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    Biomarker research centers on early glaucoma diagnosis


    Advances in adaptive optics

    The biggest news may be advances in adaptive optics. The latest techniques offer clear views of sides of the eye and high-resolution images of individual cells and layers within the retina, including the nerve fiber layer. The technique offers a non-invasive view of the retina and the photoreceptor mosaic that requires no dye or physical discomfort.

    “We stumbled on this technique while trying to visualize the ganglion cells,” Dr. Dubra said. “It was the kind of fishing expedition that this grant was designed to encourage. And sometimes, when you go on a fishing expedition, you catch a very big fish. We have seen a whole new kind of epi-retinal membrane with structures that show visible changes as glaucoma progresses.”

    Micrographs clearly show the nerve fiber layer with individual fibers in the 20-m range and even smaller structures in the 2-m range. The epi-retinal membrane exhibits changes over time that are consistent with advanced glaucoma, but the changes are not specific to glaucoma. More than two dozen different pathologies from macular holes and optic atrophy to multiple sclerosis, diabetic retinopathy, and age-related macular degeneration show similar changes.

    This new retinal structure is not a useful biomarker for glaucoma, Dr. Dubra continued, but adaptive optics has evolved into a highly sensitive investigative tool that can be used in real time. The technique can image individual blood cells moving through the microvasculature and capillaries. Researchers have already identified previously unknown forms of microaneurysms and types of retinal damage specific to physical trauma, autosomal dominant optic atrophy, and other causes.       

    “Even though it has only been two years, we have made remarkable progress,” Dr. Dubra said. “We are excited about the new tools we have developed and the new directions our findings have taken us.”      

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