Glaucoma Research

The term “glaucoma” refers to a group of diseases that can lead to damage to the eye’s optic nerve and result in blindness. Open-angle glaucoma, the most common form of glaucoma, is one of the leading causes of blindness in the United States and the number one cause of blindness among African Americans. Glaucoma usually has no early symptoms. By the time people experience problems with their vision, they usually have lost a significant amount of their sight.

Approximately three million Americans have been diagnosed with glaucoma; another two million do not know they have it. In Georgia, the prediction is that 62,000 persons over the age of 40 will develop glaucoma. When caught and treated early, the disease can be managed for the remainder of the person’s lifetime.

Because most people with glaucoma have no early symptoms or pain, it is important to see an eye doctor regularly. Early diagnosis and intervention can prevent loss of vision. For this reason, annual eye exams are advised. For those with a family history of the disease and those who are over age 45, annual check-ups are even more important.

According to the National Eye Institute (NEI), glaucoma is a group of diseases that can damage the eye’s optic nerve and result in vision loss and blindness. The damage occurs when the normal fluid pressure inside the eye slowly rises. This increased pressure damages the optic nerve, which is responsible for transmitting images to the brain. If the elevated eye pressure continues, glaucoma will worsen a person’s vision. Without treatment, it can lead to total blindness.

Emory Eye Center’s glaucoma specialists have been involved with several major studies on glaucoma. They include:

• The Ocular Hypertension Treatment Study (OHTS), which asked if medical reduction of elevated intraocular (within the eye) pressure could delay or prevent the onset of glaucoma. The resulting data published in 2002 determined that eye drops used to reduce pressure were effective in delaying the onset of primary open-angle glaucoma.After five years, researchers found that treatment reduced the onset of primary open-angle glaucoma by more than 50 percent. Funding for 20-year follow-up data collection in OHTS s nearly complete and should lead to better understanding of long-term treatment outcomes.

• The Interactive Study to Increase Glaucoma Adherence to Treatment (I-SIGHT) from 2006-2010 helped determine if an intervention strategy to improve glaucoma adherence is significantly helpful. Interactive telephone calls and tailored print materials helped glaucoma patients adhere to their treatment better, but was not significantly different when compared to a control group. The report on a randomized controlled clinical trial was published by the Archives of Ophthalmology, a JAMA Network publication. The study highlighted the complexities of studying and modifying adherence to glaucoma treatment.

• Allen Beck, MD, chair of the Emory Ophthalmology Department, was appointed a permanent member of the Executive Com- mittee of the Childhood Glaucoma Research Network (CGRN) in 2012, an international group of more than 100 clinicians and scientists who specialize in treating children with glaucoma. CGRN has developed a new, internationally approved classification system for childhood glaucoma.

• In 2013, Emory Eye Center became a site for the CGRN’s international research project, the International Pilot Survey of Child- hood Glaucoma (IPSOCG), to investigate worldwide treatment outcomes for childhood glaucoma. IPSOCG is the first large-scale collaborative international study on childhood glaucoma. Data has been collected at 16 major eye centers around the world to provide critical epidemiological data and lead to treatment strategies for the potentially blinding disease.

• In 2014, researcher Eldon Geisert, PhD, joined Emory Eye Center. He has interest in defining genetic networks associated with the risk of developing glaucoma. Identifying the genetic differences that lead to glaucoma is the central research goal being ad- dressed by a $1.5 million grant awarded to him from the National Eye Institute of the National Institutes of Health. Geisert affirms that understanding the genetic causes of glaucoma will aid in early detection of individuals at risk for developing the disease, and may lead to more effective treatments. A proposal for further research by Dr. Geisert

Defining the genetic networks associated with glaucoma is a primary interest of the basic research group at Emory. Glaucoma is a collection of diseases in which the neurons in the eye lose their connections to the brain and die. The retina (the tissue at the back of the eye) is an extension of the brain, and like the brain and spinal cord, when those retinal cells are injured they do not regenerate their connections.

This is very different from peripheral nerves, where damaged neurons do regenerate their connections and do not die. Recently, while working on models of glaucoma, we discovered that the initial regeneration response seen in peripheral nerves also occurs in the retina after a glaucoma-like injury.

We believe this demonstrates that retinal cells are trying to recover by activating the same molecular machinery that promotes regeneration in the peripheral nerve. At some point, this regeneration response gets shut down in the retinal cells. Our proposed research will attempt to define the exact point where the regeneration-like response fails in a glaucoma model of the retina. Once we know where the failure occurs, it may be possible to re- verse this molecular stop signal, re-establish connections to the brain, and thus rescue the retinal cells that would otherwise die.

Glaucoma Leadership

Allen Beck, MD, F. Phinizy Calhoun Sr. Chair in Ophthalmology at Emory, was inducted into Alpha Omega Alpha Medical Society in 1989. He won the “Clinical Teaching Award” presented by Emory Eye Center residents in 1989 and again in 2002. That same year, he was presented with the American Academy of Ophthalmology (AAO) Achievement Award; he earned the AAO’s Senior Achieve- ment Award in 2017 and has been listed among the “Top Doctors” in Atlanta magazine’s special issue (2009-2018). He is a member of AAO, the American Medical Association, the Medical Association of Georgia, the Association for Research in Vision and Ophthal- mology, the American Glaucoma Society, the American Association of Pediatric Ophthalmology and Strabismus, the Georgia Society of Ophthalmology, and the Emory Eye Alumni Association.

A graduate of the Emory School of Medicine, Dr. Beck completed both his residency in ophthalmology and his fellowship in glaucoma at Emory before joining the faculty in 1994.

Anastasios Costarides, MD, PhD, Firman Professor of Ophthalmology and Director of the Glaucoma Service, joined the Emory Eye Center faculty in 1999. He has participated in multiple clinical research studies that have advanced glaucoma care, including the landmark OHTS trials.

Dr. Costarides became Emory Eye Center’s glaucoma fellowship director in 2001. He is actively involved in the American Academy of Ophthalmology, the American Glaucoma Society, and the Georgia Society of Ophthalmology. He was recognized with the AAO’s Achievement Award in 2015. His research interests include oxidative stress in the eye, evaluating long-term outcomes of glaucoma surgery, and glaucoma drug delivery systems.

Dr. Costarides is a graduate of Emory University. He completed postgraduate training at the Medical College of Georgia prior to at- tending the Emory School of Medicine. He remained at Emory for his ophthalmology residency and completed his glaucoma fellowship at Wills Eye Hospital.

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