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Why Are People of African Descent at Greater Risk for Developing Glaucoma?

Figure. a) Typical view of the optic nerve of a glaucomatous patience; b) custom-processed and collagen tissue enhanced view; c) enhancement of the structural tissue of the optic nerve head; d) outcome of the auto-segmentation computation; e) 3D quantification of the optic nerve head morphology

Massimo A. Fazio, PhD, assistant professor in the UAB Department of Ophthalmology, and Christopher A. Girkin, MD, MSPH, received a four-year, $2.55 million R01 grant from the National Eye Institute to explore how visual field loss – developed with glaucoma – is associated with individual-specific biomechanics of the eye.

This study applies Dr. Fazio’s novel computational approaches to a large, multicenter cohort of patients followed in the African Descent and Glaucoma Evaluation Study (ADAGES). Prior studies of this cohort (ADAGES 1 and 2) have defined racial differences in the progression of glaucoma, along with genetic factors (ADAGES 3). This new study will explore the role of the morphological and biomechanical differences in the optic nerve that may explain why individuals of African descent are at greater risk of developing glaucoma.

“The scope of the work aims to uncover how the morphology and biomechanics of the optic nerve head is associated with glaucoma onset and progression,” Dr. Fazio says. “Our ultimate goal is to discover a biomarker to help physicians detect glaucoma before the visual field deteriorates, or to identify which individuals are more likely to progress too fast.”

Dr. Fazio uses a laser-based technique called optical coherence tomography, or OCT, which allows researchers to capture 3D images of the optic nerve head. These data show researchers the structural damage in each eye. He has developed novel methods to reveal and quantify structures deep within the optic nerve that are critical in the development of glaucoma.

This grant is a multi-site, multi-primary investigator study, partnering with The University of California San Diego and Columbia University. Dr. Fazio leads the investigation at UAB, together with Dr. Girkin, EyeSight Foundation of Alabama chair of the Department of Ophthalmology; Linda M. Zangwill, PhD, co-director of clinical research at the Shiley Eye Institute-The University of California San Diego; and Jeffrey M. Liebmann, MD, vice-chair and director of glaucoma services at Columbia University.

“The imaging protocols developed for this study, in collaboration with the OCT manufacturer, Heidelberg Engineering, allow us to uncover 3D structural and biomechanical parameters as no one has ever done before,” Dr. Fazio says. “This has generated a wealth of knowledge and created a large body of data that show there are indeed racial differences in the mechanical behavior of the optic nerve that may put individuals of African descent at greater risk for blindness from glaucoma. The collagen structure and biomechanics are different between the two groups and are therefore correlated with a different rate of damage. This study will define these structural and biomechanical differences in the optic nerve that exist between people of European and African descent and how these differences increase the rate of glaucoma progression and disease susceptibility within this at-risk minority group.”

Dr. Fazio has a multidisciplinary background in machine design, experimental mechanics, and biomechanical characterization of soft tissue. He also is a mechanical engineer. He has dedicated his career to developing customized methods of non-contact optical techniques to measure deformations in loaded materials to gain a deeper understanding of the biomechanical properties of ocular tissues. At UAB, with the support of the EyeSight Foundation of Alabama (ESFA), he developed the world’s first dynamic laser interferometer for the measurement of ocular tissue biomechanics with nanometric precision. This year, for his research, he received the “Xtreme Research Award” from Heidelberg Engineering and the “Innovator Award” from Wolfram Research. Dr. Fazio holds a primary joint appointment in the Department of Biomedical Engineering.

Generous Investment, Significant Outcomes

In 2003, Dr. Girkin partnered with the ESFA to fundraise for what then was known as the African-American Glaucoma Study. In 2004, the ESFA gave $200,000 to support Dr. Girkin’s vision of groundbreaking clinical research aimed at developing improved diagnostic methods to detect glaucoma. The ESFA went on to fundraise through a 2003-2006 capital campaign, raising another nearly $200,000 from 30 donors across Alabama. This $400,000 total was the baseline support system to expand this research through the ADAGES study.

Since that time in the early 2000s, the impact of this gift has been immeasurable. When these gifts were received, the department had two full-time faculty members in the glaucoma division. This grant alone has brought in approximately $8 million dollars in competitive federal funding and resulted in over 70 peer-reviewed manuscripts describing improved methods to manage this blinding disease. During this span of time, the glaucoma division has grown to seven clinical and six research faculty dedicated to translational research. This group represents one of the largest concentrations of glaucoma researchers in the country.

What Can a Small Gift Do?

The ESFA was able to support Dr. Girkin’s vision through philanthropic giving, and we want to continue this legacy for our young researchers. The UAB Department of Ophthalmology launched a new program aimed at supporting the scientists who are enabling the creation of new vision treatment options and capturing data to secure larger federal and private grants through the Research Scholars Fund. This fund provides direct support to a distinguished faculty member by offering spendable resources to fund the most promising ideas.

All biomedical discoveries have one thing in common: They begin with a researcher’s idea. However, applications for federal research grants can be completed only after researchers have gathered conclusive data from extensive laboratory studies. Philanthropic support enables ideas to be developed and tested in early studies that can lead to federal funding. Supporting a researcher’s initial investments lays the foundation for the UAB Department of Ophthalmology to develop game-changing medical breakthroughs.

If you are interested in learning more about the Research Scholars Fund, please contact Morgan Quarles at nmrobinson@uabmc.edu or 205-325-8112.