As a clinician scientist, my research interests focus on the patient. My clinical interest as an ophthalmologist is glaucoma. Ultimately I am interested in research that will have concrete benefit to the patient, whether it be by developing a potential new treatments or by the clinical study of disease progression and how that is modified by treatment. Glaucoma is the leading of irreversible blindness in the world. The condition involves progressive death of retinal ganglion cells (RGC) in the eye resulting in irreversible visual loss. We don’t truly understand how or why this happens. Recent evidence suggests that neuronal death in glaucoma has common mechanisms with other neurodegenerative conditions such as Alzheimer’s and Parkinson’s disease. Thus, advances in our understanding of glaucoma may have implications for other brain diseases and we can learn and translate breakthrough findings from those related research fields to glaucoma research.
My Current research Interests are diverse
We now have effective treatments that can dramatically slow the progress of glaucoma by lowering eye pressure. Elevated intraocular pressure (IOP) is by far the most important risk factor for the development and progression of glaucoma. IOP-lowering treatment is therefore the current mainstay of glaucoma treatment. However, some patients with glaucoma worsen and go blind despite maximal IOP reduction. At present, there is no available treatment that can restore visual function once the damage has been done.
We need understand better the mechanisms of RGC death in glaucoma, to develop methods to protect these cells, thus slowing the progression of glaucomatous visual loss. We need to be able to do this before we can focus on restoration of vision that has been lost.
With overseas collaborators, we have developed a novel laboratory model of glaucoma that has proven to be very useful in the investigation of glaucoma pathogenesis. Using this model, we have demonstrated potentially important changes in RGC metabolism that may be able to be targeted in potential new treatments for glaucoma. Potentially already existing drugs such as common antihypertensives may be able to target this pathway. This work continues through my affiliations with Westmead Institute for Medical Research and the Save Sight Institute as well as a longstanding collaboration with the Centre for Brain Repair, University of Cambridge.
Pathological Changes Associated with Selective Laser Trabeculoplasty
A common and relatively safe laser procedure to treat glaucoma is called selective laser trabeculoplasty (SLT). Rarely, it can produce changes in the cornea that lead to vision loss. We have recently published a study showing that SLT almost always produces some change in the cornea post treatment, which usually gets better. We have a project underway looking to understand why this happens and look at ways of making the treatment safer. The project is a conjoint one between the Save Sight Institute and UNSW
I am involved in a number of clinical trials as well as a study looking at the genetic basis of advanced glaucoma which is poorly understood (ANZRAG). I have an interest in the epidemiology of glaucoma and glaucoma management in places as diverse as Burma and Botswana. I have also been looking at changing models of eye healthcare delivery in both the hopsital and community setting.