Promising Glaucoma Research and the Path to a Cure

Some of the research areas that I highlighted in my talk were:

• Retinal regeneration, or rewiring within the retina, because if we are to try to rescue the ganglion cells in the retina, they need to find their appropriate partners and they need to form the appropriate connections.

• Axonal regeneration — axonal regeneration is one of the Holy Grails of optic nerve regeneration, and we need the axons to grow all the way from the retina to the brain. That’s a distance of about 40 to 50 millimeters. Once they grow back to the appropriate targets in the brain, they need to form the right connections, as well.

• Stem cells — stem cells in glaucoma therapy could be for trabecular meshwork cell replacement and for retinal ganglion cell replacement. Also, stem cells and ganglion cells that are derived from stem cells can be used to model human glaucoma for use in high throughput drug screening
• Whole eye transplant, which is a project funded by the Department of Defense and it’s very exciting. I still think it’s “early days” for this, but the idea is that there’s potential for doing a hemi-facial transplant with the eye, being able to connect the blood vessels, supply the blood vessels, and reconnect the optic nerve. Of course, there are many hurdles. Researchers will have to get the optic nerve to regenerate. The principal investigator of that study has called it a “moonshot,” and I think it is, but its potential is exciting.

New Avenues in Glaucoma Research

My lab has greatly benefited from support from the Glaucoma Research Foundation (GRF). With the research grants from GRF, we’ve been able to explore new avenues that we might not otherwise have been able to explore, and also try to generate new hypotheses, new sets of experiments that we could then further study and try to grow into bigger research directions.

One such area is the use of ERG or electroretinography, which is a more objective way of measuring retinal function than having a patient do a visual field test. And we’ve been trying to develop novel ERG stimuli to diagnose glaucoma earlier and follow its progression.

One of the main interests of my lab is trying to identify those ganglion cells that are more vulnerable in glaucoma, because we know that not every retinal ganglion cell is the same. There are some that are more susceptible and there are some that are more resilient, and this is work that has been replicated in many different labs, which I think is great because it means that it’s a robust finding. For example, Andrew Huberman, PhD (Stanford University) who was a GRF Catalyst for a Cure researcher, also found that the same retinal ganglion cell type that we found in a different model was also more susceptible to glaucoma. Glaucoma Research Foundation has been very supportive of this work through both their Shaffer Grants and their Catalyst for a Cure collaborative research grants.

The Glaucoma Patient Summit really covers a wide range of glaucoma topics, from having speakers discussing the latest surgical advances to the newest medications, as well as physicians talking about how to improve glaucoma care and the physician/patient relationship, and also alternative treatments, and new research findings. Attending the Patient Summit really is a wonderful way for a patient to get educated about their disease, which I think is an important aspect of one’s care.

I think it’s important to raise awareness about glaucoma and highlight the needs that patients have. It’s important for patients to hear about what’s going on in the research arena, and to learn about new technologies, but also for the doctors who treat glaucoma to be able to know what patients are concerned about.

When my patients ask me about new research findings, sometimes it’s hard because I have to say “well, we have interesting findings in the lab, but it’s not yet ready for use in patients.” But I do think that the bridge from the lab research to clinical use is getting smaller. There are many research scientists and clinician scientists who recognize that we need to get these new potential glaucoma treatments from the lab to the clinic more quickly, if we can.