The Macula Foundation, Inc. is pleased to report that it has had a successful year. The Foundation’s talented researchers and investigators continue to be leaders in scientific, peer-reviewed publications, chapters and editorials in the most prestigious journals. We are very proud of the number and quality of this clinical scientific work. The principal activity of the Foundation remains unchanged, with ongoing research and teaching conducted at the LuEsther T. Mertz Retinal Research Center of Manhattan Eye, Ear & Throat Hospital / NSLIJ.
The most important research initiated this year involves collaboration with New York University in which two clinical scientific laboratories were developed. The first of which has been designed to study the incidence of endophthalmitis, a potentially blinding infection of the interior of the eye that is becoming an important public health problem due to the exponential growth of intraocular procedures in recent years. The molecular pathogenesis of endophthalmitis, as well as many other bacterial infections, are poorly understood, with their potential treatments remaining largely unexplored. S. aureus, the bacteria known to be the most important cause of severe endophthalmitis, is the focus of this research.
Specifically, the goal of this research is to characterize the bacterial organisms causing severe ocular S. aureus infections and to use endophthalmitis as a model of disease that affords an unparalleled view of the mechanisms involved in the molecular pathogenesis of bacterial infections. The principal investigator of this research has an established network of investigators in New York and elsewhere to allow for a collaborative collection of etiological strains and to monitor emerging etiologic trends both nationally and aboard. Based on this research, we hope to be able to improve the visual outcome of patients with endophthalmitis and other severe staphylococcal infections.
The second laboratory supported by the Foundation in collaboration with NYU is the Erythrocyte-Mediated Diagnosis and Therapy Study. Human erythrocytes (or ghost red blood cells) are being used to detect the earliest changes in blood flow through retinal capillaries that can lead to the formation of edema (swelling of the retina) and, consequently, vision impairment. The method involves inserting a fluorescent dye into the erythrocytes followed by intravenously re-injecting a very small amount of these cells to observe their movement through the retinal capillaries. No other method currently exists by which erythrocyte dynamics can be directly observed and routinely monitored in the intact living eye. The ultimate goal of this technology is to provide a unique route for intraocular delivery of drugs which would allow for precise delivery to a determined target in the retina where controlled release could be mediated. This method involves inserting the drug into the erythrocytes at the same time as the fluorescent dye. When these loaded cells are observed to arrive at the targeted site, their contents will be released with a low intensity focal laser stimulus which is absorbed only by the transporting cells. This produces a very high drug concentration at the target site to induce a therapeutic effect without local or systemic adverse effects. This concept will hopefully be applicable to strokes in the retina, diabetic retinopathy and neovascular age-related macular degeneration (AMD).
Our analysis of aqueous fluid specimens for genetic testing continues in hopes of identifying infectious agents or inflammatory mediators that may play a role in setting off an immune response in AMD. The results of these tests will be correlated to DNA analysis at our collaborating Genetic Laboratory at Columbia University Medical Center. The investigators of this project are looking at the genetic nature of these patients with both forms of AMD as well as other disease entities, such as diabetic retinopathy and glaucoma.
The role of Compliment Factor H (CFH), an important protein component in our immune system which serves to defend the body against infection also continues to be studied in related to AMD. The Foundation has now expanded this genetic investigation to other neovascular maculopathies, including pathological myopia, pseudoxanthoma elasticum (PXE), idiopathic choroidal neovascularization (ICNV) and important inflammatory disorders like multifocal choroiditis, all of which are also associated with macular scarring. So far, our research has led to the discovery of the genetic basis for the most common inflammatory macular disease that causes neovascular macular degeneration and multifocal choroiditis.
In addition, the Foundation has maintained its mission to sponsor fellowship training programs. This year, we supported international research fellows from Italy, Japan, Turkey, Portugal, Spain and the United Kingdom. New imaging modalities have allowed our fellows to make important discoveries in central serous chorioretinopathy (CSC), age-related macular degeneration (AMD), and pathological myopia. These findings have led to new classifications of reticular pseudodrusen and increased choroidal thickness in patients with CSC, which are risk factors for geographic atrophy, neovascularization, and increased pressure in the choroid, respectively. These discoveries will affect our understanding of the development of AMD and the treatment of glaucoma in patients with central serous chorioretinopathy.
We also continue to sponsor and support various macular lectureships and meetings like the Paul Henkind Award of The Macula Society and The LuEsther T. Mertz Retinal Research Lectureship at Manhattan Eye, Ear & Throat Hospital/NSLIJ. The Foundation has also awarded specific grants to prestigious teaching institutions for macular disease research including the College of Physicians and Surgeons at Columbia University, NYU Post-Graduate Medical School, the University of Colorado, Northwestern University, Boston University and Stanford University.
Additionally, the Foundation has funded teaching models for continuing medical education and the development of patient education booklets at the LuEsther T. Mertz Retinal Research Center. Our booklet on AMD has had an enormous degree of recognition and appreciation worldwide. We are currently developing a similar booklet on diabetic retinopathy. Recognized as the most comprehensive and authoritative text in the field, The Retinal Atlas, a compilation of Dr. Lawrence A. Yannuzzi’s lifetime clinical experiences, research and accomplishments, was published in May 2010 and received the prestigious PROSE award for Clinical Medicine. This book has 928 pages and 5,500 illustrations, including macular abnormalities and multiple forms of imaging modalities. The Foundation also continues to fund and maintain instructional websites: the first is geared for ophthalmologists, ophthalmic technicians, ophthalmology residents, and fellows looking to sharpen their skills and expand their knowledgebase. OphthalmicEdge.org, which recently won the WebAward for Health Care Standard of Excellence and Medical Standard of Excellence and the 2012 Web Health Awards for Web-Based Resource/Tool, is a series of short lectures and movies, many of which have been contributed and narrated by Dr. Yale Fisher or one of an expanding roster of "Expert Contributors". The second is a website in support of people experiencing macular degeneration that makes viewing easier by offering an expanded range of viewing options. Macula.org also offers a comprehensive encyclopedia of relevant terms and the latest news related to the condition, as well as the ability to share personal experiences with others suffering from the same disease.
We are very happy to report that the administrative cost continues to be low (at the single digit level) with no investigator being paid for any of his or her research activities. However, our ongoing research, teaching and educational programs as well as the promise of new research depend on the generosity of people like yourself. Please consider making a tax-deductible gift to help us continue our mission.