UAB Medicine News


Advanced Imaging Drives AMD Research

Christine A. Dr. Curcio, PhD, a professor in the UAB School of Medicine’s Department of Ophthalmology, is validating imaging technology to help ophthalmologists understand the retina using optical coherence tomography (OCT). Her laboratory studies images and tissue samples to discover basic mechanisms underlying age-related macular degeneration (AMD) in the hope of developing better treatments for patients.

“OCT is a non-invasive imaging test that uses light waves to take cross-sectional pictures of the retina and the blood vessels behind it. It’s often described like an ultrasound,” Dr. Curcio says. “The eye functions like a camera, so when light shines through it and the light bounces back, we can visualize retinal layers. These images are able to communicate vital information about debilitating diseases, such as AMD.”

More common than Alzheimer’s

AMD is the leading cause of severe vision loss and legal blindness in Americans age 60 and older. It affects as many as 11 million people in the United States and is predicted to impact nearly 200 million people worldwide by 2020, according to the BrightFocus Foundation. It is twice as prevalent among the elderly as Alzheimer’s disease.

Dr. Curcio describes the evolution of OCT technology as starting slowly, with each step being vital to science. In the 1990s, scientists first saw edema, or swelling, in the eye using OCT. Over the years, researchers were able to see more high-definition detail in reflective bands representing layers of the retina. Many bands were labeled in 2001. But without the detailed images we have now, scientists didn’t know that the bands don’t precisely correspond to the anatomical layers.

Dr. Curcio and her colleague, Richard Spaide, MD, a renowned specialist at Vitreous Retina Macula Consultants of New York, were the first scientists to discover this discrepancy and propose new definitions. As time progressed and OCT achieved higher resolution, scientists were able to see the distinctions between all of the reflective bands. These are now all named for their anatomical layers.

“It’s amazing to see the evolution of clinical imaging over the span of time,” Dr. Curcio says. “Yes, mistakes have been made in the scientific community, but these mistakes have led to the development of better imaging technology. With better imaging technology come better tools for physicians and the ability to develop guidelines for clinical trials.”

By reviewing OCT images, Dr. Curcio’s team has made major discoveries about the pathology of AMD over the years. She aspires to develop an accurate natural history of how the retina degenerates and likens it to studying evolution from the fossil record. Pieces are missing, but her laboratory – with her collaborator K. Bailey Freund, MD, in New York – is still able to make a timeline, like a movie of AMD progression over time, using OCT. If we know how the disease unfolds, she says, we will know when to intervene and save retinal neurons for vision.

“I am an optimist and believe we can beat AMD,” Dr. Curcio says. “Although neurons are affected, AMD isn’t a primary neurodegeneration like Alzheimer’s or Parkinson’s disease. How can you not beat a disease that you can so clearly see in living people? Science takes time, but I know we can get there with continued research.”

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