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Differentiating Myopia From Glaucoma: Shortening The Diagnostic Pathway For Long Eyes With Novel Tests Of Visual Function


   Faculty of Health and Life Sciences

  Dr Padraig Mullholland, Prof Roger Anderson, Dr Victoria Stapley  Monday, February 27, 2023  Competition Funded PhD Project (Students Worldwide)

About the Project

Glaucoma is the primary cause of permanent vision loss worldwide. It affects the retinal cells that transmit visual information to the brain (retinal ganglion cells, RGCs) by putting them under stress, so they no longer work effectively (i.e., they are dysfunctional or ‘sick’). These cells eventually die if appropriate treatment is not initiated, resulting in progressive, permanent vision loss across the field of vision. Traditionally vision deficits in the disease are detected and monitored using perimetry – A test in which white spots of fixed size and presentation duration are varied in brightness to find the limit of visual sensitivity (threshold) at multiple locations across the field of vision. While universally used, this test is poor at differentiating RGC density changes attributable to glaucoma from that associated with eye elongation in individuals who are short-sighted (myopic). This creates the issue that it can take many years for clinicians to differentiate what might be a true case of glaucoma in myopic patients. This issue is further compounded by other tests designed to measure eye structure (e.g., OCT) being unable to differentiate the conditions. This can lead to increased pressure on healthcare services and marked anxiety in myopic patients who are classed as ‘glaucoma suspects’ for several years despite not having the disease.

In this PhD, a clinical strategy to more robustly differentiate what are glaucoma from myopia-related alterations in RGC density will be developed. This will be based on previous work in our group where the ability of retinal cells to collect light energy (summation) was found to be altered in both glaucoma and myopia eyes, but that the nature of these changes differed markedly between the conditions. This would suggest that a vision test, such as that being developed in this project, may be optimal to differentially diagnose myopia from glaucoma.

The PhD Researcher will become part of a long-established, multi-disciplinary, UK-wide team of collaborators including research partners at Cardiff University, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology.

Please note: Applications for more than one PhD studentship are welcome, however if you apply for more than one PhD project within Biomedical Sciences, your first application on the system will be deemed your first-choice preference and further applications will be ordered based on the sequential time of submission. If you are successfully shortlisted, you will be interviewed only on your first-choice application and ranked accordingly. Those ranked highest will be offered a PhD studentship. In the situation where you are ranked highly and your first-choice project is already allocated to someone who was ranked higher than you, you may be offered your 2nd or 3rd choice project depending on the availability of this project.


References

Recommended reading:
(1) Redmond, T., Garway-Heath, D. F., Zlatkova, M. B. & Anderson, R. S. (2010) Sensitivity loss in early glaucoma can be mapped to an enlargement of the area of complete spatial summation. Invest Ophthalmol Vis Sci 51, 6540-6548.
(2) Redmond, T., Zlatkova, M. B., Garway-Heath, D. F. & Anderson, R. S. (2010) The effect of age on the area of complete spatial summation for chromatic and achromatic stimuli. Invest Ophthalmol Vis Sci 51, 6533-6539.
(3) Mulholland, P. J., Redmond, T., Garway-Heath, D. F., Zlatkova, M. B. & Anderson, R. S. (2015) Spatiotemporal Summation of Perimetric Stimuli in Early Glaucoma. Invest Ophthalmol Vis Sci 56, 6473-6482.
(4) Mulholland, P. J., Redmond, T., Garway-Heath, D. F., Zlatkova, M. B. & Anderson, R. S. (2015) The effect of age on the temporal summation of achromatic perimetric stimuli. Invest Ophthalmol Vis Sci 56, 6467–6472.
(5) Stapley, V., Anderson, R. S., Saunders, K. J. & Mulholland, P. J. (2020) Altered spatial summation optimizes visual function in axial myopia. Sci Rep 10, 12179.
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