New Frontiers in Vision Research

Early signs of Alzheimer’s disease and other neurodegenerative diseases may be found in the eye.

Peter Koulen, Ph.D., director of basic research at the University of Missouri-Kansas City’s Vision Research Center, likens the gradual progression of eye disease to wearing a pair of old shoes. You don’t realize just how bad they have become until you put on a new pair. Just as shoes wear out over time, many of the human body’s organ systems and tissues similarly begin to decline with age.

Determining the early stages of eye disease is obviously much more complex than slipping on a new pair of shoes and requires expert physicians. Treating and curing eye disease is even more difficult and prompts the need for continued research as effective treatments for many diseases affecting vision are still lacking. Koulen and his team are exploring ways to slow degeneration and the eventual death of cells in the eye and brain.

“We’re trying to help individuals age well,” Koulen says.

Since coming to the School of Medicine in 2009 as the Felix and Carmen Sabates Missouri Endowed Chair in Vision Research, much of Koulen’s research has focused on therapies for glaucoma, macular degeneration and diabetic retinopathy, three major eye diseases that together affect nearly one-quarter of the population. The National Eye Institute estimates 38 million Americans age 40 and older experience blindness, declining vision or age-related eye diseases. That number is predicted to rocket to 50 million by 2020, driving home the urgent need for new ideas and therapies for vision-related diseases that currently have no known cures.

Clinicians and researchers at UMKC’s Department of Ophthalmology have long been recognized as trailblazers in developing and adapting clinical diagnostics and therapies for patients. Much of Koulen’s work focuses on ways to help the body’s own self-defense mechanisms slow the deterioration and death of retina cells which lead to failing vision. It also focuses on improving diagnostic processes that allow ophthalmologists to intervene earlier to impede the progression of these diseases.

A new imaging system recently implemented in the eye clinics at UMKC, for example, has proven successful in detecting early stages of diabetic retinopathy before an endocrinologist or ophthalmologist would typically suspect a patient of having the ailment.

“That allows the patient to be very vigilant and very conscientious about their disease and work together with their clinician in getting early treatment,” he says. “But all these things require research. They require new thinking, and they often don’t come cheap. When you’re coming up with new technology, it involves a lot of groundwork.”

For Koulen, that meant developing a still-growing database of information to define the baseline level of what healthy eye tissues look like and those often subtle deviations which might be an early indicator of a particular disease. His latest work is a perfect example.

When researchers study how different diseases affect the retina, a light-sensitive eye tissue that is actually part of the body’s central nervous system, they are in essence studying the brain. Using that rationale, studies at the Vision Research Center have recently branched out to benefit other fields of medicine. It turns out, those diseases that have been Koulen’s primary targets for therapy development also have many similarities to other incurable and debilitating neurodegenerative diseases such as Alzheimer’s, Parkinson’s and ALS.

Using the information collected from patients and working with local neurologists for almost two years, the UMKC researchers recognized that particular abnormalities detected in the retina during a detailed eye exam can point to the onset of Alzheimer’s, another slow-progressing disease that can be difficult to diagnose.

“We were able to pick up that these patients very likely had the neurological disorder before the neurologist was able to diagnose the very earliest forms of the disease,” Koulen says. “The nice thing about conducting the diagnostics in the clinic is that they’re non-invasive. You don’t have to draw blood. You don’t need anesthesia. It’s basically a very complicated eye exam, but it’s still an eye exam.”

The discovery earned Koulen a FastTrack Award from the University of Missouri System Office of Research and Economic Development to accelerate his research and the development of the diagnostic tools necessary for physicians to pinpoint the disease.

Koulen says turning such discoveries into useful clinical tools was the primary reason for bringing his research program to UMKC seven years ago. Before coming to Kansas City, he served as director of the North Texas Eye Research Institute at the University of North Texas. Itching to add clinical and translational elements, Koulen said UMKC provided the necessary setting, and since then his research program has grown to a group of eight Ph.D. researchers, graduate students and technicians with plans to expand further, while continuing to work closely with clinical researchers and physicians.

“We have a very active clinical research team here,” he says. “Kansas City is not just a place where great clinical therapy is being tested and implemented, it’s also where the basic science that underlies those therapies can originate.”

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