Ophthalmology seminars

Among all prevalent diseases with a central neurodegeneration, AMD can be considered the most promising in terms of prevention and early intervention, due to several factors surrounding the neural geometry of the foveal singularity. • Steep gradients of cell density, deployed in a radially symmetric fashion, can be modeled with a difference of Gaussian curves. • These steep gradients give rise to huge, spatially aligned biologic effects, summarized as the Center of Cone Resilience, Surround of Rod Vulnerability. • Widely used clinical imaging technology provides cellular and subcellular level information. • Data are now available at all timelines: clinical, lifespan, evolutionary • Snapshots are available from tissues (histology, analytic chemistry, gene expression) • A viable biogenesis model exists for drusen, the largest population-level intraocular risk factor for progression. • The biogenesis model shares molecular commonality with atherosclerotic cardiovascular disease, for which there has been decades of public health success. • Animal and cell model systems are emerging to test these ideas.

Abstract to follow.

Myopia is predicted to affect 50% of all people worldwide by 2050, and is a risk factor for significant, potentially blinding ocular pathologies, such as retinal detachment and glaucoma. Thus, there is significant motivation to better understand the process of myopigenesis and to develop effective anti-myopigenic treatments. In nearly all cases of human myopia, scleral remodeling is an obligate step in the axial elongation that characterizes the condition. Here I will describe the development of a biomechanical assay based on transient unconfined compression of scleral samples. By treating the scleral as a poroelastic material, one can determine scleral biomechanical properties from extremely small samples, such as obtained from the mouse eye. These properties provide proxy measures of scleral remodeling, and have allowed us to identify all-trans retinoic acid (atRA) as a myopigenic stimulus in mice. I will also describe nascent collaborative work on modeling the transport of atRA in the eye.

Despite her still poor visual acuity and minimal visual experience, a 2-3 month old baby will reliably respond to facial expressions, smiling back at her caretaker or older sibling. But what if that same baby had been deprived of her early visual experience? Will she be able to appropriately respond to seemingly mundane interactions, such as a peer’s facial expression, if she begins seeing at the age of 10? My work is part of Project Prakash, a dual humanitarian/scientific mission to identify and treat curably blind children in India and then study how their brain learns to make sense of the visual world when their visual journey begins late in life. In my talk, I will give a brief overview of Project Prakash, and present findings from one of my primary lines of research: plasticity of face perception with late sight onset. Specifically, I will discuss a mixed methods effort to probe and explain the differential windows of plasticity that we find across different aspects of distributed face recognition, from distinguishing a face from a nonface early in the developmental trajectory, to recognizing facial expressions, identifying individuals, and even identifying one’s own caretaker. I will draw connections between our empirical findings and our recent theoretical work hypothesizing that children with late sight onset may suffer persistent face identification difficulties because of the unusual acuity progression they experience relative to typically developing infants. Finally, time permitting, I will point to potential implications of our findings in supporting newly-sighted children as they transition back into society and school, given that their needs and possibilities significantly change upon the introduction of vision into their lives.

Ophthalmology is ideally placed to benefit from recent advances in artificial intelligence. It is a highly image-based specialty and provides unique access to the microvascular circulation and the central nervous system. This talk will demonstrate diverse applications of machine learning and deep learning techniques in ophthalmology, including in age-related macular degeneration (AMD), the leading cause of blindness in industrialized countries, and cataract, the leading cause of blindness worldwide. This will include deep learning approaches to automated diagnosis, quantitative severity classification, and prognostic prediction of disease progression, both from images alone and accompanied by demographic and genetic information. The approaches discussed will include deep feature extraction, label transfer, and multi-modal, multi-task training. Cluster analysis, an unsupervised machine learning approach to data classification, will be demonstrated by its application to geographic atrophy in AMD, including exploration of genotype-phenotype relationships. Finally, mediation analysis will be discussed, with the aim of dissecting complex relationships between AMD disease features, genotype, and progression.

The eye is a multi-component biological system, where mechanics, optics, transport phenomena and chemical reactions are strictly interlaced, characterized by the typical bio-variability in sizes and material properties. The eye’s response to external action is patient-specific and it can be predicted only by a customized approach, that accounts for the multiple physics and for the intrinsic microstructure of the tissues, developed with the aid of forefront means of computational biomechanics. Our activity in the last years has been devoted to the development of a comprehensive model of the cornea that aims at being entirely patient-specific. While the geometrical aspects are fully under control, given the sophisticated diagnostic machinery able to provide a fully three-dimensional images of the eye, the major difficulties are related to the characterization of the tissues, which require the setup of in-vivo tests to complement the well documented results of in-vitro tests. The interpretation of in-vivo tests is very complex, since the entire structure of the eye is involved and the characterization of the single tissue is not trivial. The availability of micromechanical models constructed from detailed images of the eye represents an important support for the characterization of the corneal tissues, especially in the case of pathologic conditions. In this presentation I will provide an overview of the research developed in our group in terms of computational models and experimental approaches developed for the human cornea.

Like all neural tissue, the retina has a high metabolic demand, and requires a constant supply of oxygen. Second and third order neurons are supplied by the retinal circulation, whose characteristics are similar to brain circulation. However, the photoreceptor region, which occupies half of the retinal thickness, is avascular, and relies on diffusion of oxygen from the choroidal circulation, whose properties are very different, as well as the retinal circulation. By fitting diffusion models to oxygen measurements made with oxygen microelectrodes, it is possible to understand the relative roles of the two circulations under normal conditions of light and darkness, and what happens if the retina is detached or the retinal circulation is occluded. Most of this work has been done in vivo in rat, cat, and monkey, but recent work in the isolated mouse retina will also be discussed.

My research uses electrophysiological techniques to evaluate normal retinal function, dysfunction caused by blinding retinal diseases and the restoration of function using a variety of therapeutic strategies. We can use our understanding or normal retinal function and disease-related changes to construct optimal therapeutic strategies and evaluate how they ameliorate the effects of disease. Retinitis pigmentosa (RP) is a family of blinding eye diseases caused by photoreceptor degeneration. The absence of the cells that for this primary signal leads to blindness. My interest in RP involves the evaluation of therapies to restore vision: replacing degenerated photoreceptors either with: (1) new stem or other embryonic cells, manipulated to become photoreceptors or (2) prosthetics devices that replace the photoreceptor signal with an electronic signal to light. Glaucoma is caused by increased intraocular pressure and leads to ganglion cell death, which eliminates the link between the retinal output and central visual processing. We are parsing out of the effects of increased intraocular pressure and aging on ganglion cells. Congenital Stationary Night Blindness (CSNB) is a family of diseases in which signaling is eliminated between rod photoreceptors and their postsynaptic targets, rod bipolar cells. This deafferents the retinal circuit that is responsible for vision under dim lighting. My interest in CSNB involves understanding the basic interplay between excitation and inhibition in the retinal circuit and its normal development. Because of the targeted nature of this disease, we are hopeful that a gene therapy approach can be developed to restore night vision. My work utilizes rodent disease models whose mutations mimic those found in human patients. While molecular manipulation of rodents is a fairly common approach, we have recently developed a mutant NIH miniature swine model of a common form of autosomal dominant RP (Pro23His rhodopsin mutation) in collaboration with the National Swine Resource Research Center at University of Missouri. More genetically modified mini-swine models are in the pipeline to examine other retinal diseases.

Electrophysiology of eye and visual pathway is useful tool in ophthalmology and neurology. It covers a few examinations to find out if defect of vision is peripheral or central. Visual evoked potentials (VEP) are most frequently used in neurology and neuroophthalmology. VEP are evoked by flash or pattern stimulations. The combination of these both examinations gives more information about the visual pathway. It is very important to remember that VEP originate in the retina and reflect its function as well. In many cases not only VEP but also electroretinography (ERG) is essential for diagnosis. The seminar presents basic electrophysiological procedures used for diagnosis and follow-up of optic neuropathies and some of central nervous system diseases which affect vision (mostly multiple sclerosis, CNS tumors, stroke, traumas, intracranial hypertension).