African Descent and Glaucoma Evaluation Study (ADAGES)
Multi-center study sponsored by the National Eye Institute. Design to acquire visual function and optic nerve structure data on eyes of black adults. This data will be compared to analogous data obtained on predominantly white adults through two prospectively designed longitudinal studies funded by NEI through 2007.
Ocular Hypertension Study (OHTS)
In this clinical trial, patients with newly diagnosed ocular hypertension were randomized to either close observation or medical therapy to lower IOP. The goal of the project was to determine whether early treatment of ocular hypertension prevents or delays the onset of glaucoma.
The OHTS Confocal Scanning Laser Ophthalmoscopy Ancillary Study seeks to add information regarding disc topography to this outstanding database of ocular hypertensive individuals. Dr. Liebmann is the principal investigator and Dr. Ritch is the co-investigator.
A New View of Normal Tension Glaucoma: Autoregulation and Systemic Blood Pressure (NEI)
This study is being performed in collaboration with Mary E. Charlson, MD, William Foley Professor of Medicine and Chief of General Internal Medicine at Weill Cornell Medical School. The objective of this prospective longitudinal study is to determine how blood pressure at night correlates with the risk of visual field loss and progression of glaucoma. Dr. Ritch is the principal investigator at NYEE and Dr. Liebmann is the co-investigator.
International Collaborative Exfoliation Syndrome Treatment Study (ICEST)
We are the coordinating center for this multi-site (worldwide) longitudinal study, sponsored by Pfizer. The objective is to determine the efficacy of the treatment with latanoprost and pilocarpine versus timolol or Cosopt in eyes with exfoliation syndrome and elevated intraocular pressure. Dr. Ritch is the principal investigator. The data is currently being analyzed and manuscripts and conference presentations are in development.
Multifocal visual evoked potential. (mfVEP):
The current gold standard for assessing visual field loss in glaucoma patients is the Humphrey visual field (HVF), a subjective test. An objective visual field test, the multifocal visual evoked potential (mfVEP) is currently under development. The mfVEP measures a brain-evoked electric field and can predict dysfunction caused by damage of the optic nerve and its projections onto the visual cortex of the brain. It is hoped that this new method of testing visual fields objectively will lead to better understanding and earlier diagnosis of the disease.
Functional Magnetic Resonance Imaging (fMRI):
The recent discovery that MRI can be used to map changes in brain hemodynamics that correspond to mental operations extends traditional anatomical imaging to include maps of human brain function. The ability to observe both the structures and also which structures participate in specific functions is due to a new technique called functional magnetic resonance imaging, fMRI, and provides high resolution, noninvasive reports of neural activity detected by a blood oxygen level dependent signal. Currently we are conducting research to map functional changes secondary to glaucoma in an attempt to better understand how the visual image is represented in the brain and to be able to describe the functional and structural changes that occur.
The New York Glaucoma progression Study (GAPS)
Because of the huge amount of data collected at GANY during the past years, we have been able to develop a series of longitudinal studies investigating the role of various risk factors on the development and progression of glaucomatous damage. In the last years, our publications allowed better understanding of the etiology of disc hemorrhages, a well-known and strong risk factor for glaucoma deterioration. Also, along with imaging devices that provide high-resolution images of the retina and optic nerve head (FD-OCT and HRT), GAPS has brought up knowledge on previously unknown risk factors, such as parapapillary atrophy. With a database that exceeds 40,000 patients and 132,000 visual field tests, we have been able to investigate the role of each risk factor for progression. This will ultimately be used to develop the first risk calculator for patients with treated glaucoma. This tool will allow to physicians to treat more aggressively patients at greater risk of disease worsening, preventing irreversible loss of vision. Each patient will therefore be classified as low, medium, or high risk of progression, allowing to tailor treatment more precisely.
Effect Of Argon Laser Iridotomy and Peripheral Iridoplasty on Corneal Endothelium
Ocular Response Analyzer (ORA)
This new modality of tonometry allows estimation of the intraocular pressure (IOP) that are very similar to the true IOP, that is, measurements that are not affect by the artifact of corneal properties. The true IOP is the pressure that actually causes damage to the optic nerve, and we are now getting an almost precise estimate of these values. Enhances treatment can therefore be provided and prevent glaucomatous worsening. Also, by investigating one the parameters derived from the ORA, called corneal hysteresis, we will be able to understand why specific populations have higher prevalence of normal-tension glaucoma, which may allow optimization of treatment. Among other findings, we were the first to report that this new parameter is associated with more rapid velocity of glaucomatous visual field loss, and thus know what patients require more aggressive therapy.
Aqueous Humor Studies
CD-44 Receptor in Aqueous Humor in Glaucoma and its role in causation.
Analysis of aqueous humor, ocular tissue, and blood in patients with and without exfoliation syndrome
Stem Cells in Trabecular Meshwork
Isolation of Stem Cells from Human Trabecular Meshwork, in conjunction with Ting Xie, PhD, Stowers Institute, Kansas City.
Myocilin (GLC1A) Glaucoma – Ultrastructural Studies
Electron Microscopic Examination of Trabecular Meshwork from Primary Open Angle Glaucoma Patients with Mutations in the GLC1A (Myocilin) gene. In collaboration with Professor Ernst Tamm, Department of Anatomy, University of Erlangen, Germany
UBM and Slit-lamp adapted OCT for Narrow Angles
Biometric Evaluation of Iridocorneal Angle and Ciliary Body of Patients with Narrow Angles
General Imaging Protocol
Functional and Structural Testing For Optic Nerve Disease. The new technologies available in our center (OCT, GDx, HRT) provide high quality images of the optic nerve and retinal nerve layer, the initial sites of glaucomatous damage. These studies have helped understand the relationship between the amount of neuronal cell loss and the extension of visual field defects in glaucoma. Such information was only available in animal models, and we are now able to provide better estimates and correlation using real-time, in vivo devices. We have also been able to image structures unbeknownst to be involved in glaucomatous pathogenesis, such as the choriocapilaris, retinal pigmented epithelium, and photoreceptors.
Effect of new treatment modalities on the survival and function of trabeculectomy filtering blebs
Effect of laser cautery of blood vessels on the bleb surface on the success rate of transconjunctival needle revision
Effect of injections of Avastin, a vascular endothelial growth factor inhibitor, on the success rates of both bleb development and transconjunctival needle revision
Normal-tension Glaucoma and High-tension Glaucoma
Evaluation of patients with normal visual fields and imaging of the retinal nerve fiber layer to analyze correlations of function and structure in early glaucoma
Examination of the frequency of disc hemorrhages in different glaucomas and their effect on the rate of progression of glaucoma
Assessment of the risk factors and perimetric characteristics of initial glaucomatous visual field defect threatening fixation. This study confirms that normal-tension glaucoma patients tend to have visual field defects closer to fixation compared with other types of glaucoma and a detailed visual field test for central 10 degrees is essential for evaluation and follow-up of initial visual field defect threatening fixation. Identified systemic risk factors can be modified to stop or minimize the visual field progression. This study also demonstrates that glaucoma may be classified based on its perimetric characteristics.
Progression of initial glaucomatous visual field defect threatening fixation compared with initial nasal step is under investigation. The progression rate and pattern will be compared between those two groups, and the results will be useful for clinicians in making therapeutic plans for early open-angle glaucoma patients, based on the individual visual field defect pattern.
Alpha-1 Adrenergic Receptor Antagonists
To identify iris structural alterations associated with intraoperative floppy iris syndrome (IFIS) in patients using systemic a-1-adrenergic receptor antagonists (a-1ARA).
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