like age-related macular degeneration and diabetic retinopathy – novel developments of the center could benefit thousands of individuals in our community and millions worldwide.”

Childhood glaucoma is rare; about one of every 10,000 babies born have the condition. Signs include unusually large eyes with cloudiness and excessive tears as well as light sensitivity. But sometimes there aren’t apparent symptoms. Glaucoma can damage vision so gradually that you might not notice any vision loss until the disease is at an advanced stage. That’s what happened to Emily. They don’t know the cause.

Emily underwent eight surgeries, missing out on swimming during summers because she had to be careful to avoid an eye infection. She began learning braille, but to master it, she’d have to learn blindfolded.

“To give up her sight, even temporarily, in case she might lose her sight just didn’t seem like an option,” Jodi said. “Waking up and being completely blind is her worst fear.”

Jodi watches Emily in awe. She makes great grades by working harder than her peers, leaving her tired. What takes Morgan and Abigail 90 minutes to read takes Emily four hours.

Emily has 20/400 vision in one eye that detects only light and shadows, and 20/50 in the other, although it’s a narrow field of vision.

For the past three years, Emily’s eyesight has remained the same. She credits advances in research like the glaucoma tube shunts she has that reduce inner eye pressure and the damage it causes to the optic nerves by draining excess fluid. She uses eye drops.

She also credits her doctor, Rohit Krishna, of the Vision Research Center at UMKC and Sabates Eye Centers. Specializing in the diagnosis and management of glaucoma, including the use of tube shunts like Emily’s, Krishna keeps the family informed about the latest in technology and research.

“There have been important advancements made in the treatment of glaucoma over the last decade, including new surgical techniques, laser interventions and medications,” Krishna said. “On the horizon are several promising potential therapies, including medications that provide protection to the cells that are typically destroyed by inner-eye pressure associated with glaucoma. In the future, gene therapy may be useful in preventing the condition in patients with a genetic propensity for conditions that can lead to glaucoma. The discovery of biomarkers for glaucoma may lead to a simple blood test that could predict the risk of a patient developing the condition.”

Under development at the Vision Research Center at UMKC are potential drugs that target cells affected by the disease and replace absent growth factors that support the health of the retina—the part of the eye that is used to see clearly. In addition, Vision Research Center researchers are developing a new drug-delivery approach for established glaucoma drugs that would eliminate the need for daily eye drops. They also are testing a promising approach to treat the inflammatory component of glaucoma.

So grateful for the vision she does have, Emily and her sisters created an organization to raise money for glaucoma research. “Never Lose Sight” is printed on T-shirts and green bracelets. The sisters also launched a “Never Lose Sight” Facebook page that has information about glaucoma and Emily’s journey.

“It’s cool that something we care about and launched at a little sleepover has taken off,” Morgan said.

“This cause is bigger than just our family,” Abigail said.

The results so far: a $1,000 check delivered to Krishna for glaucoma research at UMKC.

And a future full of hope for Emily and other glaucoma patients across the community.

Click here for more information.

Donate Today

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The Vision Research Foundation (VRF) is the fund development arm of for the UMKC Department of Ophthalmology and the Vision Research Center. The VRF exists to help generate financial support to fund vision research at the UMKC School of Medicine. Currently, research is underway to find meaningful cures and new treatment options for diseases of the eye, most specifically, age-related macular degeneration, glaucoma and diabetic retinopathy.

To donate now, click here.

To learn more or to inquire about giving opportunities for the Vision Research Foundation at the UMKC School of Medicine, contact Jay Wilson, Assistant Vice President-Health Sciences, at UMKC Foundation: 816-235-5565 or wilsonjay@umkcfoundation.org.

Diabetic Retinopathy

Over four million individuals in the United States have Diabetic Retinopathy, the country’s leading cause of adult blindness. The numbers are increasing rapidly due to an increase in the incidence of both Type I (sometimes called “Juvenile Diabetes”) and Type II Diabetes. Effective, long-term treatment options are not available. Diabetic retinopathy happens when the disease damages the tiny blood vessels inside the retina. Early symptoms are often gradual and unnoticed.

“VRC saved my vision.”

As a diabetic, Paul Tonga was no stranger to the eye doctor. He was diligent about his eye care. He came to the Vision Research Center after being referred by Truman Medical Center-Lakewood where he had cataract surgery. Following the surgery, his eyesight had improved. But, one eye was still quite weak. At the Vision Research Center, the physicians used an experimental treatment with lasers to treat his eye. “The treatment helped a lot. I believe it saved my vision. Because of it, I have maintained my independence and enjoy all the daily activities that were in danger of being lost.” Mr. Tonga adds, “I recommend the community gives to the Vision Research Foundation. It will go to a very important cause. Vision is one of the most important assets we have and its loss threatens millions of people. The Vision Research Center is committed to eliminating this threat. They have helped me greatly.”

Click here for additional information.

Contact

UMKC School of Medicine
Department of Ophthalmology

2101 Charlotte St, Suite 200
Kansas City, MO 64108
Phone: 816-404-1780

Nelson Sabates, MD
Professor and Chairman of the UMKC Department of Ophthalmology

Matthew Sniegowski, MD
Program Director

Saundra Thompson
Program Coordinator
Saundra.Thompson@tmcmed.org

Phone: 816-404-1780
Fax: 816-404-2920

Age related Macular Degeneration

In the United States, over nine million people over age 40 have AMD; no effective treatment is available for 90% of them. By the year 2030, an estimated 20 million Americans will have been diagnosed with this disease. It is a leading cause of blindness in Americans ages 60 and over. It is a disease that destroys one’s sharp, central vision that is needed to see objects clearly and to do tasks such as reading and driving. AMD has become more prominent in recent decades, due to Americans living longer.

The Vision Research Center is a great boon to our Nation.

Elaine comes from a long line of people with macular degeneration. Her mother and four other family members suffered from it, blinding most of them. Elaine did not want to suffer the same fate, so in partnership with her ophthalmologist, she was extra diligent in looking for the signs and symptoms of the disease. One day, shortly after receiving a new pair of glasses, she noticed that her vision had changed. At first, she thought there was a problem with her new eyeglasses. Later, she and her ophthalmologist determined that her sudden vision problems were the start of her macular degeneration. Immediately, Elaine was placed in a clinical research trial at the Vision Research Center where, over the past year, she has benefited from cutting edge treatment and care. Today, Elaine’s eyesight has improved and she thanks the Vision Research Center for saving her vision. But, she’s thankful for more than that. In her words, “I am very happy to be a part of a program whose findings will help others for generations to come. When my mother went blind from macular degeneration, she had no treatment options. It is phenomenal that the next generation has access to ground-breaking, sight-saving research. The Vision Research Center is a great boon to our nation.”

Click here for additional information.

New Report from Prevent Blindness America Shows Sharp Increase in Eye Disease Prevalence

The 2012 update of the “Vision Problems in the U.S.” report shows the number of those ages 40 and older with vision impairment and blindness has increased 23 percent since the year
2000. The data also includes an 89 percent spike in diabetic eye disease over the last decade. Chicago, IL (PRWEB) June 20, 2012 — More adult Americans are facing the reality of eye disease than ever before. According to the 2012 update of the “Vision Problems in the U.S.” report, a study released today by Prevent Blindness America and the National Eye Institute, the number of those ages 40 and older with vision impairment and blindness has increased 23 percent since the year 2000. The study, conducted by researchers from Johns Hopkins University, provides prevalence rates and estimates cases of age-related eye conditions. A full version of the study is available at preventblindness.org/visionproblems.
In addition, a preliminary update to the 2007 Prevent Blindness America “Economic Impact of Vision Problems” report shows a $1 billion increase in costs of excess medical care expenditures, informal care and health-related quality of life related to visual impairment and blindness. Further cost information is being developed and a full updated report on the economic impact of vision problems will be available at a later date. Overviews of both reports will be presented today at the Prevent Blindness America “Focus on Eye Health
Summit” in Washington, DC. The Summit will also feature a number of other key public health updates and presentations from national leaders, including reports on eye health surveillance efforts and NEI planning activities for vision research. Statistics from the 2012 Vision Problems in the U.S. report on the four most common eye diseases highlight
alarming increases since 2000, including:

• 2,069,403 people age 50 and older have late AMD (age-related macular degeneration), a 25 percent
increase
• 24,409,978 million people age 40 and older have cataracts, a 19 percent increase
• 2,719,379 million people age 40 and older have open-angle glaucoma, a 22 percent increase
• 7,685,237 million people ages 40 and older have diabetic retinopathy, an 89 percent increase

“It’s no surprise that the numbers of those affected by eye disease are continuing to climb, especially due to the aging Baby Boomer population,” said Hugh R. Parry, president and CEO of Prevent Blindness America. “What is exceptionally concerning is the dramatic spike in diabetic retinopathy cases, a consequence of the diabetes epidemic that this country is experiencing with no end in sight.” Diabetes is the leading cause of new cases of blindness in adults 20-74 years of age. According to the Centers for Disease Control, diabetes affects 25.8 million people in the United States. Although there is no cure for diabetic eye disease, annual eye exams for diabetes patients are essential to help slow the progression of the disease.
All data from the Vision Problems in the U.S. report can now be obtained through a new searchable database housed on the Prevent Blindness America website at preventblindness.org/visionproblems. This unique tool enables users to research a wide range of information including eye disease and condition numbers broken down by state, age, sex, and race, and provides comparisons across disease conditions. Added Parry, “It is our hope that this new data will provide those in the health community, the public and our
nation’s leaders with the vital information they need to address these troubling numbers through programs, research and funding.” For more information about the 2012 Vision Problems in the U.S. report, the Prevent Blindness America “Focus on Eye Health: A National Summit,” diabetes and other eye diseases, please visit preventblindness.org or call (800) 331-2020. For media: Downloadable graphs and other resources can be found under the News & Resources tab at preventblindness.org/visionproblems

About Prevent Blindness America

Founded in 1908, Prevent Blindness America is the nation’s leading volunteer eye health and safety
organization dedicated to fighting blindness and saving sight. Focused on promoting a continuum of vision
care, Prevent Blindness America touches the lives of millions of people each year through public and
professional education, advocacy, certified vision screening and training, community and patient service
programs and research. These services are made possible through the generous support of the American public.
Together with a network of affiliates and regional offices, Prevent Blindness America is committed to
eliminating preventable blindness in America. For more information, or to make a contribution to the sightsaving
fund, call 1-800-331-2020. Or, visit us on the Web at preventblindness.org or facebook.com/preventblindness.