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Building Momentum: NIH Funding Grew Nearly 50 Percent in 2015

Diligent work by UAB Ophthalmology research faculty led to significant increases in research funding. For 2015, the department achieved a 48% year-over-year increase in research funding from the National Institutes of Health.

“These results are commendable, especially considering the challenges of the federal funding environment,” says Christopher A. Girkin, MD, MSPH, EyeSight Foundation of Alabama Endowed Chair. “The NIH funding rate for unique principle investigators is about 25%, so we are pleased that our faculty was able to achieve an approximately 33% funding rate in 2015.”

The more than $3.6 million in funding received this year from the NIH includes several existing grants, but three new R01 awards contributed greatly to that success. The details of those three awards are highlighted on the following pages.

ROLE OF IOP FLUCTUATION IN DEVELOPMENT AND PROGRESSION OF GLAUCOMA

J. Crawford Downs, PhD, Vice-Chair of Research, was awarded a three-year, $1.23 million grant from the National Eye Institute to explore intraocular pressure fluctuation as it relates to the development and progression of glaucoma, a potentially blinding disease that affects more than 2.2 million Americans.

Downs, a leading ocular biomechanics expert, is director of the UAB Ocular Biomechanics and Biotransport Program, and he studies the eye using principles traditionally associated with mechanical engineering. He is exploring the underlying reasons that make the elderly and people of African descent more likely to develop glaucoma.

“It is well-known that IOP and age are the most consistent independent risk factors for glaucoma,” Downs says. “Despite this, many people who present with these risk factors will not develop glaucoma, while others develop glaucoma or worsen rapidly at clinically measured normal levels of mean IOP. This illustrates the need for further research into the underlying causes of this complex, multifactorial disease.”

Lowering mean IOP is the only clinical treatment that has been shown to slow the progression of glaucoma, but little is known about IOP variations. In earlier research, Downs developed a system to continuously monitor IOP. He demonstrated that IOP does not stay at a consistent level as previously thought but instead continually fluctuates, with some 7,000 large IOP spikes occurring per hour during waking hours.

“Our research shows that IOP spikes account for up to 15 percent of the total IOP energy the eye must absorb,” Downs says. “This is extraordinary in that IOP spikes represent a previously unknown component of the IOP insult that has yet to be characterized or considered in previous studies. We had no idea that the eye is constantly subjected to these pressure spikes, and this could be a significant contributor to the optic nerve head damage typical with glaucoma. Our biomechanics work has shown that IOP spikes are likely to be much larger in the elderly and persons of African descent, which may explain their increased susceptibility to glaucoma.”

Downs suspects that there are poorly understood disease-related components of IOP that independently contribute to the onset and progression of glaucoma. His studies will further explore how IOP fluctuations affect the development and progression of glaucoma, especially among high-risk populations.

CHARACTERIZING AMD’S LESIONS THROUGH ADVANCED OPTICAL IMAGING

Yuhua Zhang, PhD, assistant professor, has been awarded a $1.83 million grant from the National Eye Institute to characterize extracellular lesions associated with age-related macular degeneration (AMD), a common, vision-stealing disease.

AMD affects more than 10 million Americans and can lead to severe vision impairment. To date, effective treatments are available only for the late stages of the disease. Despite its prevalence, the factors that lead to development and progression of AMD are not completely clear.

Zhang aims to expand scientific understanding of the disease by characterizing subretinal drusenoid deposits (SDD), lesions recently recognized as conferring risk for progression to advanced AMD. Zhang will use an instrument he built to study retina changes related to these lesions at an unprecedented resolution. He seeks to develop imaging-based biomarkers and biometrics for assessing the progression of AMD. New knowledge about the role of SDD could help inform novel approaches to treatment.

Zhang, an optics engineer with expertise in adaptive optics imaging, has been mentored by two eminent scientists in the Department of Ophthalmology: Christine A. Curcio, PhD, and Cynthia Owsley, PhD. Curcio was the first to identify SDD in human donor tissue, and Zhang’s work builds upon Curcio’s findings.

“These lesions may impact vision by preventing the traffic of key nutrients to and wastes from the lightsensing photoreceptors and by directly exposing these cells to toxic compounds,” Curcio says. “They also may stimulate the ingrowth of abnormal blood vessels and indicate changes in the underlying blood supply to the photoreceptors.”

IMPROVING MEDICATION ADHERENCE IN AFRICANAMERICAN GLAUCOMA PATIENTS

Researchers at the University of Alabama at Birmingham are hoping a telemedicine-based health promotion intervention can improve medication adherence rates among older African-Americans with glaucoma. Glaucoma is the leading cause of irreversible blindness among African-Americans, who are more than three times more likely to develop glaucoma than are Caucasians.

“Not only are African-Americans at increased risk for glaucoma, studies have shown that they are at increased risk for being nonadherent with medications for glaucoma,” says principal investigator Laura Dreer, PhD, associate professor in the Department of Ophthalmology. “Reasons for nonadherence include age-related memory loss, finances, and barriers to care.”

Unchecked, glaucoma can have a serious negative impact on an individual’s quality of life, independence, and everyday functioning and potentially can lead to blindness. Standard therapy involves the use of pressurereducing eye drops that can significantly delay or prevent the onset of disease.

Dreer’s study, funded by a five-year, $1.83 million grant from the National Eye Institute, is recruiting 240 African- American adults with glaucoma to determine whether a culturally relevant behavioral health intervention can improve adherence. The multicomponent intervention includes glaucoma education, motivational interviewing, and problem-solving training.

“Part of the objective is to plant a seed and help these individuals reach a better understanding of their glaucoma and realize the importance of taking increased responsibility for their own health behaviors,” Dreer says. “We’ve made great strides in getting people to take charge of their health and wellness in areas such as diabetes, cardiovascular health, and nutrition. We believe glaucoma is deserving of the same effort.”

Study subjects will be divided into two sections. One will be treated with standard glaucoma therapy, including medication, laser treatments, conventional surgery, or any combination of these. The second section will receive standard therapy and the telemedicine-based behavioral health intervention. Participants will have one in-person visit with the research team at the UAB Callahan Eye Hospital, followed by weekly phone interaction for six weeks.

Researchers will employ a self-measuring drug dispensing tool to determine whether patients are adherent or non-adherent with medications. Standard medication therapy usually is 1-2 eye drops, once or twice daily. The tool measures how many drops are dispensed at any one time and records the date and time of dispensation.

Patients at UAB’s glaucoma clinic who enroll in the study will use the device for one month. A failure rate of 75 percent or greater will transfer the subject into the full study. Outcomes will be assessed at three-, sevenand 12-month follow-up visits by determining whether glaucoma medication adherence improves in the group receiving the intervention.

“The practical question to be addressed is whether a culturally relevant health promotion-based intervention improves glaucoma medication adherence among a highrisk segment of the population,” Dreer says. “Information from this project will be particularly useful for African- Americans with glaucoma, their families, and eye care providers.”